EAPs That Meet Four Requirements May Avoid Application of Health Care Reform

Benefits provided through an employee assistance program (“EAP”) may be considered group health plan coverage, which would subject the EAP to the health care reform requirements mandated by HIPAA and the Health Care Reform Act, unless the EAP meets the criteria for being “excepted benefits.”

In September 2013, the IRS, HHS, and DOL collectively issued Notice 2013-54, which stated that, through 2014, benefits provided through an EAP were considered excepted benefits if the EAP did not provide “significant benefits in the nature of medical care.”  The notice did not elaborate on the terms “significant” or “medical care,” but the notice permitted employers to use a reasonable, good faith interpretation of these terms.  Read More ›

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Accurate Documentation of Welfare Plans May Save Employers Certain Costs and Headaches Down the Road

ERISA requires all pension and welfare benefit plans to be maintained in a written plan document.  The DOL and several courts have taken a broad view of what constitutes a “written plan document,” and while pension plans are usually very well documented, many welfare plans consist of a loose, and often out-of-date, collection of insurance policies, certificates of coverage and summary plan descriptions.

While a loose collection of documents may technically satisfy the ERISA written plan document rule, there are many other reasons an employer may want to consider more formal, updated plan documents:

•  The DOL has recently started to focus more on welfare plan audits.  Read More ›

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HIPAA Business Associates Agreements – Reminder of September 22 Deadline

On January 17, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule under HIPAA making substantial changes to the rules for vendors that provide services to HIPAA-covered plans, such as third-party administrators, pharmacy benefit managers and certain brokers – known in the HIPAA world as “Business Associates.” Under this final rule, Business Associates are required, for the first time, to comply with the HIPAA Security Rule, many provisions of the HIPAA Privacy Rule and are subject to direct enforcement by HHS. As a brief reminder, and as we discussed in our Employee Benefits Update 2013 End of Year Plan Sponsor “To Do” List Part 2 – Health and Welfare, existing agreements with Business Associates must be amended to comply with the requirements of this final rule on or before September 22, 2014. Read More ›

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