Understanding Employee Benefits
Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE
HIPAA nondiscrimination provisions prohibit group health plans and health insurance issuers from discriminating against individual participants and beneficiaries in eligibility, benefits, or premiums based on a health factor. Wellness programs offered in conjunction with group health plans must also be nondiscriminatory.
Final regulations issued on June 3, 2013, describe nondiscriminatory wellness programs. The regulations amend…
As many of our readers know, on Tuesday, May 14, 2013, Minnesota became the twelfth state to recognize same sex marriages. The effective date of the change is August 1, 2013, which gives employers some time to react to the change and analyze its effect on their employment policies and benefits. We sent an Alert …
ERISA requires that plans contain a reasonable claims procedure. Courts have generally required claimants to exhaust that claims procedure before filing a lawsuit. In addition, if the plan gives the plan administrator discretion to interpret the plan and decide claims, a court will often give deference to the plan administrator’s decision. These rules should encourage …
Many employers know that one benefit to an ERISA plan is the standard of review available when the participant brings a lawsuit for benefits under the plan. If the plan documents give the plan administrator discretion to decide claims, then the court will review the exercise of the plan administrator’s discretion under an arbitrary and …
Pactiv Corporation sponsored a severance plan subject to ERISA. The plan required an employee to sign a separation agreement and release in a “form acceptable to the company” in order for the employee to be entitled to a payment under the plan. The severance plan itself did not contain a no compete provision. When an …
I recently blogged about an employer who continued health insurance coverage for an employee on short term disability in contravention of the health plan document. The employer lost its stop-loss coverage for health claims incurred by the disabled employee because the health plan document did not specifically allow for continued coverage during disability. Today’s blog …
I blogged recently about an Eighth Circuit decision where the court concluded that a deferred compensation agreement with a single employee did not constitute an ERISA plan. I warned employers that courts do not always accept an employer’s characterization of a plan or program as being covered by ERISA. Another example of this phenomenon is …
Blue Cross of Northeastern Pennsylvania (“Blue Cross”) insured New Life Homecare, Inc. (“New Life”) under a group health insurance contract. The insurance contract required New Life to enroll at least 75% of its eligible participants in the plan and provided that no more than 15% of the eligible employees could reside more than 20 miles …
On Monday March 26th, almost exactly two years after its enactment on March 23, 2010, the United States Supreme Court will begin the first of three days of oral arguments relating to the health care reform law, the Patient Protection and Affordable Care Act of 2010 (“PPACA”). The Supreme Court agreed to hear six hours …
Mary worked for IT, Inc. at its headquarters in Maryland. Her husband moved to New Jersey for his work and Mary moved with him. Mary continued to work for IT, Inc., writing computer code from her home in New Jersey and uploading her work to her co-workers in Maryland via the Internet. IT, Inc. withheld …
