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Making a List, Checking it Twice

It’s that time of year when boys and girls start making their lists for the holidays, but we in the employee benefits world make a very different kind of list.  In the rapidly changing world of employee benefits and executive compensation law, a checklist can be particularly helpful to make sure important issues do not […]

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Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims.  The letters are usually 20 to 30 pages long, not very specific, and make various accusations against the plan and its fiduciaries.  Most of the letters follow a standard approach.  They start […]

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What is Telemedicine? A Cool Benefit or a Hot Mess?

We’ve had numerous inquiries lately about telemedicine benefits.  My clients most typically ask either “is this a group health plan?” or “is it just access to another provider?”  Clearly, there is much confusion surrounding telemedicine benefits.  Part of the problem is that the regulators have yet to issue guidance on how telemedicine should be treated.  […]

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When Anything Less than 95% is a Failing Grade: An Update on the Employer Shared Responsibility Penalties

As a reminder, effective January 1, 2016, employers must offer minimum essential coverage to 95% or more (up from 70% or more for 2015) of their full-time employees and their dependents each month or pay a very steep penalty.  Missing the mark even slightly, for example coming in at 94%, will require the employer to […]

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Late Or Incorrect Forms 1095-C: The IRS Provides Relief, But Only For Employers Acting In Good Faith To Comply Or Who Missed The Deadline Due To Reasonable Cause

Many employers struggled to furnish correct Forms 1095-C to employees by the March 31, 2016 deadline.  Section 6721(a)(2) of the Internal Revenue Code provides penalties for failure to furnish Forms 1095-C to individuals by the deadline.  Although the presumptive penalty is $250 for each delinquent or incorrect return, the penalty amount may be reduced if […]

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If You Blinked You Might Have Missed Important Affordable Care Act Guidance

Notice 2015-87 issued by the IRS on December 16, 2015, provides guidance on numerous Affordable Care Act provisions.  Below are some of the highlights. The Notice provides additional guidance on integrating health reimbursement arrangements (“HRAs”) with major medical plans, as originally explained in IRS Notice 2013-54.  See Q&As 1-4. It provides further guidance on arrangements […]

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Check(list) It Out!

Who doesn’t love a good checklist?  I know I do. In the rapidly changing world of employee benefits and executive compensation law, checklists can be particularly helpful to make sure important issues don’t fall through the cracks.   To help folks stay apprised of changes in the law, changes they might need to make to their […]

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EEOC Ruling on Sexual Orientation Impacts Same-Sex Spouse and Domestic Partner Benefits

In our July 2, 2015 blog, Obergefell v. Hodges – Same-Sex Marriage Now Legal in All 50 States, we indicated that employers may need to offer same-sex spouse health and welfare benefits and rethink domestic partner benefits in order to avoid discrimination claims.  Shortly after posting that blog, the Equal Employment Opportunity Commission (the “EEOC”) […]

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King v. Burwell – Supreme Court Confirms Tax Subsidies are Available in All States

In an earlier blog post this year, I discussed the King v. Burwell case and the possible ramifications if the United States Supreme Court did not uphold the Internal Revenue Service position that residents in states with either a state or federal Health Care Exchange are entitled to receive subsidies from the federal government to […]

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Wellness Programs: Agencies Issue Helpful Guidance but Look Before You Leap

Recent studies indicate that wellness programs significantly improve the health of workers.  If only it were so easy to implement a wellness program . . . As explained in our July 17, 2013 Benefits Update – Final Wellness Rules May Require Review of Existing Wellness Programs, final HIPAA wellness regulations were issued by the Departments […]

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