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HEALTH CARE REFORM: NEW 90-DAY WAITING PERIOD REGULATIONS ISSUED
In February 2014, the DOL, IRS and HHS issued final regulationsFor the 2014-15 plan year, plans can rely on either the final waiting period regulations or the proposed regulations that were issued in 2013. This Bulletin focuses only on the final regulations, as they are generally more favorable to plans. The final regulations are available at: http://www.dol.gov/opa/media/press/ebsa/20140220-redfeg1.pdf. on the Affordable Care Act's 90-day waiting period rule, as well as proposed regulations [...]
2013 YEAR END UPDATE: EMPLOYEE BENEFIT PLAN CONTRACTS
For general contracting tips, see our older article. The final HIPAA/HITECH regulations required new business associate contracts by, at the latest, September 23, 2014. Read more here. We’ve seen business associates request changes in the new contracts that go beyond updates required by the final regulations, for example: Adding that they may de-identify protected health information (PHI) This is permitted by the final HIPAA/HITECH regulations. See 45 CFR § 164.514. – respond by [...]
2013 YEAR END UPDATE: LEGAL DEVELOPMENTS IMPACTING RETIREMENT PLANS
The DOL's two significant retirement plan fee and investment disclosure regulations issued in 2010 became applicable in 2012. First, most retirement plans should have received fee disclosures from covered service providers before July 1, 2012. 29 CFR § 2550.408b-2(c). After that, covered service providers must deliver fee disclosures before contracting with a plan (or updating an existing contract with the plan). Second, administrators of participant-directed individual account plans should have first delivered disclosures [...]
2013 YEAR END UPDATE: LEGAL DEVELOPMENTS IMPACTING HEALTH PLANS (OTHER THAN HEALTH CARE REFORM (“PPACA”))
In June 2013 the Supreme Court issued a decision invalidating a section of DOMA, the law which limited federal recognition of marriages to opposite-sex couples. U.S. v. Windsor, 133 S. Ct. 2675 (2013). And so, applicable state law now determines the marital status of same-sex couples for federal purposes. Several federal agencies, including the IRS for purposes of the Tax CodeSee Rev. Rul. 2013-17. and the DOL for purposes of ERISA, DOL Technical [...]
2013 YEAR END UPDATE: HEALTH CARE REFORM (“PPACA”) LEGAL DEVELOPMENTS
In 2012 the USPTF updated its recommendation describing the preventive health services plans must provide for obesity under the "preventive care" requirements of PPACA. Non-grandfathered plans must provide preventive care without cost-sharing. Significantly, preventive care for obesity does not include weight-loss or weight-management medications or weight-loss surgeries.http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesers.htm. The updated recommendation is effective for plan years beginning on or after June 30, 2013. PPACA's preventive care requirements also mandate that plans provide contraceptives without cost-sharing. The [...]
JANUARY 2014: RECENT CASE LAW REGARDING FIDUCIARY REVIEW OF FEES AND INVESTMENT CONSULTANTS
Several courts have recently held that fiduciaries breached their duties with respect to fees paid from plan investments.See, e.g., Tussey v. ABB, Inc., 2012 WL 1113291 (W.D. Mo. 2012). The DOL also occasionally submits briefs at the Circuit Court level, generally supporting a finding of fiduciary breachSee, e.g., Tibble v. Edison Int'l, 729 F.3d 1110, 1138 (9th Cir. 2013). From the perspective of these courts, plan fiduciaries should take the following steps: Follow [...]
DECEMBER 2013 – PROPOSED HEALTH PLAN EXCEPTED BENEFITS REGULATIONS
In December 2013, the IRS, DOL and HHS issued proposed regulations on “excepted benefits,” which are generally exempt from HIPAA’s portability rules and Health Care Reform’s benefit mandates. The proposed regulations would make it easier for dental and vision coverage to qualify as excepted benefits, and would create new classes of excepted benefits for certain employee assistance programs (EAPs) and for supplemental Exchange coverage (called “wraparound” coverage). Until final regulations are issued [...]
NOVEMBER 2013 – FINAL REGULATIONS UNDER MHPAEA
In November 2013, the IRS, DOL, and HHS (the "agencies") jointly issued final regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA"), and a related set of FAQs. Generally, MHPAEA prohibits group health plans from imposing financial requirements (such as deductibles, copays, or coinsurance) or treatment limitations on mental health and substance use disorder ("MH/SUD") benefits that are more restrictive than those that apply to the plan's medical/surgical [...]
SEPTEMBER 2013 – PROPOSED REGULATIONS GOVERNING REPORTING BY EMPLOYERS AND HEALTH INSURERS
On September 9, 2013, the IRS released two new sets of proposed regulations covering plan sponsor, insurer and large employer reporting requirements designed to implement key provisions of the Affordable Care Act (“ACA”). The first set of proposed regulations would implement Internal Revenue Code (“Code”) Section 6055, which generally requires that health insurers and plan sponsors of self-insured coverage report certain information to the IRS and enrollees. The second set of proposed [...]
SEPTEMBER 2013 NEW HRA GUIDANCE
On September 13, 2013, the IRS and DOL issued new Q&A guidanceIRS Notice 2013-54 and DOL Technical Release 2013-03. HHS has also published a memorandum stating that it concurs in the application of the laws under its jurisdiction as set forth in the IRS and DOL guidance. on the application of PPACA's annual limit and preventive services requirements to Health Reimbursement Arrangements ("HRAs"), Health Flexible Spending Arrangements ("Health FSAs"), and employer [...]