A high deductible health plan (“HDHP”) is not permitted to pay for medical expenses until the plan’s deductible has been satisfied, with the exception of medical expenses incurred for preventive care. Preventive care did not generally include expenses for any service or benefit intended to treat an existing illness, injury or condition. In a welcome …
Association Health Plans: Still Viable?
The Department of Labor (“DOL”) issued final regulations in June 2018, which loosened the DOL’s long-standing sub-regulatory guidance and allowed more organizations to form Association Health Plans (“AHPs”). The impetus for issuing the regulations was to provide another option for small employers to have access to affordable, high quality health care. AHPs would allow small …
Surprise! A QDRO Can Apply to a Welfare Benefit Plan
Most plan administrators are familiar with a qualified domestic relations order or “QDRO,” which is used to split retirement plan benefits between a plan participant and an alternate payee, such as an ex-spouse or minor child. Even an experienced plan administrator may not be aware that a QDRO can also apply to a welfare benefit …
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Determining Eligibility for the Employer Credit for Paid Family and Medical Leave
Section 45S of the Internal Revenue Code (“Code”), added to the Code by the Tax Cuts and Jobs Act of 2017, establishes a general business credit for an employer who provides paid family and medical leave to qualifying employees. The credit would partially offset the cost of the paid leave, however, it is available only …
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SPD v. Plan Document: Who Wins?
Conflicts between a benefit plan Summary Plan Description and a plan document are an ever-present concern for plan sponsors. An aggrieved participant who relies on SPD language will often pursue a claim for benefits even though he/she is not entitled to the benefit under the plain terms of the plan document. This problem is illustrated …
ACA Employer Penalty Tax Update: Responding to Letter 227
Many applicable large employers received an unpleasant surprise earlier this year when they received Letter 226-J, which imposed an employer shared responsibility payment (ESRP) under Section 4980H of the Internal Revenue Code on Forms 1094-C and/or 1095-C filed for the 2015 calendar year. Employers were required to respond to Letter 226-J within a short 30-day …
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Final ERISA Claims Procedures for Plans Providing Disability Benefits Effective April 1, 2018
March and April will be critical months for employers who sponsor ERISA-governed employee benefit plans that provide benefits subject to the disability claim procedures. Any claims filed after April 1, 2018 will be subject to a new final rule issued by the Department of Labor (“DOL”) in December of 2016. Plans subject to these rules …
Is a Self-Funded STD Plan an ERISA Plan or an Exempt Payroll Practice?
ERISA generally governs all pension and welfare benefit plans. In regulations, the Department of Labor (“DOL”) has exempted certain types of plans or practices from the definition of a welfare benefit plan under Title I of ERISA. One commonly used exemption is the “payroll practice” exemption. Exempt payroll practices include “payment of an employee’s normal …
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Why Do I Need a Plan Document for my Welfare Benefit Plan?
An employee comes into your office and requests a copy of the plan document for the medical plan. What document do you give to the employee? One of the basic ERISA rules is that all employee benefit plans must have a written plan document. Under ERISA Section 402, a plan document must include these elements: …
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