Texas Court Overrules Qualified Payment Amount Assumption for Non-Contracting Claims

In December 2020, Congress passed the No Surprises Act, which, among other things, aims to end balance billing for services provided by non-contracting providers at contracting facilities and by providers of emergency services. Providers can only receive payment for these services from the Plan. Under the No Surprises Act, if a provider that does not have a contract to provide services to Plan Participants (non-contracting provider) disagrees with an...

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DOL Rules on ESG Factors

The Department of Labor (“DOL”) has issued updated guidance on fiduciary issues related to the investment of plan assets and the pendulum has swung back in the other direction. The saga began back in 2020 after the DOL published a final rule which limited the ability of fiduciaries to consider, environmental, social, and corporate governance (i.e., “ESG”) issues when making investment decisions with plan assets. Under this rule, fiduciaries...

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Plans Now Required to Cover Over-the-Counter COVID Tests

On January 10, 2022, the Biden administration suddenly announced that health plans and insurers must begin covering the cost of over-the-counter (“OTC”) COVID-19 tests by January 15, 2022. The three federal agencies mostly responsible for overseeing this process are the Departments of Health and Human Services, Treasury, and Labor (i.e., the “Joint Agencies”). Since the January 10th announcement, the Joint Agencies have released two FAQs aimed at addressing questions...

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IRS Issues Updated Retirement Plan and IRA Limits for 2022

The IRS released updated 2022 annual limits for retirement plans and Individual Retirement Accounts (“IRAs”). These limits, which are updated each year, impact all retirement plans (both defined contribution and defined benefit) and IRAs (both Traditional and Roth) and are crucial in plan administration and proper tax reporting. The following summary highlights some of the changes for 2022. Retirement Plan Limits

  2022 Limit 2021 Limit Change
Maximum...

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How Far Does Withdrawal Liability Extend? Local 705 International Brotherhood of Teamsters Pension Fund v. Pitello

Employers often ask how far withdrawal liability extends? Does it include other business entities owned by the same company? What about property those other entities own? On July 7, 2021, the Seventh Circuit decided in Local 705 International Brotherhood of Teamsters Pension Fund v. Pitello that withdrawal liability can reach affiliated trades or businesses that are under “common control” with the withdrawing employer, including any real estate owned by...

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Zirbel v. Ford Motor Company – Benefit Overpayment Decision Upheld in the Sixth Circuit

Incompetent Board of Trustees is not a defense. Benefit overpayment cases having been trending across the country. One of the latest was heard by the Sixth Circuit Court of Appeals in Ohio. In Zirbel v. Ford Motor Company, the appeals court upheld the Ford retirement plan’s decision on a benefit overpayment mistakenly paid to an ex-spouse of a participant. In this case, Donna Zirbel received a $351,000 retirement-benefits payment from...

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No Surprises Act Expands Emergency Medical Services in Two Important Ways

The No Surprises Act ushered in several changes for health and welfare plans. Much has been said about the out-of-network emergency medical charges, out-of-network charges provided at an in-network facility, and air ambulance rules. But the Act also expanded the definition of “emergency services” in two important, but subtle, ways. That definition now includes (1) services provided at a “Free Standing Emergency Department” and (2) Post-Stabilization Services. Free Standing Emergency...

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The IRS Gives Defined Benefit Plans Two New Options to Address Overpayment

Mistakes are a fact of life and administering a pension plan is no different. In fact, the average pension plan is full of landmines that can create potential problems, most notably the accuracy of plan data, benefit calculations, and accrual computations. That is why the IRS created the Employee Plans Compliance Resolution System, or “EPCRS,” to help plan sponsors proactively address and correct any mistakes or errors they encounter. Recently,...

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Protecting Plan Assets – Department of Labor Releases Cybersecurity Guidance

Are your assets properly protected? Are your firewalls up to date?  As of 2018, defined benefit and defined contribution plans hold over nine trillion dollars with of assets. However, the level of security safeguarding these assets were deemed subpar by the Department of Labor (DOL). As a result, the DOL drafted broad-reaching guidance to address issues with securing assets. On April 14, 2021, the DOL’s Employee Benefits Security Administration (ESBA)...

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U.S. Supreme Court Upholds the Affordable Care Act (Again)

Like a cat with nine lives, the Affordable Care Act has survived yet another challenge at the U.S. Supreme Court level. On a 7-2 vote, the Court rejected the latest challenge to the Affordable Care Act (“ACA”), concluding that the plaintiffs did not have standing to challenge the constitutionality of the Act. With this ruling, authored by Justice Breyer, the ACA looks secure for the foreseeable future. In the latest...

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