The Transparency in Coverage Proposed Rule aims to give individuals greater access to health care pricing information. The proposals essentially require most group health plans, including self-insured plans, to disclose price and cost-sharing information to participants and beneficiaries. More specifically, not only do these rules require disclosure of cost-sharing estimates, plans would also be required to disclose negotiated rates for in-network providers and allowed amounts paid for out-of-network (OON) providers. Out-of-pocket cost information would be provided ...

The First Circuit unanimously found that two Sun Capital private equity funds could not be held jointly and severally liable for multiemployer defined benefit pension plan withdrawal liability incurred by a bankrupt portfolio company. The lower court based its liability ruling on its finding that the funds were partners in an implied partnership-in-fact which was engaged in a “trade or business.” However, on appeal the First Circuit disagreed and found that several factors rebutting the partnership-in-fact formation were too greatly discounted by the lower court. The ...

Once again, the IRS extended the due date for certain 2019 ACA information reporting requirements in Notice 2019-63. The due date for furnishing Form 1095-C (and 1095-B) to employees is extended from January 31, 2020, to March 2, 2020. (The due date for filing with the IRS remains unchanged at February 28, 2020, or March 31, 2020, if filing electronically). In addition, the IRS will not impose a penalty for failure to furnish Form 1095-C to any employee enrolled in an ALE member's self-insured health plan who is not a full-time employee for any month of 2019 if certain conditions are met ...

Lawsuits by 401(k) plan participants related to employer stock in a 401(k) plan are nothing new. These lawsuits typically allege that ERISA plan fiduciaries failed to protect employees' retirement savings when the employer stock price falls. In the wake of the U.S. Supreme Court's Dudenhoeffer decision, which included the elimination of the presumption of prudence, these suits are often dismissed. However, during oral arguments for the case of IBM et al. v. Jander et al., the Supreme Court is now faced with reconciling the tension between federal securities law and ERISA ...

Plans and issuers will be required to use the new 2021 Summary of Benefits and Coverage (SBC) template in connection with coverage and plan years beginning on or after January 1, 2021. Updated instructions and other materials are also available on the agencies' websites. Specifically,

  • The new form revises the minimum essential coverage statement to reference the impact on premium tax credit eligibility, and removes the reference to the individual mandate (given the mandate has been effectively eliminated),
  • Likewise, the Uniform Glossary has removed references to the ...

This month the IRS announced increased retirement plan contribution limits for 2020. Employees in 401(k) plans will be able to contribute up to $19,500 next year, and the catch-up contribution limit for employees aged 50 and over has increased from $6,000 to $6,500. The complete list of notable employer retirement plan increases are summarized below:

The increased contribution limits for employer sponsored retirement plans stand in contrast to the more stagnant limits for IRAs: the limit on annual contributions to an IRA is unchanged at $6,000, along with the IRA ...

The Seventh Circuit recently issued a stern warning about the importance of strict compliance with ERISA claim review timeframes in holding that the “substantial compliance” standard “does not apply to blown deadlines.” In this case, Fessenden v. Reliance Standard Life Ins. Co. (7th Cir. 2019), the disability plan administrator issued a decision on review about eight days after the time prescribed by ERISA. In the short time period after the ERISA deadline expired and before the decision on review was rendered, the claimant filed suit as he was deemed to have ...

This year, we have seen a string of COBRA class actions seeking monetary penalties on account of defective COBRA notices. Most recently, in Hicks v. Lockheed Martin, the spouse of a former employee alleged various technical defects in Lockheed’s COBRA notice. Although on its face it appeared to include a good deal of required information, the Lockheed notice allegedly failed to state the COBRA coverage termination date, failed to provide an address to which payment should be sent, and failed to sufficiently identify the plan administrator. And, without this information, the ...

On October 22, 2019, the Department of Labor issued proposed rules intended to relax the current (and, in many respects, outdated) electronic disclosure rules. The proposed rules offer additional e-disclosure options and have the potential to save ERISA plans significant time and money. Notably, the proposed rule includes a new, voluntary safe harbor which would allow employers to make retirement plan disclosures via website, subject to certain requirements such as participant notifications and specific website standards. The rule would permit default electronic delivery ...

Has your employee sought premium tax credits (PTCs) for coverage under a health insurance marketplace? If so, this could be an opportunity for you to reduce your ACA penalty risk. When an employer receives notice from a health insurance marketplace that an individual is eligible for PTCs, the best course of action is to read the notice carefully and ask plenty of questions: What is the deadline to appeal? Is this individual still an employee? Are you an applicable large employer under the ACA? Is the employee full-time or part-time?  Was affordable, minimum value coverage offered to ...

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