The No Surprises Act of 2021 and the Employee Retirement Income Security Act of 1974 (“ERISA”) § 716(f) were enacted to protect patients from unexpected medical bills and to make healthcare pricing more transparent. To achieve this goal, healthcare providers must supply patients with good faith estimates (“GFEs”) of items or services to be received. Additionally, the patient’s group health plan (“GHP”) must use the GFE to create an advance...
Continue reading…Senators Hawley and Warren Introduce a Bill to Break Up “Big Medicine.”
An unlikely duo has teamed up to craft legislation targeting pharmacy benefit managers (“PBMs”). Senators Josh Hawley (R., M.O.) and Elizabeth Warren (D., M.A.) may not agree on much, but it appears that both agree that consolidation within the pharmaceutical industry is hurting the average consumer. The bill targets vertical integration within the prescription drug industry with supporters calling it the “Glass-Steagall” of health care (referring to the 1930s-era...
Continue reading…Supreme Court to Decide Key Issue on Withdrawal Liability: What It Means for Multiemployer Pension Plans
The United States Supreme Court is set to address a pivotal issue in the world of multiemployer pension plans. In M&K Employee Solutions, LLC v. Trustees of the IAM National Pension Fund, the Court will determine whether pension plans can use actuarial assumptions adopted after an employer’s withdrawal to calculate withdrawal liability. This decision could have far-reaching implications for employers, plan sponsors, and actuaries alike, as it seeks to...
Continue reading…Minimum Essential Coverage Basics and its Effects on Multiemployer Health Plans
Several statutes and regulations, including from the Internal Revenue Code (“IRC”) and the Affordable Care Act (“ACA”), have been issued to regulate group health plans (“GHPs”) to address and ensure that minimum essential coverage (“MEC”) is offered to employees and participants. The goal of MEC is to reform and improve the availability, quality, and affordability of health insurance coverage in the United States. MEC applies to multiemployer health plans...
Continue reading…Eligible HRA Expenses
What is a Health Reimbursement Arrangement? A Health Reimbursement Arrangement (“HRA”) is an employer owned and funded plan that reimburses employees for qualified medical expenses. Any reimbursements made by an HRA are generally tax-free for the employee and tax deductible for the employer. Unused HRA funds can either roll over for use in the next year, or the employer can impose a “use it or lose it rule. ...
Continue reading…How (and When) an Ohio Court Can Vacate an Arbitration Award Understanding the Limits of Judicial Review under R.C. 2711
Ohio law gives extraordinary deference to arbitration. Once parties agree to arbitrate, they agree to accept the arbitrator’s interpretation of both the facts and the contract. Courts are not “super-arbitrators,” and the circumstances in which a judge can undo an award are deliberately narrow. Why the Bar Is So High Arbitration is designed to bring disputes to a final and binding conclusion without the time, cost, and unpredictability of litigation. That...
Continue reading…When is Spousal Consent Required?
Under ERISA, “spousal consent” is needed when participant in a defined benefit (“DB”) or a defined contribution (“DC”) plan wants to make an election that would adversely affect the married participant’s rights. For example, a Participant will often need a spouse’s consent to waive an annuity form of payment and instead receive a lump-sum payment. To give “consent” the non-participant spouse must execute a waiver that satisfies IRS rules...
Continue reading…New Roth Catch-up Rules for High Earners Set to Take Effect
Defined Contribution plans can allow employees age 50 or older to make “catch-up contributions,” which are additional elective deferrals beyond the annual limit. The purpose is to allow those close to retirement to stash away extra money just before they cease working. Like all other elective deferrals, these extra contributions are made on a pre-tax basis. However, the SECURE Act 2.0 made two major changes to these rules. First, participants...
Continue reading…Searching for Missing Participants: Duties and Best Practices
Under the Employee Retirement Income Security Act of 1974 (“ERISA”) multiemployer retirement plan fiduciaries must make reasonable efforts - under the duties of prudence and loyalty - to locate missing participants entitled to benefits from Defined Benefit (“DB”) and Defined Contribution (“DC”) retirement plans. Multiemployer plans often face challenges due to increased participant mobility. To assist plan fiduciaries in meeting their obligations, the Department of Labor (“DOL”) and the...
Continue reading…ACA Preventive Care List – Updated Coverage Requirement and Surviving a Supreme Court Challenge
It was an eventful month for a portion of the Affordable Care Act’s (“ACA”) that is rarely in the news. However, the ACA’s preventive care list was a recent news topic for two separate reasons. First, the agencies responsible for overseeing and updating the preventive care list added four new types of screenings to the list. Second, on June 27, 2025, the U.S. Supreme Court issued an opinion upholding...
Continue reading…