“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 […]
“Providing telemedicine services to employees can raise a number of legal issues – the most common being compliance with federal laws such as ERISA, COBRA and HIPAA, as well as state laws concerning medical licensure and practice and informed consent. Employers offering access to a telemedicine program […]
“If the individual is left enrolled as an active employee, fully-insured employers may risk violating the medical plan eligibility requirements in their insurance contract. Similarly, self-funded employers may violate the coverage provisions of their stop-loss agreement. Consequently, failure to offer COBRA can expose an employer to significant […]
“Given the current House and Senate ‘repeal and replace’ ACA legislation, many employers are wondering if they need to take the time to revise their SBCs to comply with the new template and requirements. The short answer is use of the new SBC templates is still required. Both the House-passed legislation and the current legislation […]
“After eliminating employee premiums for all coverage tiers, HSA-eligible health plan enrollment increased from 4 percent to 25 percent among individuals with employee-only coverage and from 2 percent to 31 percent among individuals with family coverage…. Offering coverage with no payroll deduction attracted individual enrollees who were marginally healthier than those who would have enrolled […]
“Just a few miles from where President Trump addressed his blue-collar base last Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging.
It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but […]
Use Wrap–Tight sm online to produce ERISA wrap welfare benefit plans and SPDs.
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“HHS has announced two major settlements it has reached with covered entities to resolve alleged violations of the HIPAA Privacy and Security Rules. The terms of each settlement agreement require the covered entity to pay a multimillion dollar penalty to HHS and implement a corrective action plan.” Read the details: [The […]
In litigation involving a health plan reimbursement claim, the Fifth Circuit ruled that a plan’s summary plan description (SPD) could serve as the plan’s “written instrument” under the Employee Retirement Income Security Act of 1974 (ERISA) (that is, the plan document) in the absence of a separate written instrument. The court concluded that the plan […]