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...
Continue reading…HHS Doubling Down on Health Plan Cybersecurity and HIPAA Compliance
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...
Continue reading…IRS Issues Extends Previously Granted Relief for Missed Required Minimum Distributions issued in 2024 and 2025
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...
Continue reading…Benefit Statements for Defined Benefit Plans – When to Send and What to Say
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...
Continue reading…District Court Decision Reminds Plan Administrators About the ERISA Disclosure Rules
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...
Continue reading…HRA vs. FSA vs. HSA: What’s the Difference?
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...
Continue reading…Is Your Denial Letter Good Enough?
Plan administrators are engaged to administer claims on the plan’s behalf, which include determinations of eligibility and denying coverage, among other services. When a claim is denied, the plan administrator is required to provide adequate notice to the participant, among other things. The Employee Retirement Income Security Act of 1974 (“ERISA”) generally requires the notice to include the specific reasons for the denial and to provide citations to the...
Continue reading…AbbVie v. Payer Matrix Pending Litigation
Introduction: In May 2023, AbbVie, a pharmaceutical manufacturing company, filed suit against Payer Matrix, a company that provides alternate funding options for their clients, usually health plans, by way of enrolling participants in the health plan into programs aimed at providing expensive specialty medication for low income and uninsured participants. After realizing Payer Matrix’s business model, AbbVie filed suit against Payer Matrix and alleged that Payer Matrix violated, and continues...
Continue reading…Roth 401(k) Accounts
When planning for retirement, employers can offer a wide variety of investment vehicles. One such vehicle is a Roth 401(k). A Roth 401(k) operates similarly to a traditional 401(k); your employer sponsors the plan, you contribute money to the account, you choose how the money is invested, and you can begin withdrawing the money after you retire. As discussed in greater detail in the next section, the differences between...
Continue reading…Recovering Overpayments After the SECURE Act 2.0. How do Plans Proceed?
Multiemployer benefit plans are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”) and the Internal Revenue Code. The SECURE Act 2.0 (“SECURE Act”) became effective on December 29, 2022, as part of the 2023 Consolidated Appropriations Act. The law brings significant changes to the Department of Labor (“DOL”) and Internal Revenue Service (“IRS”) regulations on benefit overpayments, which occur, for example, when retirees, or their beneficiaries,...
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