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HEALTH CARE REFORM (“PPACA”) LEGAL DEVELOPMENTS 2016 YEAR-END UPDATE
1. Under PPACA, non-grandfathered plans must provide in-network preventive care benefitswithout cost-sharing. In 2016, the IRS, DOL and HHS (the "Agencies") published FAQs clarifying preventive care requirements for colonoscopies and contraceptives. Also, the U.S. Preventive Services Task Force issued multiple new and/or updated preventive care recommendations, for example: (1) statin use to prevent heart disease; (2) tuberculosis screening; (3) skin cancer screening; (4) tobacco use counseling and interventions for non-pregnant adults; and (5) women's [...]
LEGAL DEVELOPMENTS IMPACTING RETIREMENT PLANS 2016 -YEAR-END UPDATE
1. In July 2016, the IRS issued guidance formalizing major changes to its determinationletter program. Notably, the guidance confirmed the IRS will stop issuing most types of determination letters, advised that expiration dates in prior determination letters no longer apply, and stated the IRS's intent to annually publish a Required Amendments List establishing deadlines for certain plan amendments. 2. The DOL finalized its regulation on the definition of an ERISA fiduciary. The regulation [...]
U.S. SUPREME COURT SUBROGATION RULING
Montanile v. Board of Trustees of Nat. Elevator Industry Health Benefit Plan A copy of the decision is available at: http://www.supremecourt.gov/opinions/15pdf/14-723_1bn2.pdf. Many ERISA health plans will advance payment of a participant's accident-related medical expenses so long as the participant promises to reimburse the plan out of the participant's third-party settlement or other recovery (for example, a car insurance settlement). However, when the participant spends the settlement without reimbursing the plan, federal courts have [...]
LEGAL DEVELOPMENTS IMPACTING RETIREMENT PLANS 2015 YEAR-END UPDATE
1. At the request of President Obama, the DOL issued proposed regulations on the definition of an ERISA fiduciary and corresponding changes to the DOL's prohibited transaction exemptions. The proposals, if adopted, would make it more likely that a person providing investment advice would qualify as an ERISA fiduciary. The proposal has sparked considerable debate, with the DOL receiving more than 3,000 written comments. The DOL intends to finalize the regulations and exemptions in [...]
HEALTH CARE REFORM (“PPACA”) LEGAL DEVELOPMENTS 2015 YEAR-END UPDATE
1. In November 2015, the IRS, HHS, and DOL (the "Agencies") published final regulations on many PPACA benefit mandates , including the rules regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits, rescissions, coverage of adult dependent children, claims and appeal procedures, and patient protections. The final regulations are effective for plan years beginning in 2017 or later, and will replace prior regulations issued in 2010. The final regulations break little [...]
LEGAL DEVELOPMENTS IMPACTING HEALTH AND WELFARE PLANS (OTHER THAN HEALTH CARE REFORM) 2015 YEAR-END UPDATE
1. Federal law does not expressly require that ERISA health plans cover same-sex spouses . However, in 2015 the Equal Employment Opportunity Commission ("EEOC") took the position that sexual orientation is protected under federal anti-discrimination law (Title VII). Therefore, health plans that do not cover same-sex spouses may be targets for discrimination lawsuits. Also, insured plans may need to cover same-sex spouses in order to comply with state insurance law. 2. The Third Circuit [...]
HHS CLARIFIES PPACA’S COST-SHARING LIMITS
For plan years beginning in 2014 or later, PPACA requires that non-grandfathered group health plans impose annual out-of-pocket maximums with respect to "self-only" coverage and family coverage, and the maximums cannot exceed certain dollar amounts. Generally, all deductibles, copays and coinsurance for essential health benefits incurred in-network will count toward the out-of-pocket maximums. However, for the 2014 plan year, HHS provided a special exception for plans that have to coordinate multiple service [...]
FINAL EXCEPTED BENEFITS REGULATIONS ISSUED
On October 1, 2014, the IRS, DOL and HHS (the "Departments") issued final regulations on "excepted benefits," which are generally exempt from HIPAA's portability rules and Health Care Reform's benefit mandates.79 FR 59130. These regulations were published in proposed form in December 2013. For more information about the proposed regulations, see our December 2013 bulletin. Like the proposed regulations, the final regulations make it easier for dental and vision coverage to [...]
JANUARY 2015: LEGAL DEVELOPMENTS IMPACTING RETIREMENT PLANS 2014 YEAR END UPDATE
1. In June 2014, the U.S. Supreme Court in Fifth Third Bancorp v. Dudenhoeffer eliminated the "Moench" presumption that employer stock is a prudent investment under ERISA.Fifth Third Bancorp v. Dudenhoeffer, 134 S. Ct. 2459 (2014). And so ESOP fiduciaries must now review employer stock in the same manner as other plan investments, and must invest plan assets in employer stock with care, skill, prudence, and diligence. As a result of the decision, several cases [...]
JANUARY 2015: HEALTH CARE REFORM (“PPACA”) LEGAL DEVELOPMENTS 2014 YEAR END UPDATE
1. Non-grandfathered plans must provide certain preventive care benefits without cost-sharing.All of the USPSTF's recommendation statements are available at http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/. Plans must comply with new and revised recommendations starting with the first plan year that begins one or after the date that is one year after the new or revised recommendation is first published. These requirements received considerable attention in 2014, both from the federal courts and the IRS, DOL, and HHS. Key [...]