Tag Archives: Health plans

Signature Authority Can Trigger ERISA Fiduciary Responsibility

One of the most sensitive — and often misunderstood — aspects of being an executive of a company with a retirement plan is knowing when senior leaders are fiduciaries for the plan. A recent federal case added some clarity when…

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IRS Lawyers Discuss Reporting on Offers of Coverage

IRS officials described when employers themselves have to fill out full information on all health plan enrollees along with months enrolled, and when employers can hand that over to another entity, such as an insurer. Most employers offer minimum essential…

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Plan Identifier Rules Not Written for Self-funded Plans

With the HIPAA deadline for obtaining a health plan identifier less than two months away, plan sponsors have encountered major problems trying to get one — if they’ve started at all, according to a poll conducted by the ERISA Industry…

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More IRS Guidance on ACA’s Health Coverage Reporting Rules

IRS on Aug. 29 issued two sets of questions and answers about reporting on health coverage for large employers under Section 6056 and for all employers under Section 6055 of the reform law. Section 6056 reporting is required by “applicable large employers” that provide…

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Learning How to Count: IRS Attorneys Discuss ACA’s Pay-or-play Provisions

Employer preparation for preparing for health care reform’s pay-or-play provisions, especially data reporting (under Sections 6055 and 6056) to the IRS, can be complicated by: (1) changes in workers’ employment status (from part-time to full-time); (2) an organization’s switching from…

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Ruling: Providers Are Not ERISA Beneficiaries

In a decision sharply at odds with a recent Illinois ruling, a federal district court in Arizona held that health care providers cannot be characterized as plan beneficiaries who can sue to compel payment of ERISA benefits. The court rejected…

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Employer Faces State-law Claims After False Promise Causes Beneficiary to Skip COBRA Coverage

A former employee left with more than $13,000 in unpaid medical bills after his employer retroactively terminated his employment and health benefits can sue for state-law claims, a federal district court ruled. The individual alleged that while he was hospitalized,…

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Insurer’s Recovery Rights Were Rooted in ERISA Docs in Spite of Plan Administrator’s Contrary Words

An insurer won recovery of health expenses paid from a member’s $255,000 settlement after said member refused to reimburse the insurer for medical payments it made. It did so in spite of an affidavit from the company plan administrator saying…

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In Case You Missed It: Plan Administrator Must Give Providers ERISA Appeal Process

The ruling in Penn. Chiropractic Ass’n v. BCBSA threatens to make recoveries more difficult for all insurers and may complicate the claims administration of self-funded plans. It also may necessitate self-insured plan sponsors reviewing network contracts with providers. Here’s what happened:…

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FAQs Describe How Plans, Administrators Will Pay Reinsurance Contributions

On May 22, CMS issued guidance (registration required) describing how plans, third-party administrators and insurers will pay reinsurance contributions required under health care reform for the next three years. The guidance says a contributing entity can complete all required steps for the…

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