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JUNE 2013 – SUPREME COURT STRIKES DOMA § 3
On June 26, 2013, the U.S. Supreme Court ruled, in United States v. Windsor, that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional. Background DOMA was signed into law in 1996. Section 2 allows states not to recognize same-sex marriages performed in other states or countries. Section 3 provides that, for purposes of all federal laws, “marriage” means only marriage between a man and a woman, and a “spouse” can only [...]
MAY 2013 – FINAL HIPAA WELLNESS PROGRAM REGULATIONS
HIPAA generally prohibits health plans from discriminating against individuals based on a health factor –such as nicotine addiction, high blood pressure, or diabetes. Under current guidance, a wellness program is not treated as discriminatory if it meets certain requirements. PPACA codified those requirements, with some modifications. In May 2013, the DOL, HHS, and IRS jointly issued final HIPAA regulations that incorporate the changes made by PPACA, along with some general updates to [...]
SUBROGATION DEVELOPMENTS: U.S. AIRWAYS V MCCUTCHEN SUPREME COURT HOLDS THAT ERISA PLAN TERMS TRUMP EQUITABLE DOCTRINES
Many ERISA health plans will advance payment of a participant's accident-related claims if the participant agrees to reimburse the plan out of any third-party settlement (for example, car insurance proceeds). Federal courts have generally supported a plan's right to demand full reimbursement if plan terms preclude application of equitable doctrines that would require the plan pay a share of the participant's attorney's fees (such as the "common fund" doctrine) or that would [...]
FEBRUARY 2013 FAQ ON HEALTH PLAN ANNUAL OUT-OF-POCKET MAXIMUMS
For plan years beginning on or after January 1, 2014, all non-grandfathered employer-sponsored group health plans must comply with annual out-of-pocket maximums on essential health benefits.PHSA § 2707(b). Deductibles, copays, and coinsurance applied to essential health benefits all contribute to the out-of-pocket maximum. For the 2014 plan year, these amounts are $6,350 for self-only coverage and $12,700 for family coverage and are indexed after 2014. In a February 2013 FAQ, the [...]
JANUARY 2013 – FINAL HIPAA PRIVACY REGULATIONS
In January 2013, HHS issued final regulations updating the HIPAA privacy and security rules. The new regulations reflect changes made by HITECH and GINA, The Health Information Technology for Economic and Clinical Health Act of 2009 ("HITECH") imposed more stringent HIPAA privacy and security requirements on health plans, business associates and other vendors of personal health information. The Genetic Information Nondiscrimination Act of 2008 ("GINA") protects individuals from discrimination, in health coverage [...]
After the DOL’s Fee Disclosure Rules: Best Practices for Fiduciaries – PowerPoint Presentation
After the DOL’s Fee Disclosure Rules: Best Practices for Fiduciaries Institutional Investor Forum | September 11, 2012 Presented by Steve McCaffrey and Ellen Mondress Click here to download the PowerPoint Presentation
RECENT DEVELOPMENTS IN EMPLOYEE BENEFITS LAW
New Guidance Related To Health Plans & Health Care Reform (PPACA) Further Guidance on PPACA's Summary of Benefits and Coverage (SBC) Requirement In March and May of this year, the IRS, DOL, and HHS issued two new sets of Frequently Asked Questions (FAQs) to assist plan administrators and insurers in understanding and applying the agencies' February 2012 final regulations implementing PPACA's summary of benefits and coverage ("SBC") requirement. For an overview of the [...]
Contracting Tips for ERISA Plans – May 2012 Benefits Magazine
Contracting Tips for ERISA Plans By M. Ellen Mondress May 2012 Benefits Magazine
FEBRUARY 2012 – FINAL REGULATIONS ON 4-PAGE SUMMARY OF BENEFITS & COVERAGE
On February 14, 2012, federal agencies (the DOL, IRS, and HHS) published final regulations implementing PPACA’s requirement that group health plans and insurers provide applicants and enrollees with a four-page uniform summary of benefits and coverage (“SBC”), and separately issued model SBC templates, samples, and instructions developed by the NAIC. The regulations and other guidance documents (including the SBC templates, instructions, and uniform glossary) are available on the DOL’s website, at http://www.dol.gov/ebsa/healthreform/. [...]
FEBRUARY 2012 – NEW DEVELOPMENTS IN EMPLOYEE BENEFITS LAW
New Guidance Related To Health Plans & Health Care Reform (PPACA) Summary of Benefits and Coverage Requirement Delayed; New Regulations Published Last August, the government issued proposed regulations implementing PPACA’s four-page uniform summary of benefits and coverage (“SBC”) requirement. The proposed regulations originally included a compliance date of March 23, 2012, which was delayed pending the issuance of final SBC regulations. This month, the responsible federal agencies (DOL, HHS and IRS) issued the [...]