Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE

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In an opinion released earlier this month, the United States Court of Appeals for the Seventh Circuit held that a self-insured health plan was not entitled to a refund of the nearly $1.7 million it paid to two Wisconsin hospitals for treatment administered to a participant’s newborn child, despite the plan’s ultimately concluding the newborn…

In Cigna v. Amara, the U.S. Supreme Court held that the plan document is the governing document for an ERISA plan and that in a conflict between the plan document and the summary plan description (SPD), the plan document must be enforced. A participant misled by an SPD may be able to bring various …

Terminating employees who lose coverage under an employer’s group health plan are frequently entitled to continue that coverage under the federal law commonly known as COBRA. Employers are required to provide a former employee with a notice at the time of termination of employment describing the employee’s rights to continue coverage and the cost of …

Over the years we have seen some employers, particularly small employers, choose to provide health coverage to their employees by paying all or part of the premium for individual insurance policies that the employees have obtained. Under an old IRS revenue ruling, Rev. Rul. 61-146, that type of premium subsidy could be provided on a …

On August 29, 2013, the Treasury Department and the Internal Revenue Service issued a public announcement and released Revenue Ruling 2013-17 wherein it answered a number of open questions concerning the impact of the U.S. Supreme Court Decision, United States v. Windsor. This is the case that overturned the federal Defense Of Marriage Act…

I blogged a few months ago about an employer who had to pay more than $83,000 in penalty, attorneys’ fees and costs for failure to give a proper COBRA notice for a dental plan. I warned employers that failure to maintain adequate procedures for COBRA compliance can be costly. That amount pales in relation to …

On June 26, 2013, in a 5-4 vote the U.S. Supreme Court ruled that the 1993 Defense of Marriage Act (DOMA) was unconstitutional as a violation of Fifth Amendment guarantees of equal protection and equal liberty. The case, United States v. Windsor No.12-307(US June 26, 2013)  http://www.supremecourt.gov/opinions/12pdf/12-307_6j37.pdf dealt with the marital exclusion under the federal…

On July 2 the White House announced that it is delaying the enforcement of the employer mandate that it provide health care coverage to employees or pay a penalty (the “play or pay” provisions) until 2015. http://www.whitehouse.gov/blog/2013/07/02/we-re-listening-businesses-about-health-care-law.

According to the White House Blog, the other provisions of the Affordable Care Act will proceed, including…

I blogged recently warning employers to be careful when enrolling employees in plan benefits because the employer could be responsible to pay life insurance or disability benefits if an employee who is improperly enrolled incurs a claim. The increased liability comes from the recent Supreme Court decision, Cigna v. Amara,  allowing certain types of …