DOWNLOAD PDF MAY 2019 COMPLIANCE UPDATE NEW DRUG TV ADVERTISING RULES COMING Beginning in July, the Trump administration is requiring drug manufacturers, when they advertise on television, to list the cost of the drugs covered by Medicare or Medicaid, if the drug’s monthly cost is more than $35. HHS RULE REQUIRES MANUFACTURERS TO DISCLOSE DRUG PRICES Plan sponsors should expect that the plan participants may start to question how the costs of drugs impact them. ... Read More
DOWNLOAD PDF APRIL 2019 COMPLIANCE UPDATE WHEN DOES THE “CLOCK” START? The ERISA claims procedures require claimants to follow certain timelines when appealing an adverse ruling. ERISA Administrative Appeal Barred As Untimely This court case held that the “clock” starts on the date the plaintiff got notice that her benefits were going to terminate; not on the date the benefits were actually terminated. Complying with the timelines is important and failure to comply can... Read More
DOWNLOAD PDF MARCH 2019 COMPLIANCE UPDATE Contract Theory Governs Retiree Health Coverage Health coverage is expensive and employers are having a hard time offering quality/affordable coverage to employees. Therefore, it comes as no surprise that employers often want to reduce or eliminate coverage for retirees. COURT APPLIES ORDINARY PRINCIPALS OF CONTRACT LAW FOR BARGAIN AGREEMENTS SIXTH COURT RULES FOR EMPLOYER TO TERM RETIREE COVERAGE It also should come as no surprise the retirees will... Read More
DOWNLOAD PDF FEBRUARY 2019 COMPLIANCE UPDATE As the government re-opens its doors, it appears it is making tax changes with a vengeance. Please take a minute to read this month’s newsletter for some important changes that have come across Capitol Hill, along with other rulings that may affect you as an employer or employee. Don’t Use My Money!! A recent Federal court case prohibited United HealthCare from using money from one health plan to offset... Read More
DOWNLOAD PDF We hope everyone had a safe and happy holiday season. Time to get back to work unless you are impacted by the government shutdown. No telling when that will end. This newsletter will be longer than most since it includes articles from the date of the last newsletter (i.e. November 15, 2018) till today. PLAN LIMITS FOR 2019 Many of the rules of government benefit plans have an inflationary factor. That is, the... Read More
DOWNLOAD PDF HOLIDAY SEASON GIFT IDEAS Just in time for the gift giving season I am pleased to announce the 2018/2019 Edition of my book, the Welfare Benefits Guide: Health Plans and Other Employer Sponsored Benefits, is now available. 2018-2019 Welfare Benefits Guide This makes the perfect stocking stuffer and we are adding a new twist. If you buy at least 10 sets of my book, I will autograph each one for a nominal fee.... Read More
DOWNLOAD PDF MEDICARE PART D NOTICES There are two Medicare Part D Notice requirements. Medicare Part D is the prescription drug benefits under Medicare. There are two notices. One goes to the employees and the other goes to the government. There is some confusion regarding the notices to employees. Everyone says this notice has to be distributed by October 15, which is the start of the annual open enrollment period. However, the rules say the... Read More
DOWNLOAD PDF LEGAL FEES UNDER ERISA LITIGATION No one likes to be involved in a lawsuit except the lawyers. Oftentimes lawyers will take on a case because the statute allows for legal fees. ERISA is one of those laws. ERISA allows fees for “some success” The courts have expanded the circumstances under which lawyers can be awarded fees when the basis of the lawsuit is ERISA. The standard is now that the court may award... Read More
Download PDF UPDATED MARKETPLACE NOTICES One of the most important parts of the Affordable Care Act is the marketplace, or health care exchange. Although the Trump administration continues to attack the statute, it still is the law of the land. One of the requirements is that employers notify new employees at the time of hire about the marketplaces or health care exchanges. Update to the Marketplace Notice The government provides a model notice employers can... Read More
DOWNLOAD PDF PCORI FEE DUE The PCORI fee is due the end of this month. The fee is assessed against all health plans. If you are sponsoring a fully insured health plan, the carrier pays the fees but passes the cost on to the employer through higher premiums. On the other hand, if you sponsor a self-funded health plan (including an HRA) then you have to report and pay the fee. PCORI fee: Key action... Read More