Welfare Benefit Plan ERISA News
July 2016

 
ACA's Affordability Contribution Percentages Increased for 2017

"Several ACA provisions measure the 'affordability' of employer-sponsored health coverage. 'Affordability' is defined differently depending on the specific ACA provision. Employers subject to the ACA's employer shared responsibility provisions may be subject to penalties if the coverage offered to full-time employees is unaffordable. The different measurements of affordability are summarized and compared in this article.." (Ascende)

Key Facts You Need to Know:
Minimum Essential Coverage and the Individual Mandate Penalty
"The ACA requires most individuals to have minimum essential coverage (MEC) or pay a penalty... Questions and answers in this article describe the individual mandate, the types of coverage that are considered MEC, and the penalty for not maintaining MEC." A reference chart on MEC is also provided. (Center on Budget and Policy Priorities)

Fiduciary Liable Under ERISA for Denied Life Insurance Coverage

"This case illustrates how an employer can end up paying a high price for assuming that an insurance company will take responsibility for providing necessary information to its employees. In this instance, the group life carrier denied coverage for additional benefits due to failure to supply an 'evidence of insurability' form for the increased coverage. The Court was not impressed with the employer's attempt to shift blame." Loo v. Cajun Operating Co. d/b/a Church's Chicken, No. 14-CV-10604 (E.D. Mich. June 6, 2016) (Health Plan Law)

Cigna Administered Self-insured ERISA Health Plans Sued for Embezzlement

"Just eight days after a federal court slammed Cigna with a $13M judgment, 113 of Cigna's self-insured clients, along with their Plan Administrators, have been named as defendants in a massive fraud lawsuit, alleging the plans 'participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme'." (AVYM Healthcare Revenue Consultants)

"According to the court documents, Macys, through Cigna, sent EOBs telling the hospital that it would not get paid until it provided proof the patient paid their entire out-of-pocket costs, at the same time, according to the complaint, Macys, through Cigna, sent a different EOB to its member patients telling them they owed nothing!" (AVYM Healthcare Revenue Consultants)
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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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