Understanding Employee Benefits

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

IRS Clarifies Medicare Premium Deductions for Sole Proprietors, Partners and S Corporation Shareholder-Employees

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Sole proprietors, partners (including LLC members) and two percent shareholders in an S corporation are not treated as “employees” for purposes of certain benefits. Among those benefits is employer provided health insurance coverage. While employer subsidies for health coverage are generally excluded from the income of employees, that is not... Read More

Topics: Cafeteria Plans, Health Plan, Payroll

Self-Compliance Tool for HIPAA and Other Health Care Related Provisions

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The Department of Labor recently updated its self-compliance tool for plan sponsors and plan administrators of group health plans. The self-compliance tool contains questions relating to requirements on issues such as limitations on preexisting conditions, certificates of creditable coverage, special enrollment rights, HIPAA nondiscrimination rules, wellness programs, Mental Health Parity... Read More

Topics: Health Care Reform, Health Plan

Key Provisions of the Affordable Care Act Upheld by U.S. Supreme Court

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            Last Thursday, June 28, in a 5-4 decision, the U.S. Supreme Court found that the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act” or “Act”) is constitutional paving the way for final implementation of its provisions. http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf While the Administration argued that the Act was... Read More

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

Texting Can Cause HIPAA Violations

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The Office for Civil Rights, which is the arm of the Department of Health and Human Services that enforces HIPAA privacy and security rules, recently announced the settlement of an enforcement action against a small cardiothoracic surgery practice. The practice reportedly posted protected health information (PHI) on an internet-based publically... Read More

Topics: Health Plan