Flexible Spending Account Relief Adopted by the IRS in 2020 Extended Under the Consolidated Appropriations Act of 2021

Flexible Spending Account Relief Adopted by the IRS in 2020 Extended Under the Consolidated Appropriations Act of 2021 The Consolidated Appropriations Act of 2021 (“CAA”) extended the relief provided to health care and dependent care flexible spending accounts under IRS Notice 2020-29 for the 2021 and, in some cases, 2022 Plan Years. This relief was largely expected and essentially extended the rules provided by the IRS under IRS Notice 2020-29....

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Congress Finally Tackles “Surprise” Out-of-Network Medical Billing & Also Adds New Rx Benefit Reporting Requirements

The Consolidated Appropriations Act of 2021 (the “Appropriations Act”) that was recently signed into law on December 28, 2020 by President Trump is mostly famous for two things: (1) it extended unemployment benefits and rental assistance for those impacted by the COVID-19 pandemic and (2) it provides a second round of stimulus payments to most Americans, though less then the earlier payments issued under the CARES Act. However, the Appropriations...

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Close Counts in Horseshoes & Hand Grenades: But Not ERISA

ERISA is full of statutory deadlines, includes those related to disclosing Summary Plan Descriptions, changes enacted through Plan Amendments, required financial information, and governmental filings. Perhaps none of those deadlines is more critical than those related to the claims and appeals rules. Participants that are denied benefits are likely to sue. And as shown in the case of Fessenden v. Reliance Standard Life Insurance Co and Oracle USA, Inc.,...

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Department of Labor Dials Back ESG Investing Regulations

The Department of Labor has issued its final rules on the investment duties of fiduciaries under the Employee Retirement Income Security Act (“ERISA”). These rules differed from the proposed rules issued over the summer which required additional responsibility for retirement plans who wanted to consider environmental, social, or governance factors in their investing (known as “ESG” investments). This is of particular concern to Taft-Hartley Plans, who often include investment...

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Public Employees and the Use of Social Media

Are political posts shared on social medical by Ohio public employees protected speech under the law? In short, it is unclear. The answer ultimately depends on how the activity is categorized under the Ohio Administrative Code (“OAC”). OAC section 123:1-46-02 separates protected (subsection B) and prohibited (subsection C) political activities. Although government employees do not completely forfeit their First Amendment rights at work, their employers can impose restrictions that...

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Insurance 101 – Understanding the Nuts and Bolts of Your Health Plan

Health insurance is a complex and confusing topic; one that most people are reluctant to approach. This is especially true for trustees and administrator who must understand their own plan design, how that design differs from other available options, and be prepared to answer questions from participants and beneficiaries. In this installment, we will discuss the ins-and-outs of deductibles. Most participants understand that a deductible is the amount of money...

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Cross-Plan Offsetting: What Health & Welfare Plans Must Know

Cross-plan offsetting is becoming increasingly problematic and has become the subject of litigation. This practice involves a network provider shorting one out-of-network claim to make up for an overpayment made to the same provider on services to a different participant in a different plan! The United States Court of Appeals for the Eighth addressed this issue in Peterson v. UnitedHealth Group, Inc., 913 F.3d 769 (2019). The case was...

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Defined Benefit Plan Participants Must Have “Standing” to Sue Plan Fiduciaries

Can a participant in a defined benefit plan sue the plan’s fiduciaries under ERISA without first showing an individual financial loss or an imminent risk of such harm? The Supreme Court of the United States recently decided the question in the negative, holding a participant must have “standing” to bring suit. That means the participant must show that he or she suffered an actual injury or have...

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Abuse of Discretion – ERISA’s Standard of Review You Do Not Want to Lose

When a court reviews the decision of an ERISA plan (both health and welfare and pension plans), it must first determine the standard of review: abuse of discretion or de novo. Under an abuse of discretion standard, the court gives the plan’s sponsor (or trustees) more deference and looks at whether the decision was reasonable under the plan’s terms and available evidence. The court will also pay...

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How many Non-Bargaining Employees is Too Many?

A Multiemployer Plan under the Employee Retirement Income Security Act (“ERISA”) is a plan in which one or more employers contribute, is maintained pursuant to one or more collective bargaining agreements between one or more employee organizations and one or employer, and satisfies other requirements set forth by the United States Department of Labor. However, and despite this definition, you will often find non-bargaining employees covered under...

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