Posts Categorized: Health Benefits

The Demise of ERISA Preemption has been Exaggerated

in Court Cases, Health Benefits

Many states have recently enacted laws requiring insurers, and self-funded health plans, to report detailed medical information to state databases, including eligibility and medical claims data.   The purpose of collecting this information in what are known as “all payer claim databases” is to find ways to control health care costs and improve outcomes.  Today, in a case challenging Vermont’s law requiring self-funded health plans subject to ERISA to disclose this information, the Supreme Court, in a 6-2 decision, agreed with the Second Circuit Court of Appeals:  the Vermont statute is preempted by ERISA with respect to self-funded health plans. Click here… Continue Reading

Congress Delivers on Campaign Promise

in Affordable Care Act, Health Benefits

The 40% excise tax on high cost health plans, often referred to as the “Cadillac Tax,” has been delayed for two years.  President Obama signed the Consolidated Appropriations Act of 2016, which contains the following provisions relating to the Cadillac Tax: Delays the tax from 2018 to 2020. Amends Code Section 4980I(f) to provide that the tax is deductible by employers, which is welcome news for any employer that may become subject to the tax. Increases the annual limits of $10,200 and $27,500 by cost of living indexes. This means the annual limits that will be in effect for 2020… Continue Reading

No Surprises in the Final Rules Issued Under ACA

in Affordable Care Act, Health Benefits

Final rules have been issued regarding grandfathered plans, pre-existing conditions, rescissions, dollar limits, claims and appeals procedures, and patient protections. These rules, effective on the first day of the plan year beginning on and after January 1, 2017, finalize the current interim final rules and amendments without substantial change, incorporating important clarifications issued in prior guidance.  The final rules can be found here.  Here is a sampling of the requirements addressed in the regulations: • To maintain grandfather status, the plan must include a statement that it is believed to be a grandfathered plan, and contact information for questions or… Continue Reading

The Individual OOP Maximum Really, Really Applies

in Affordable Care Act, Health Benefits

HHS is holding firm on its position regarding the embedded individual out-of-pocket maximum, even though many have questioned whether this position is consistent with the clear language of the statute. Reports indicate that in a recent letter to members of the National Coalition on Benefits, HHS reinforces that, beginning in 2016, consistent with guidance issued in May (at http://www.dol.gov/ebsa/faqs/faq-aca27.html), group health plans, including self-insured plans and grandfathered plans, must cover a participant’s expenses at 100% once that individual reaches the individual out-of-pocket maximum ($6,850, in 2016). This applies regardless of what tier of coverage in which the individual is enrolled… Continue Reading

Soliciting SSNs for Information Reporting Requirements

in Affordable Care Act, Health Benefits

Many employers and health plans are sending SSN solicitations to comply with the 6055/6056 information reporting requirements.  One issue that has arisen is whether the $50 penalty under Code Section 6723 applies to the individuals who fail to furnish a SSN to his/her employer or health plan. Under the SSN solicitation regulations of Code Section 6724,  the regulations provide that when soliciting a SSN in writing that the solicitation should mention the possibility of a $50 IRS penalty.  The $50 IRS penalty can be imposed under Code Section 6723, which allows the IRS to penalize anyone who does not provide… Continue Reading