An ERISA plan participant assigned her claims for benefits under an employer-sponsored group health plan to her medical service provider. The service provider then assigned those claims to a sub-assignee collection agency which brought suit against BlueCross BlueShield of Florida. Citing Fifth Circuit precedent, the Eleventh Circuit held that the collection agency had derivative standing to sue under ERISA Section 502(a), notwithstanding the agency?ÇÖs status as a sub-assignee of the participant?ÇÖs benefit claim. The Court explained that nothing in ERISA prohibits a non-healthcare provider from obtaining derivative standing through a sub-assignment, and that allowing a healthcare provider to sub-assign claims does not frustrate the purposes of ERISA. Note that the holding of this case is relevant for ERISA plan sponsors only to the extent that plan participants are permitted under the terms of their plans to make initial assignments of plan benefits. Gables Ins. Recovery, Inc., v. Blue Cross &… Continue Reading
IRS Notice Provides Additional Guidance on the Application of the ACA to Employer-Provided Health Coverage
On December 16, 2015, the Internal Revenue Service released Notice 2015-87 (the ?Ç£Notice?Ç¥), which provides guidance related to the application of market reform provisions of the Affordable Care Act (the ?Ç£ACA?Ç¥) to health reimbursement arrangements (?Ç£HRAs?Ç¥) and other types of employer-provided health coverage, primarily addressing questions concerning the reimbursement of premiums for individually purchased health insurance policies. The Notice also clarifies how HRA contributions, flex credits and opt-out payments may impact certain determinations under the employer shared responsibility provisions of the ACA (i.e., the ?Ç£play or pay?Ç¥ rules). Furthermore, the Notice provides guidance regarding (1) the application of COBRA continuation coverage rules to unused amounts in health flexible spending accounts for employers that adopted the carryover provisions permitted under IRS Notice 2013-71, and (2) penalty relief for employers that make good faith efforts to comply with ACA reporting requirements. A copy of the Notice is available?áhere.