“A Trap for the Unwary” – Does Your Self-Funded Health Plan Provide Transgender Benefits? It Might Need to Soon.

Assistant Secretary of Labor Phyllis Borzi recently offered informal guidance on the broad scope of nondiscrimination regulations proposed under Section 1557 of the Affordable Care Act. During her remarks at the ABA Labor Section Employee Benefits Committee Meeting in February, Ms. Borzi indicated that the proposed regulations would apply to any health plan that receives federal funds, including a self-funded plan that uses a third party administrator that receives federal funds.  Ms. Borzi characterized the proposed regulations as a “trap for the unwary,” noting that many self-funded plans assume that the nondiscrimination rules will not apply to them.  In light of Ms. Read More ›

Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform | Tagged , , , , , ,

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Proposed IRS Regulations Simplify Section 83(b) Filing Requirements

As explained in a prior blog post, an employee who timely files a Section 83(b) election will be taxed on the fair market value of property transferred (typically restricted stock) to him or her in exchange for services on the date of grant rather than as the stock vests.  In addition, by making a Section 83(b) election, the employee will start the clock on the capital gains holding period. The Section 83(b) election must be filed with the Internal Revenue Service within 30 days from the date on which the property is transferred to the employee.  In addition, the employee is required to provide a copy of the 83(b) election to his or her employer and must attach a copy of the election to his or her individual tax return for the year in which the election is made. Read More ›

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Proposed Regulations for Summary of Benefits and Coverage Seek to Simplify Compliance

As part of Health Care Reform, employers and insurers are required to provide group health plan participants with a Summary of Benefits and Coverage (“SBC”) describing the important features of the group health plan option(s) offered by the employer/insurer.  The SBC is also intended to provide participants a way to easily compare different group health plan options.  The current rules for complying with the SBC requirement were viewed by some as not being “user-friendly.”  On December 22, 2014, the DOL, HHS and Treasury released proposed guidance that is designed “to improve consumer access to important plan information so that [the consumers] can make more informed choices.”

The proposed regulations suggest the following changes/additions:

•  A new coverage example regarding a foot fracture and emergency room visit would be added to the existing coverage examples of “having a baby” and “managing type 2 diabetes.”  These coverage examples have been shown to be helpful in a participant’s understanding of how their coverage works. Read More ›

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FMLA to Apply to All Employees in Same-Sex Marriages

When the U.S. Supreme Court declared DOMA unconstitutional in United States v. Windsor, many federal benefits that were previously denied to individuals in same-sex marriages became available to those individuals.  However, job-protected leave under the Family and Medical Leave Act (“FMLA”) was not one of them.

Generally, an employee is able to take 12 weeks of unpaid, job-protected leave to care for a sick family member (including a spouse).  For purposes of FMLA, “spouse” is defined as a husband or wife as defined or recognized under state law for purposes of marriage in the state where the employee resides.  This is known as the “state of residence” standard, which means that an employee validly married to a same-sex spouse cannot receive FMLA protections if they live in a state that does not recognize same-sex marriage. Read More ›

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