One of the many jobs in administering a health plan is determining whether a claim should be paid. This requires looking at the plan and determining whether the claim meets the criterium established under the plan. As one would imagine, this may lead to claims being denied. Section 503 of the Employee Retirement Income Security Act of 1974 (“ERISA”) requires the plan to provide any participant or beneficiary...

On July 9, 2024, the Federal Trade Commission (FTC) released a critical interim staff report shedding light on the role of pharmacy benefit managers (PBMs) in driving up prescription drug costs. The report outlines how these PBMs profit at the expense of patients and independent pharmacies by inflating drug prices and imposing unfair practices. Just a day later, news broke that the FTC is preparing to sue the nation’s...

Recently, health entities have experienced cybersecurity attacks at an alarming rate, causing concern for the integrity of the healthcare system. The information compromised during these attacks may include personally identifiable information (“PII”), which includes names, dates of birth, and social security numbers. In response, the Department of Health and Human Services’ Office of Civil Rights (“OCR”), which oversees compliance with the Health Insurance Portability and Accountability Act of 1996...

Introduction Recently, the IRS issued Notice 2024-35 providing additional guidance on Required Minimum Distributions (“RMDs”) due for the 2024 and 2025 calendar years. The purpose of the new guidance was to remind taxpayers of the new 10-year rule introduced under the SECURE Act of 2019 and extend relief to those who failed to take an RMD. These rules impact both the participant and beneficiary of a defined contribution retirement plan...

Section 105 of the Employee Retirement Income Savings Act of 1974 (“ERISA”) (29 U.S.C. §1025) requires the plan administrator for defined benefit plans, such as pension plans, to provide benefit statements to the participants and beneficiaries of the plan. The benefit statement is essentially a notice that contains information about the plan, including the rights of the participants and the benefits available to the participant or beneficiaries, among...

A recent district court decision from California serves as helpful reminder to ERISA plans about their obligation to disclose certain documents upon request. In Zavislak v. Netflix, a California District Court reviewed whether an ERISA health plan adequately complied with ERISA’s disclosure rules and, if not, whether it should be subject to the daily penalty under ERISA Section 502(c)(1). Background The Plaintiff was a Netflix employee who was a covered participant...

As the price of healthcare continues to increase, employers can assist employees by providing employees the opportunity to enroll in special accounts to help pay for medical expenses. Some of these accounts enable the employer to share the cost burden with the employee while providing tax-savings to each. Generally, there are three (3) employer-sponsored vehicles that are commonly used to help pay for qualified medical expenses: (1) Health Reimbursement...