“To become a MEWA, a plan needs only to cover employees of two or more employers. Because intent is irrelevant, an employer can find itself inadvertently creating a MEWA if it allows employees of other employers or nonemployees to participate in its welfare plan…. Once a MEWA, a plan can face penalties of more than […]
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New Year’s Resolution
At this time of year, many people resolve to change or modify their behavior or actions to lead a better life. We at ERISAPros would like to challenge you to make […]
Mercer’s Mike Sinkledam Reminds Calendar Year Plans to Implement New SBC Requirements During This Year’s Open Enrollment
“While ‘not a lot has changed from last year, from a compliance standpoint, when it comes to open enrollment, the new Summary of Benefits and Coverage (SBC) template and uniform glossary need to be implemented during this year’s open enrollment for calendar year plans,’ according to Mike Sinkeldam, a principal for Mercer’s Health and Benefits […]
“A physician-owned, out-of-network health care service provider – such as an ambulatory surgery center or a sleep center – sends a demand letter to the plan administrator. The letter asserts an appeal of a denied benefits claim by one of the plan’s participants; requests copies of a lengthy list of plan-related documents; and alleges that […]
“For the first time, an individual must complete line 61 (as shown in previous iterations) of the Form 1040 when filing his/her tax return…. It is reasonable to assume that an employee is more likely to inquire as to the whereabouts of the ACA information necessary to complete his/her 2017 tax return. Therefore, the possibility […]
“According to one recent survey, telemedicine services (i.e., remote delivery of healthcare services using telecommunications technology) among large employers (500 or more employees) grew from 18% in 2014 to 59% in 2016. Common selling points touted by telemedicine vendors include reduced health care costs and employee convenience. However, state licensure laws imposing restrictions on telemedicine […]
“The Labor Department opposes a health insurance practice called ‘cross-plan offsetting,’ in which insurers like UnitedHealth reduce payments owed to medical providers for services rendered to specific patients. The reductions are meant to offset overpayments the providers previously received on account of different patients who participate in other plans insured by the same company. This […]
The U.S. Court of Appeals for the Eleventh Circuit, in Bradshaw v. Reliance Standard Life Insurance Co., has rejected a disability insurer’s decision to deny disability benefits to an insured who suffered a stroke days after giving birth on the basis that her pregnancy was a pre-existing condition.
…While the Affordable Care Act has eliminated health […]
“A self-insured medical plan included an anti-assignment provision that prohibited a health care provider from suing on behalf of a participant. The court found the anti-assignment clause to be valid and enforceable. This case highlights the value of a well drafted plan document. Employers sponsoring self-insured plans are encouraged to review their plan documents to […]
How Qualified and Nonqualified Plan Sponsors Should Respond to the Latest Guidance on ERISA Disability Claims Procedures
“While the fiduciary rule has received most of the attention in the world of ERISA as of late, a lesser known regulation that was finalized late last year also may require action by plan sponsors. This regulation, issued by the Department of Labor (DOL) in December 2016, requires applicable plans to satisfy additional procedural and […]