Understanding Employee Benefits

What You Say in Your SPD About Claims Processing Makes a Difference

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Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others provide that the claims processor is simply acting in a ministerial fashion so that the employer ultimately... Read More

Topics: ERISA and Other Benefits Litigation, Health Plan

Time to Review Plan Subrogation Procedures

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Most self-funded ERISA medical plans provide that participants who have been injured by other people (think car accidents) must reimburse the plan if the participant recovers from the other person for those injuries. In order to obtain that reimbursement, a plan document must contain appropriate reimbursement/subrogation language and the plan... Read More

Topics: ERISA and Other Benefits Litigation, Health Plan, Welfare Plans

EEOC Loses Another Wellness Case, Part 1

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The EEOC has been bringing lawsuits against employers challenging wellness programs. A recent case involved a company that had previously provided a credit to employees enrolled in the health plan who participated in a health risk assessment (HRA) and biometric screenings. The company had eliminated the credit and instead conditioned... Read More

Topics: Health Care Reform, Health Plan

Federal Court Determines that Employer Use of Employee Health Insurance Premium Payments Breach of ERISA Fiduciary Duties

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On November 9, 2015, Minnesota Federal District Judge Susan Richard Nelson ruled that the president and CEO of Faribault Woolen Mills Company breached his fiduciary duties under ERISA by diverting Employee health insurance premiums toward corporate and personal use. The lawsuit was brought by the U.S. Department of Labor. Facts:... Read More

Topics: ERISA and Other Benefits Litigation, Fiduciary Guidance, Health Plan, Payroll, Welfare Plans

IRS Annual Limits on Qualified Plans

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The Internal Revenue Service has released the 2016 cost of living adjustments affecting dollar limits on benefits and contributions under qualified retirement plans and health savings accounts, which are largely unchanged from the 2015 numbers. https://www.irs.gov/pub/irs-news/IR-15-118.pdf.  The following chart summarizes the 2016 retirement plan limits and other benefit plan limits. ... Read More

Topics: Health Plan, Retirement Plans, Welfare Plans