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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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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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...

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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...

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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...

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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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