In one of the few cases that has considered the legality of an employer wellness program, the Eleventh Circuit Court of Appeals considered a challenge by an employee of Broward County, Florida to the county’s imposition of a $20.00 bi-weekly charge on employees enrolled in the group health insurance plan who refused to participate in
Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE
Benefits Notes
Another Health Insurance/Disability Insurance Coverage Issue
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 …
TPA is a Fiduciary Under ERISA
A recent Sixth Circuit Court of Appeals decision considered whether a third party administrator of a self-funded medical plan was a fiduciary under ERISA. Under ERISA, fiduciaries owe strict duties of loyalty and prudence to plan participants and beneficiaries and can be personally liable for losses if they are not. Many third party administrators of …
Employers Can Withdraw from Multiemployer Plans in Critical Status
Employers participating in multiemployer plans should be well aware of the funded status of those plans. Annually the employer must receive notice from the plan about its funded status including whether it is in “endangered” or “critical” status. Under the Pension Protection Act of 2006, a multiemployer pension plan is endangered if among other criteria, …
Just Because You Have Insurance Doesn’t Mean That You Have Coverage
A recent federal court decision from the Eastern District of Wisconsin dealt with a situation of an employer who failed to provide a former employee proper COBRA notices and failed to accept a premium payment for the COBRA coverage. The employer had sent the required COBRA notice when the employee terminated employment but had not …
Employer Avoids Excise Tax on Reversion from Defined Benefit Plan
An employer who wishes to terminate a defined benefit pension plan must make sure that the plan is fully funded in order to do so. Sometimes the employer must contribute funds to the plan in order to provide sufficient assets to pay all the benefits on plan termination. A recent private letter ruling addressed the …
IRS Clarifies Medicare Premium Deductions for Sole Proprietors, Partners and S Corporation Shareholder-Employees
Sole proprietors, partners (including LLC members) and two percent shareholders in an S corporation are not treated as “employees” for purposes of certain benefits. Among those benefits is employer provided health insurance coverage. While employer subsidies for health coverage are generally excluded from the income of employees, that is not the case for sole proprietors, …
DOL Publishes Submission Procedures for Employers to Report Delinquent Service Providers
As we have blogged before (here and here), certain service providers to qualified plans are required to provide plan administrators with fee disclosures. The initial disclosures were due July 1, 2012. The Department of Labor has now published a new mailing address and web based procedures for employers and plan administrators to report …
It is Always Good to Follow the Plan’s Claims Procedure in Denying a Claim
A recent Eighth Circuit Court of Appeals decision involved high ranking executives who participated in a company’s long-term incentive plan. Under the plan agreements, executives who did not continue employment for a three year performance period forfeited benefits under the plan unless they qualified for a pro-rated award. A pro-rated award was available for participants …
Participants Are Entitled to Specific Information About Their Service Credit Even Before They Are Entitled to Their Pensions
In a recent federal district court case, Whirlpool Corporation closed a factory and notified a number of former employees about the status of their pensions, including their years of credited service. The corporation’s records differed from the service records maintained by the union. Approximately five years after the factory closed, some of the participants …