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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 [...]
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 [...]