cmonfils | November 8, 2011
Because self-funded health care plans are governed by the federal Employee Retirement Income Security Act, they are exempt from state premium taxes and state laws that mandate minimum coverage requirements.
cmonfils | November 7, 2011
October 26, 2011 (PLANSPONSOR.com) – The U.S. District Court for the Northern District of Georgia ruled, a former employee can continue with his claim that his former employer violated the Employee Retirement Income Security Act (ERISA) when it made improper suggestions regarding his post-employment health insurance options.
cmonfils | October 26, 2011
Washington, D.C. — The ERISA Industry Committee (ERIC) today submitted comments on proposed regulations regarding implementation of the uniform summary of benefits and coverage (SBC) provisions under the Patient Protection and Affordable Care Act (ACA). The Departments of Health and Human Services, Labor, and Treasury published the proposed regulations in the Federal Register on August 22, 2011.
cmonfils | October 18, 2011
SACRAMENTO, Calif.—A new California law will require employers to extend health insurance coverage for up to 16 weeks to employees classified as disabled due to pregnancy, childbirth or related medical conditions.
The measure, S.B. 299, which Gov. Jerry Brown signed into law last week with a Jan. 1, 2012, effective date, mandates that employers continue health care coverage for up to 16 weeks to disabled pregnant employees on the same basis as prior to the employee taking disability leave.
http://www.businessinsurance.com/article/20111016/NEWS03/310169980#crit=California
cmonfils | October 18, 2011
(From the October 10, 2011 issue of Deloitte‘s Washington Bulletin, a periodic update of legal and regulatory developments relating to Employee Benefits.)
A recent Eighth Circuit Court of Appeals case illustrates the complexity of determining whether an employment agreement is an ERISA plan, and the impact of that decision on the employee’s ability to bring suit. In a case of first impression for the Eighth Circuit, the Court ruled that as matter of law a one-person, individually-negotiated employment agreement is not an ERISA plan. (more…)
cmonfils | October 18, 2011
www.employeebenfitsupdates.com
Wednesday, October 5, 2011 at 10:16AM
Eric D. Altholz in Church Plans
IRS Revenue Procedure 2011-44 imposes a new notice requirement upon any employer requesting a ruling from the IRS to confirm the status of an employee benefit plan as a “church plan” within the meaning of Code Section 414(e). The notice, for which the IRS has provided a model, is intended to let employees know that their employer is seeking a church plan ruling for its identified plans and explain the consequences to them (as plan participants) of such a ruling. Since those consequences include the elimination of many rights that participants and beneficiaries would enjoy if the subject plans were governed by ERISA, it seems appropriate that an employer seeking church plan status should have to make this kind of disclosure to its employees. More interesting to us, however, is what Rev. Proc. 2011-44 could mean for an employer who already maintains a church plan and the conclusions that such an employer can draw from this new guidance. (more…)
cmonfils | September 28, 2011
Resource type: Legal Update: Archive
Status: Published on 15-Aug-2011
Jurisdiction: USA
In Dakota, Minnesota & Eastern Railroad Corporation v. Schieffer, the US Court of Appeals for the Eighth Circuit ruled that a one-person employment contract is not a plan under the Employee Retirement Income Security Act (ERISA). However, the court held that a federal court may still have jurisdiction over portions of the complaint and remanded the case with instructions for addressing ERISA preemption. (more…)
cmonfils | September 19, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
We are familiar with cases holding that state laws limiting reimbursement to self-funded ERISA health plans from tort settlements or judgments through the madewhole, common-fund and collateral source rules are preempted by ERISA. However, we are not familiar with cases where there is a conflict between the right of a self-funded ERISA health plan to recover the benefits it paid under its plan provisions and the right of a hospital to recover its unpaid costs through a state statutory lien. We now have a case that discusses and resolves that conflict. The case is Osterman v. Smith, 2011 WL 1343056 (C.D. Ill., March 17, 2011). (more…)
cmonfils | September 16, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
We’ve seen many cases where a self-funded ERISA health plan successfully recovers the benefits it paid from tort settlement proceeds, but we haven’t seen many cases where the plan also recovers its own attorney’s fees. American courts generally follow the practice that each party to a lawsuit bears the costs it incurs, whether it wins or loses the case. However, it’s not impossible for a successful litigant to recover its own legal fees from its unsuccessful opponent. (more…)
cmonfils | September 16, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
This case involved the right of a state Medicaid agency to recover the Medicaid benefits paid for two individuals injured by third parties. Under federal law, when a Medicaid recipient settles with a tortfeasor for an amount less than the full damages suffered, Medicaid’s share of the settlement may not exceed the portion of the settlement that represents the Medicaid participant’s medical expenses. The court in this case ruled that the program would be limited to recovering discounted charges actually paid, and not the amount billed. But the court refused to eliminate the agency’s lien against future medical expenses the participant might incur that will be paid by Medicaid. (more…)
cmonfils | September 16, 2011
The Self-Insurer August 2011
By Carolyn Smith, Esq. and John Hickman, Esq., Alston & Bird, LLP
New Claim Review Regulations Ease Compliance Burdens For Group Health Plans
On June 24, 2011, the U.S. Department of Treasury, Labor (DOL) and Health and Human Services (HHS) (collectively, the “Agencies”) jointly issued new interim final regulations (“Final Regulations”) and related guidance regarding the internal appeals and external claim review procedures (“Claims Review Rules”) for fully insured and self-funded group health plans and insurance policies issued in the individual market. These new requirements were added by the Affordable Care Act (ACA). The Claims Review Rules apply only to non-grandfathered group health plans otherwise subject to the health insurance reforms added by ACA. (more…)
cmonfils | September 16, 2011
The Self-Insurer August 2011
From the Bench Michael Friedman and John Eggertsen
The U.S. Supreme Court, in GIGNA Corp v. Amara, et al., 563 U.S., 2011 WL 1936077 (May 16, 2011), revisited, and likely expanded, the scope of equitable remedies available under ERISA § 502 (a)(3). The Court also rejected Plaintiff’s effort to sue under the terms of the SPD as opposed to the terms of the actual ERISA plan document. (more…)
cmonfils | September 16, 2011
www.smarthr.blogs.thompson.com
September 14, 2011 – 12:42 pm | By Todd Leeuwenburgh | No comments yet
Health care reform is still alive and kicking. Employer-sponsored health plans have implemented many of its thorny provisions, but one provision now looks like the biggest thorn of all.
We are talking about Section 2715 of the Patient Protection and Affordable Care Act (PPACA). You must, of course, know all about this section … no? Well, Section 2715 explains how employers and insurers are supposed to provide “Uniform Explanation of Coverage Documents.” (more…)
cmonfils | August 31, 2011
August 24, 2011 By Stanley D. Baum
In Kough v. Teamsters’ Local 301 Pension Plan, No. 10-2128 (7th Cir. 2011) (Nonprecedential Opinion), the plaintiff had suffered a disability, and then returned to work in 2005. He soon (in that year) suffered a heart attack and abandoned his attempt to work. He filed a claim for disability benefits under a union pension plan subject to ERISA (the “Plan”), but the claim was denied by the Plan. The plaintiff then filed this suit. (more…)
cmonfils | August 31, 2011
August 19, 2011 Peter Wand, David Manch
The Department of Labor recently announced plans to substantially increase the number of ERISA compliance audits it conducts each year. This is the first in a series of Client Alerts that Lewis and Roca LLP will publish over the coming months to help our clients evaluate their compliance with ERISA and related federal mandates, including COBRA, HIPAA and the Patient Protection and Affordable Care Act of 2010. (more…)
