In an opinion released earlier this month, the United States Court of Appeals for the Seventh Circuit held that a self-insured health plan was not entitled to a refund of the nearly $1.7 million it paid to two Wisconsin hospitals for treatment administered to a participant’s newborn child, despite the plan’s ultimately concluding the newborn
Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE
Welfare Plans
Are All Severance Plans Subject to ERISA?
I blogged recently about an ERISA case involving an executive severance plan where the executive sued claiming that his employment termination was effective before the first anniversary of a change in control, thereby entitling him to severance benefits under the plan. The court had concluded that the severance occurred after the first anniversary but allowed …
Bad Faith Termination Can be Good ERISA Interference Claim
It is not uncommon for employers to have executive severance plans that pay substantial severance if an executive loses employment in connection with a change in control. In a recent federal district court decision, a former chief executive officer sued an employer for $700,000 claimed to be owed as severance as a result of …
No More Pre-Tax Premiums for Individual Insurance Policies?
Over the years we have seen some employers, particularly small employers, choose to provide health coverage to their employees by paying all or part of the premium for individual insurance policies that the employees have obtained. Under an old IRS revenue ruling, Rev. Rul. 61-146, that type of premium subsidy could be provided on a …
Courts Do Not Always Agree
I blogged recently about a decision from a federal district court in Virginia (Eastern Distrct) involving a widow who sought to recover life insurance benefits from her late husband’s employer-sponsored group term life insurance plan. The employer had improperly allowed the late husband to enroll in the plan. The court had found on summary judgment …
Be Careful With Your Life Insurance Enrollments
Over the years there have been a number of cases that have involved employers improperly enrolling employees in group life or disability insurance benefits. If the employee who should not have been enrolled dies or becomes disabled, the insurance carrier will deny coverage on the grounds that the employee should never have been enrolled. These …
Final Regulations Issued on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans
HIPAA nondiscrimination provisions prohibit group health plans and health insurance issuers from discriminating against individual participants and beneficiaries in eligibility, benefits, or premiums based on a health factor. Wellness programs offered in conjunction with group health plans must also be nondiscriminatory.
Final regulations issued on June 3, 2013, describe nondiscriminatory wellness programs. The regulations amend…
Effect on Employers of Same Sex Marriage in Minnesota
As many of our readers know, on Tuesday, May 14, 2013, Minnesota became the twelfth state to recognize same sex marriages. The effective date of the change is August 1, 2013, which gives employers some time to react to the change and analyze its effect on their employment policies and benefits. We sent an Alert …
It Pays to Add a Statute of Limitations to Your Plan’s Claims Procedure
ERISA requires that plans contain a reasonable claims procedure. Courts have generally required claimants to exhaust that claims procedure before filing a lawsuit. In addition, if the plan gives the plan administrator discretion to interpret the plan and decide claims, a court will often give deference to the plan administrator’s decision. These rules should encourage …
A Wrap Plan Can Be Helpful
Many employers know that one benefit to an ERISA plan is the standard of review available when the participant brings a lawsuit for benefits under the plan. If the plan documents give the plan administrator discretion to decide claims, then the court will review the exercise of the plan administrator’s discretion under an arbitrary and …