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The U.S. Court of Appeals for the First Circuit, in Santana-Diaz v. Metro. Life Ins. Co, has ruled that an ERISA-covered employee benefit plan's three year limitation period for filing a lawsuit to contest adverse determinations did not apply because the plan...
To enforce the Affordable Care Act's ("ACA's") employer and individual mandates, the IRS requires information about the group health coverage provided by applicable large employers ("ALEs"). IRS receives this information from the Forms 1094-C and 1095-C filed by...
With the imminent release of the proposed ERISA fiduciary regulation in final form, many financial advisors are weighing the pros and cons of delivering participant investment advice. Does the "Best Interest Contract Exemption" impose costs and responsibilities that...
The Second Circuit Court of Appeals has ruled, in Graziadio v. Culinary Institute of America, that human resources personnel and supervisors who handle the administration of leave requests under the Family and Medical Leave Act ("FMLA") may be personally liable for...
DOL, HHS and IRS have jointly proposed a revised Summary of Benefits and Coverage ("SBC") template and related materials. The revised SBC will likely become effective for plan years beginning with the second quarter of 2017. Background. Under the Affordable Care...
IRS has released guidance to address when assets held in a voluntary employee beneficiary association ("VEBA") to fund one type of welfare benefit are reallocated to fund other benefits under the plan. Background. The Internal Revenue Code allows employers to prefund...
The Department of Health and Human Services ("HHS") has issued guidance clarifying individuals' right under the HIPAA Privacy Rule to access their protected health information ("PHI") maintained by covered entities, including health plans. Background. Under HIPAA's...
The IRS has issued Notice 2015-87, which provides guidance on a myriad of Affordable Care Act ("ACA") market reforms, including ACA compliance issues raised by health reimbursement arrangements ("HRAs"). Background. ACA generally prohibits group health plans from...
The DOL, in Advisory Opinion 2015-02A, has determined that a stop-loss insurance policy purchased by an employer for its self-insured health plan is not a plan asset, even though part of the plan's costs are paid through employee contributions. Background. Under a...
The DOL has issued proposed regulations for adjudicating disability benefit claims. This proposal would apply many of the procedural protections and safeguards provided under the Affordable Care Act ("ACA") to disability claims. Background. ERISA requires employee...