Understanding Employee Benefits

Certain Plan Designs Will Cost More Under the Patient-Centered Outcomes Research Institute Fees

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The Affordable Care Act establishes a Patient-Centered Outcomes Research Institute as a private nonprofit corporation to assist patients, clinicians, purchasers and policy makers in making informed health decisions using evidence based medicine. The Institute is to be funded through a trust fund called the Patient-Centered Outcomes Research Trust Fund. Under... Read More

Topics: Health Care Reform, Health Plan

Who Cares if I Give a COBRA Notice for My Dental Plan?

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Employers are generally aware that medical plans are subject to continuation coverage under the federal law known as COBRA.  They may forget that COBRA extends to all group health plans, including dental, vision and medical flexible spending account plans. A recent federal district court decision highlighted the risk to employers... Read More

Topics: Health Plan

GAO Issues Multiple Employer Plan Report

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The Government Accountability Office (GAO) has issued a report on Multiple Employer Plans, encouraging the federal agencies that regulate the plans to collect data and coordinate oversight of them. The report is interesting reading for those wanting more information about these types of plans.

Topics: Health Plan, Retirement Plans

Self-Funded Plans Need to be Careful in Enforcing Subrogation Rights

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A recent Eighth Circuit Court of Appeals decision considered the situation of a participant covered under a self‑funded ERISA plan who sustained injuries in a slip and fall accident. The plan paid health benefits for that accident. The participant also obtained compensation by settling a civil lawsuit. Like many self‑funded... Read More

Topics: ERISA and Other Benefits Litigation, Health Plan

Court Upholds Wellness Program

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In one of the few cases that has considered the legality of an employer wellness program, the Eleventh Circuit Court of Appeals considered a challenge by an employee of Broward County, Florida to the county’s imposition of a $20.00 bi-weekly charge on employees enrolled in the group health insurance plan... Read More

Topics: Health Plan

TPA is a Fiduciary Under ERISA

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A recent Sixth Circuit Court of Appeals decision considered whether a third party administrator of a self-funded medical plan was a fiduciary under ERISA. Under ERISA, fiduciaries owe strict duties of loyalty and prudence to plan participants and beneficiaries and can be personally liable for losses if they are not.... Read More

Topics: Fiduciary Guidance, Health Plan

No Good Deed Goes Unpunished

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A recent Sixth Circuit Court of Appeals case considered a situation that we have seen in our practice: An employee gets sick, goes out on FMLA leave, and then is placed on short term disability. The employer’s health plan provides that employees are eligible for the plan if they are regularly... Read More

Topics: Health Plan