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...
Continue reading…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...
Continue reading…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...
Continue reading…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...
Continue reading…Why Beneficiary Forms are Not Static
Filing out a beneficiary designation form seems like a simple task. And in all honesty, it is; you simply list the name of the person or persons you want to inherit the account, designate percentages, make sure they add up to 100%, and then sign and date the form. However, getting this message across to participants is different story. And any plan administrator or trustee of a...
Continue reading…Are PCORI fees refundable?
By now, I am sure you have heard or read that the Supreme Court of the United States has recently agreed to revisit the Affordable Care Act to determine its constitutionality. If you have not, the Court agreed to hear the case of California, et al., Petitioners v. Texas, et al., No. 19-840 to determine whether the Patient Protection and Affordable Care Act...
Continue reading…Defined Benefit Plans & Collecting Overpayments
Richardson vs. IBEW Pacific Coast Pension Fund - District Court bars a pension plan from recovering overpayments made as a result a benefit miscalculation Anyone that works with defined benefit pensions plans, whether it be as an administrator, fund counsel, trustee, or actuary, knows just how complicated these plans can be. And like any complicated task, mistakes and errors occur in the administration of a defined...
Continue reading…New Model COBRA Notices, Emergency Regulations, & Considerations for Health & Welfare Plans
In May of 2020, the Department of Labor (DOL) issued two separate pieces of guidance that both affect how health & welfare plans comply with the COBRA regulations. First, the DOL updated the model COBRA notices that must be provided to participants when they enroll and when they experience a “qualifying event.” Second, and in response to the COVID-19 pandemic, the DOL issued emergency regulations that extends...
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Are Quarterly Board of Trustee Meetings Enough?
The majority of all multiemployer employee benefit plans are managed by a Board of Trustees, comprised of an equal number of members from the applicable Union(s) and representatives from Employers who employee union members. Such Trustees are charged with significant responsibilities that range from overseeing the delegated administrator of their employee benefit plans, monitoring the collection of plan contributions to eligibility for and approval of all types of plan...
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Group Health Plan’s Residential Treatment Exclusion Violates Mental Health Parity Requirements
The Mental Health Parity Act (“MHPA”) was enacted in 1996. The principal goal of MHPA was to bring parity to the treatment of mental health disorders by imposing the same aggregate lifetime and annual dollar limits for mental health benefits as for medical and surgical benefits. In Munnelly v. Fordham Univ. Faculty and Admin. HMO Ins. Plan, 2018 WL 1628839 (S.D.N.Y. 2018), the application of this goal was tested...
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