Welfare Benefit Plan ERISA News
June 2015

 
An Employee Moving from Full-Time to Part-Time Status May Have to Stay on Your Health Plan for More Than a Year Under ACA Rules
"Most employers are using the IRS's 'look-back' method to determine which employees are full-time... In some cases, an employer may have to keep a part-time employee on benefits for the remainder of their current stability period or the remainder of the current one and the subsequent one. This can be up to a year and a half in certain situations. One way for an employer to partially avoid this is to use the IRS's month-to-month method; at least with respect to salaried personnel." Read the full article by Craig Gottwalls, Esq., Benefit Revolution.
Drugs Cost Over $50,000/Year for 500,000 Americans
"The latest drug spending trend report from pharmacy benefit manager Express Scripts shows 576,000 Americans with annual medication costs of $50,000 or more. That's a 63% increase in 2014 from 2013 when 352,000 Americans had such high costs. While the number of patients with annual spending above $50,000 was just 0.2% of patients, the amount of drugs they and their health plans or employers paid for accounted for 16% of total spending[.]" Bruce Japsen, Forbes
Two Wrongs Don't Make a Right
Richard Thomas embezzled nearly $20,000,000 from his employer. The employer then kept Thomas's profit sharing account of about $21,000 as an offset against the embezzled amount. Of course, this violated ERISA's anti-alienation provisions. Thomas sued his former employer for the money and won. Although this case involves a qualified retirement plan, a similar principle generally applies to welfare benefit plans in that an employer should not withhold claim or other ERISA payments (e.g., MLR rebates) owed to a participant to offset amounts owed by the participant to the employer. Read the full story.
Recent Guidance on Wellness Programs
The EEOC has been attacking employers' wellness programs for failure to comply with the Americans with Disabilities Act. Here is a good summary of the EEOC's recently proposed regulations that employers and health plans should be aware of when reviewing their wellness programs.
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© 2017 ERISAPros, LLC, All rights reserved. Information on ERISAPros' website, its newsletter, “News & Views,” and its blog, “ERISA Wonk,” is published as a general informational source. Information and articles are general in nature and are not intended to constitute legal or tax advice in any particular matter. Blog posts and comments reflect the personal views of their respective authors - not those of ERISAPros. Transmission of this information does not create an attorney-client relationship. ERISAPros, LLC is not a law firm and is not giving legal or tax advice. It does not warrant and is not responsible for errors or omissions in the content on its website or in its newsletters. ERISA is a complicated and confusing law. Summary Plan Descriptions (SPDs), Wrap Plan Documents, and Form 5500s require review and updating by qualified ERISA compliance professionals.

 

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