Must Drug Manufacturer Coupons Count Toward Annual Maximum Out-Of-Pocket Limits? Stay Tuned …

What is the Annual Maximum Out-Of-Pocket Limit (“MOOP”)?

MOOP is the most a participant must pay for covered services under a group health plan in a plan year. After a participant spends this amount on deductibles, copayments, and coinsurance, the health plan must pay 100% of the costs of covered benefits.

What are Drug Manufacturers’ Coupons (“Coupons”)?

Many drug manufacturers offer coupons to patients to reduce out-of-pocket costs. Drug manufacturers may offer these coupons for various reasons including: (1) to compete with another brand name drug in the same therapeutic class; (2) to compete with a generic equivalent when released; or (3) to assist consumers whose drug costs would otherwise be extremely high due to a rare or costly condition. Read More ›

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

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Form 5500 Penalty Relief Deadline Approaching for MEPs

On July 24, 2019, the Department of Labor (the “DOL”) issued Field Assistance Bulletin 2019-01 (the “Bulletin”), which provides transition relief to multiple employer plans (“MEPs”) that failed to comply with certain annual reporting requirements. 

The Bulletin focuses on a Form 5500 reporting requirement added by the Cooperative and Small Employer Charity Pension Flexibility Act, which requires MEPs to report on the Form 5500 all participating employers and an estimate of the percentage of contributions made by participating employers during the plan year.  This disclosure requirement first became effective for plan years beginning after December 31, 2013.             

The DOL has identified widespread and ongoing failure by MEPs to comply with the above reporting requirement.  Read More ›

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Design Considerations for Medical Emergency Leave-Sharing Programs

Employers often allow employees to donate leave to co-workers who are experiencing medical emergencies. If properly structured, these leave transfers can be excluded from the gross income of the donor employee and included in the gross income of the co-worker recipient.  There are no statutes or regulations governing these arrangements. The only formal guidance available to employers seeking this favorable tax treatment for medical emergency leave-sharing programs is Revenue Ruling 90-29 (“Rev. Rul. 90-29”). Other leave-sharing programs, such as those for major disasters or military leave, are subject to different rules and may or may not receive similar tax treatment.

Departure from the medical emergency leave-sharing program design approved by the IRS in Rev. Read More ›

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The Ninth Circuit Reverses Itself and Enforces ERISA Mandatory Arbitration Clause

A three-judge panel of the Ninth Circuit recently decided that Charles Schwab Corp. can require a proposed class action to arbitrate its claim that Schwab breached its fiduciary duties by including Schwab-affiliated investment funds in the Plan, despite the funds’ poor performance, to generate fees for Schwab and its affiliates.  In doing so, the Ninth Circuit overturned its former decision in which it held that ERISA claims cannot be arbitrated.

Specifically, the Ninth Circuit panel determined that the Ninth Circuit’s 1984 opinion in Amaro v. Continental Can Co. should no longer be followed because of more recent precedent permitting ERISA claims to be arbitrated, including the U.S. Read More ›

Posted in Employee Benefits, Executive Compensation, Qualified Retirement Plans | Tagged , ,

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Preventive Care Can Now Be Covered for Specified Chronic Conditions Before HDHP Deductible

On July 17, 2019 the IRS released Notice 2019-45  resolving a preventive care problem that has been plaguing many high deductible health plans (“HDHPs.”).  The Affordable Care Act’s free preventive care mandate appears to be working.  People are catching medical problems sooner.  As a result, many employers have embraced the concept of free preventive care and want to go a step further – providing free preventive care for certain chronic conditions, such as asthma, diabetes, and heart disease.  However, they have run into a snag.  Under IRS guidance, treatment for chronic conditions is not “preventive care” and covering it before the deductible is met jeopardizes the plan’s status as an HDHP. Read More ›

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DOL Finalizes Regulations Requiring Electronic Filing of Top Hat Statements

On June 17th the Department of Labor finalized a set of proposed regulations requiring that all “top hat” plan statements be filed with the Department electronically though this website.  As brief background, a “top hat” statement is a one-time filing made with the Department of Labor to protect against a non-qualified plan established for a select group of management or highly compensated employees becoming subject to some of the more onerous requirements of ERISA.  Accordingly, to maintain this protection, effective August 16, 2019, “top hat” filings must be made electronically.

The Department introduced the proposed regulations on the electronic filings in September 2014 and has indicated that since the release of the proposed regulations 54% of the “top hat” filings received have been made electronically.  Read More ›

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Authorized Representatives – Fresh Look at an Old Rule

Earlier this year, the Department of Labor issued an information letter explaining ERISA’s authorized representative requirement.  Below are some of the takeaways employers may want to consider.

1.     The Authorized Representative Requirement Under ERISA

ERISA’s claims procedure regulations expressly give participants and beneficiaries the right to appoint authorized representatives to act on their behalf in connection with a claim for benefits and an appeal of an adverse benefit determination.  Furthermore, when a claimant clearly designates an authorized representative to assist with a claim and/or appeal, the plan should direct the claimant’s information and notifications to the authorized representative to act on behalf of the claimant. Read More ›

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Reassigning Section 1557: Trump Administration Proposes Reversal of Transgender Benefits Rule

In 2016, the Department of Health and Human Services (“HHS”) Office of Civil Rights issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act (“Section 1557”), which prohibit the categorical refusal of health coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity. These regulations drew sustained legal challenges and prompted HHS to withdraw, revise and reissue the Section 1557 regulations (the “Proposed Regulations”).

In short, the Proposed Regulations would repeal large portions of the original nondiscrimination rules and would redefine the scope of various protections under Section 1557. Specifically, the Proposed Regulations negate the provisions of Section 1557 covering nondiscrimination based on sex and gender identity. Read More ›

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The SECURE Act – A Primer on the Top Six SECURE Act Changes that could be coming to Retirement Plans Next Year

The SECURE Act (the “Act”) passed the House with bipartisan support and is on its way to the Senate with predictions that it could end up on the President’s desk by the end of the year. Here are some highlights of this potential legislation.

1. Longer Life means Later Mandatory Distributions. To account for increases in life expectancy, the Act would increase the age for required minimum distributions from 70 ½ to 72. The Act will also repeal the maximum age for traditional IRA contributions.

2. Auto-Enrollment Incentives. Automatic enrollment has been shown to increase both participation and higher savings, so to incentivize this plan design, the Act will provide a tax credit for small employers adopting plans with this design and increases the cap from 10% to 15% for automatic escalation in an automatic enrollment safe harbor plan. Read More ›

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A Quick Reminder: Three Best Practices for Beneficiary Designations

Three best practices for plan administration that often fall by the wayside include: (1) regularly reminding participants to review and update their beneficiary designations; (2) checking recordkeeping practices to avoid loss of beneficiary designation information; and (3) acquiring identifying information for designated beneficiaries.  Implementing these three best practices could save plan administrators significant costs and headache.

1. Periodic Beneficiary Designation Reminder

Problems arise when plan participants fail to update their beneficiary designations after a change in circumstances (such as marriage, divorce, childbirth, or adoption).  Plan administrators should be cautious when dealing with non-plan documents arising from such events that purport to waive or establish a right to benefits under the plan.  Read More ›

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