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Which Plans are Subject to the DOL’s Final Rules for Disability Claims Procedures?

Overview On December 19, 2016, the U.S. Department of Labor (DOL) issued final rules revising the claims procedures for ERISA plans that make disability determinations affecting plan benefits.  The DOL noted that nearly two-thirds of all ERISA litigation involves claims under long-term disability plans, and the final rules are intended to improve the “full and fair review” of disability claims under ERISA § 503 and ERISA Reg. § 2560.503-1 by expanding the procedural requirements.  It’s debatable whether the new procedures will actually cut down on the volume of future litigation once individuals have exhausted the appeals process, but the final rules should lead to a better administrative record for review during litigation. The final rules generally make the disability claims procedures more consistent with the procedures for group health plans as modified by the Affordable Care Act (ACA), although the unique timelines for disability procedures remain intact, there is no… Continue Reading

2016 Health and Welfare Plan Year-End Action Items

There are a number of health and welfare plan action items to address as 2016 closes and 2017 begins. The election results have created uncertainty in the minds of many regarding whether certain legal obligations will remain in effect (or be enforced). Employers should assume Affordable Care Act (ACA) and other existing obligations will continue unless and until repealed or otherwise affected by subsequent guidance. It is not clear how soon change may occur after the inauguration on January 20, 2017. Based on the promises by both President-Elect Trump and the Republican Party to repeal and/or replace the ACA, we expect that revenue related ACA requirements, such as the employer shared responsibility provisions, are more likely to be affected during 2017 than other ACA requirements like the preventive services mandates that merely impact plan design. Other changes, such as those suggested by the President-Elect in his healthcare position statement or… Continue Reading

The Sandbox Bully: Health Savings Accounts (HSAs), Onsite Clinics, and Telemedicine

Employers are increasingly looking toward alternatives like telemedicine and onsite clinics to help lower the cost of their group health plans, particularly those employers that feel they are running out of room to further pare down medical plan design(s) or shift cost sharing to employees. Telemedicine is relatively easier to implement than an onsite clinic which requires a sufficient concentration of participants (which can include employees and their dependents) in a given location to be effective.  This is less of an issue for health care systems which also have the advantage of being able to operate an onsite clinic as an own-use facility.  Note:  It is possible for multiple employers to share an onsite clinic with clever separate accounting and administration, but that is beyond the scope of this article. For all of their advantages, HSAs do not easily co-exist with many other benefits.  This article focuses on the HSA… Continue Reading

IRS Releases Final Instructions for Forms 1094-B/1095-B and 1094-C/1095-C

IRS Releases Final Instructions for Forms 1094-B/1095-B and 1094-C/1095-C

The IRS recently released final instructions for the 2016 Forms 1094 and 1095.  Highlights of the changes and clarifications included in the final instructions are provided below. While a of the few items are “neutral” and merely reflect pre-programmed changes under the Affordable Care Act that were already known and set to occur, many of the changes and clarifications are welcome news. Form 1094-B Highlights There are no substantive changes for 2016. View the 2016 Form 1094-B here. Form 1095-B Highlights The statement, “Do not attach to your tax return. Keep for your records.” was inserted underneath the main heading, suggesting that the form will continue to not be required for direct substantiation purposes as part of a personal income tax filing in the future. Part I, Lines #2 and #3 and Part IV, columns (b) and (c) have been updated to reflect that TINs may be substituted for SSNs.… Continue Reading

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