The Internal Revenue Service and U.S. Departments of Health and Human Services and Labor recently issued guidance on the Affordable Care Act employer mandate and market reforms. Notice 2015-87 contains 26 FAQs that clarify the application of market reforms to health reimbursement arrangements and employer payment plans and the affordability of employer-sponsored health coverage, among other topics.
The U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) recently issued new guidance regarding the intended timeframe for the use of the new summary of benefits and coverage (SBC) template and instructions, an updated uniform glossary and other associated materials.
Background
The Affordable Care Act (ACA) generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide an SBC to participants and beneficiaries. The Departments issued revised final regulations governing the SBC requirement on June 16, 2015, and published a proposed new SBC template on February 26, 2016. Comments on the proposed template and associated documents are due by March 28, 2016.
On December 4, 2015, President Obama signed the Fixing America’s Surface Transportation Act (FAST Act). In addition to authorizing $305 billion in funding for federal highway projects, the FAST Act also repeals the recently enacted extension to the Form 5500 filing deadline included in the Surface Transportation and Veterans Health Care Choice Improvement Act (Surface Transportation Act).
On January 25, 2016, the Supreme Court of the United States issued a per curiam opinion in Amgen Inc. v. Harris, holding that the Amgen, Inc. employees who filed suit after the value of the employer stock in which they had invested dramatically decreased, failed to sufficiently plead a breach of fiduciary duty claim under ERISA in light of the Court’s decision last term in Fifth Third Bancorp v. Dudenhoeffer.
The U.S. Department of Labor recently published proposed revisions to the template and related materials for the summary of benefits and coverage (SBC) and the Uniform Glossary. These documents are required to be provided to plan participants under the Affordable Care Act (ACA).
See our articles Additional Guidance Issued on Summary of Benefits and Coverage Disclosure Requirements and Summary of Benefits and Coverage Disclosure Requirements for more details on the SBC.
The Internal Revenue Service recently updated Publication 969. This publication is used by individuals for preparing tax returns when they participate in HSAs, HRAs, health FSAs, Archer MSAs and Medicare Advantage MSAs.
Compliance with the Affordable Care Act (ACA) has resulted in increased health benefit costs for many employers. A recent court decision demonstrates that while programs to reduce the number of full-time employees may lower health care costs in the short run, they also may lead to ERISA class action litigation. In Marin v. Dave and Buster’s, a federal district judge in the Southern District of New York denied a motion to dismiss a class action lawsuit claiming that the Dave and Buster’s amusement chain violated ERISA by cutting employee hours to avoid providing health care benefits to a class of employees.
The Internal Revenue Service (IRS) recently issued Notice 2015-86, which provides some additional clarification, in the form of questions and answers, on the treatment of same-sex spouses under tax-qualified retirement plans and health and welfare plans, including cafeteria plans, as a result of the June 26, 2015, decision from the Supreme Court of the United States in Obergefell v. Hodges.
The Supreme Court of the United States’ recent ruling in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan holds that an ERISA plan cannot enforce an equitable lien against a participant’s general assets when the full amount of the settlement is spent on non-traceable items. This decision should encourage plan fiduciaries to take action on reimbursement and subrogation rights more quickly after learning of a third-party recovery, in order to preserve their right to assert an equitable remedy against an identifiable, traceable fund.
On December 30, 2015, a federal judge in the Western District of Wisconsin ruled in favor of Flambeau, Inc. and against the Equal Employment Opportunity Commission (EEOC) in holding that Flambeau’s medical exams as part of its wellness program and self-insured medical plan did not violate the Americans with Disabilities Act (ADA).
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