Employers Encouraged To Review Health Plan Administrators’ Payment Practices After Recent Court Decision

In Peterson v. UnitedHealth Group Inc., plaintiffs filed a class action lawsuit against United Healthcare claiming that its cross-plan offsetting practice violated ERISA.  This practice allows an insurer or third party administrator (TPA) to recover overpayments to a provider by offsetting future payments for claims related to different employers’ plans and participants. The claims […]

By |2019-01-28T13:40:02+00:00January 28th, 2019|2019 News, News|

Don’t Lament, “I Could Have Done More”

Employers are often surprised to learn they are liable for ERISA statutory penalties associated with participant document requests even though they have retained an insurance company or TPA to administer their ERISA welfare benefits plans. Generally, only the Plan Administrator, as defined by ERISA, can be penalized for failure to respond […]

By |2019-01-02T09:16:13+00:00January 1st, 2019|2019 News, News|

Court Rules ACA Unconstitutional – But Law Remains in Effect for Now

In 2017 Congress enacted the Tax Cuts and Jobs Act, which reduced the individual mandate penalty to zero, effective January 1, 2019. Recently a federal district court in Texas ruled that the Affordable Care Act’s individual mandate is no longer permissible under Congress’s taxing power and that the entire Affordable Care Act (ACA) is invalid because the […]

By |2019-01-02T08:55:44+00:00January 1st, 2019|2019 News, News|

2019 Limits for Welfare Benefit Plans

The IRS has released the 2019 inflation-adjusted limits for certain welfare benefit plans and the amounts used for discrimination testing.

The salary reduction limitation for health flexible spending account coverage for 2019 is $2,700, an increase of $50 over the amount for 2018.

The 2019 health savings account (“HSA”) limit will increase to $3,500 for a self-only […]

By |2018-12-03T11:26:56+00:00December 1st, 2018|2018 News, News|

Form W-2 Reporting of Employer-Sponsored Health Coverage

The ACA requires large employers to report the total cost of employer-sponsored group health coverage on employees’ W-2s, which are due to employees by January 31, 2019. Reporting the cost of health care coverage on the Form W-2 does not mean that the coverage is taxable. It is for informational purposes only and will provide employees useful […]

By |2018-12-03T11:23:28+00:00December 1st, 2018|2018 News, News|

Health Plans Must Explain Reasonable and Customary

Lawsuits from non-network providers have been on the rise recently due to the sharp rise in their billing rates, more providers moving out-of-network, and self-insured health plans reducing reimbursement rates. One of the ways that health plans have curtailed out-of-network reimbursement rates is through reasonable and customary reductions. A health plan is required to disclose the […]

By |2018-11-01T15:10:05+00:00November 1st, 2018|2018 News, News|

No More Secrecy— New Laws Ban Pharmacist ‘Gag Clauses’ on Drug Prices

According to a 2013 study published in JAMA in March, people with Medicare Part D drug insurance unknowingly overpaid for prescriptions by $135 million. Copays in those plans were higher than the cash price for nearly 25% of drugs purchased. Patients overpaid by more than 33% for 12 of the 20 most commonly prescribed drugs.


President […]

By |2018-11-01T15:08:49+00:00November 1st, 2018|2018 News, News|

Bipartisan Legislation to Protect Against Surprise Medical Bills

Concern over surprise medical bills—those from out-of-network physicians that patients had no role in choosing—has grown tremendously in recent years.  Some states have taken steps to mitigate this problem. However, these measures do not apply to the roughly half of Americans enrolled in self-insured health plans because ERISA precludes states from regulating these plans.

A bipartisan group […]

By |2018-10-01T10:10:30+00:00October 1st, 2018|2018 News, News|

The Pros and Cons of Telehealth

The term telehealth encompasses clinical diagnosis, education, management, and the monitoring of health via technology. It is not a specific service, but rather an umbrella term for a variety of strategies to enhance medical care delivery.

The greatest advantage of telehealth is ease of access. Patients can quickly and easily speak with doctors making them more likely to […]

By |2018-10-01T10:07:36+00:00October 1st, 2018|2018 News, News|

Q&A on Employer Shared Responsibility Provisions Under the ACA

The IRS answers FAQs regarding The Affordable Care Act’s employer shared responsibility provisions related to:


  • Basics of the Employer Shared Responsibility Provisions
  • Employers Subject to the Employer Shared Responsibility Provisions
  • Identification of Full-Time Employees
  • Offers of Coverage
  • Affordability and Minimum Value
  • Liability for the Employer Shared Responsibility Payment
  • Calculation of the Employer Shared Responsibility […]
By |2018-09-04T10:11:04+00:00September 4th, 2018|2018 News, News|