The past year has seen a number of new state and local laws covering a range of benefits-related areas. However, this legislative and regulatory patchwork has a downside for employers, who may find it increasingly difficult to deal with complying with the requirements of multiple jurisdictions.
Question: What do employers and James Bond Have in common? Answer: Both have to combat Spectre. However, the problem for employers is that in addition to fighting the new Spectre computer bug, employers must also combat the Meltdown computer bug. And, employers must do so in a way that complies with HIPAA. This blog will [...]
A new proposed regulation opens the way to expand association health plans (AHPs). AHPs are plans sponsored by a group of unrelated employers, linked by factors such as a common industry or geography. These AHP plans will be allowed to offer reduced benefits in order to lower the cost of coverage. The stated goal of the proposed regulation is to make it easier for small employers to buy lower cost health insurance.
The U.S. Department of Labor has taken a series of legal actions against a multiple employer welfare associations (MEWA) plan operated by Black Wolf Consulting. The actions were taken by the DOL against this plan (the AEU Holdings LLC Employee Benefits Plan) include freezing bank accounts, replacing the plan fiduciaries, and issuing an order to [...]
The Affordable Care Act (“ACA”) remains on the books. And, in a significant new development, the IRS is poised to begin levying penalties on employers, under the ACA’s employer mandate, for 2015. These penalties may be significant and it we cannot anticipate any “relief” reaching back to 2015.
The proposed Tax Cut and Jobs Act (“TCJA”) has generated a number of big stories with big numbers, such as $1.5 trillion to lower individual tax rates and $1.5 trillion to lower corporate tax rates. But, also lurking in the 430-page draft, are many important “smaller” provisions that will affect the HR world.
As the political battles – and stalemate - over the Affordable Care Act continues, employers may find themselves with the worst of all worlds. The portions of the ACA that create the greatest burdens on employers, such as the mandates, taxes and administrative obligations under the ACA stay, in place. At the same time, uncertainty in the individual markets creates blowback that hurts employers in a number of ways.
Two recent cases illustrate the risks of allowing plan practices to diverge from plan documents. In one case, Acosta v. Macy’s, the Department of Labor has brought a lawsuit against Macy’s department store for (among other things) changing the payment methodology for calculating out-of-network claims without appropriately modifying the Macy’s plan document. In the other case, Erwood v. Life Ins. Company of North America, an administrator’s failure to follow documented plan procedures triggered a $750,000 judgment. Both of these cases highlight how easy it is to overlook the fundamental ERISA responsibility of ensuring that plan administration syncs up with the plan documentation. And, both of these cases highlight the risks posed by such failure.
In addition to the opportunities for policymakers to actually reduce rather than merely shift health care costs noted in Don’t Confuse Cost Shifting with Cost Savings (such as bundled payments for certain episodes of care and value-based payments for prescription drugs), there is a larger trend that also promises to reduce health care costs. However, be forewarned – [...]
As legislators continue to repeal and replace the ACA, they look for new ways to separate portions the insurance markets into different segments. Some efforts counter actuarial and insurance principles: segmenting the risk pool increases volatility and that creation of different risk pools based on health status and effect premiums