Understanding Employee Benefits

Final Regulations Issued on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

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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... Read More

Topics: Health Plan, Welfare Plans

The U.S. Supreme Court Upholds Plan Sponsor’s Recovery of Participant Damages Award

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On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a traffic accident. McCutchen was a participant in the... Read More

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

It Pays to Add a Statute of Limitations to Your Plan’s Claims Procedure

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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... Read More

Topics: ERISA and Other Benefits Litigation, Welfare Plans

A Wrap Plan Can Be Helpful

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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... Read More

Topics: Welfare Plans

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