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

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

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

The 2010 Affordable Care Act (ACA) includes a number of new taxes and fees to be assessed to pay for many of the new federal health care mandates. One of such fees is called the Patient- Centered Outcomes Research Trust Fund Fee (“PCORI fee”), which is to be remitted to a new Patient-Centered Outcome Research

On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a traffic accident.

McCutchen was a participant in the U.S. Airways Group Health Plan

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