Welfare Benefit Plan ERISA News
March 2016

Under the ACA, Are Employees Receiving Short-Term or Long-Term Disability Benefits Still Considered
Full-Time Employees?
Long-Term Disability"For purposes of calculating hours of service, an individual receiving payments from a short-term disability (STD) or long-term disability (LTD) arrangement might be treated as a full-time employee. Two of the determining factors are whether the recipient of disability payments retains his or her status as an employee and who paid for the disability arrangement. However, hours of service will only result from disability payments made to a person who has not terminated employment with the employer." (Graydon Head & Ritchey LLP)
Employers: Be Prepared to Respond to Exchange Notices of ACA-Subsidized Employees
"Beginning in spring 2016, the Affordable Care Act (ACA) Exchanges will begin to send notices to employers whose employees have received government-subsidized health insurance through the Exchanges...

Although CMS has provided these guidelines to apply only to the Federal Exchange, it is likely that the state-based Exchanges will have similar notification programs. Employers should be prepared in advance by developing a process for handling the Exchange notices, including appealing any incorrect information that an employee may have provided to the Exchange. Advance preparation will enable you to respond to the notice promptly and help to avoid potential employer penalties." (Marsh Consulting Group)

HIPAA Phase 2 Audits Include
Business Associates (BAs)

HIPPA Compliance Audit"BA services include claims processing or administration, data analysis, billing and benefit management. Service providers can include third-party administrators, accountants, attorneys, consultants, cloud data storage companies, and pharmacy benefits managers ... Here's a closer look at Phase 1 and Phase 2 audits and the background information you'll need to prepare for a possible audit." (International Foundation of Employee Benefit Plans [IFEBP])

'Where's My 1095?' – Addressing Tax Filing Confusion

"Many employees had been told that they would need these forms to prepare their 2015 income taxes. Many even believed, incorrectly, that Form 1095s were to be filed with their tax returns, along with their Form W-2s... Employers, therefore, should inform workers to expect these forms by March 31, and assure them they may go ahead and file their taxes -- and collect any refunds that may be coming their way -- without waiting until the form is in their hands." (Society for Human Resource Management [SHRM])

Importance of Carefully-Drafted
Provider Assignment Clauses

Carefully-Drafted Provider Assignment Clauses"As ERISA payor-provider litigation increases, ... insurers have frequently challenged the scope of patient assignments, requiring courts to analyze the assignments and determine whether they are sufficiently drafted to confer derivative standing on the provider to assert ERISA claims. The United States District Court for the Southern District of Florida (the "Court") recently addressed this issue.... While the assignment conferred the provider the right to collect benefits stemming from a 'collateral source,' the 'core focus' of the assignment was on the assignee's ability to recover benefits 'owed under any policy of insurance' and to pursue any rights to collect from the insurance company if for any reason the 'insurance company fails to make payments due.' Because a self-funded plan is not a form of insurance, the Court granted Cigna's motion to dismiss with respect to those claims. This decision is the latest in a number of cases in which a healthcare provider's ability to bring ERISA claims against insurers has turned on the language of the assignment, further underscoring the importance of careful drafting of those provisions." [BioHealth Medical Laboratory, Inc. et al. v. Conn. Gen. Life Ins. Co., No. 1:15-cv-23075 (S.D. Fla. Feb. 1, 2016)] (K&L Gates LLP)
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© 2017 ERISAPros, LLC, All rights reserved. Information on ERISAPros' website, its newsletter, “News & Views,” and its blog, “ERISA Wonk,” is published as a general informational source. Information and articles are general in nature and are not intended to constitute legal or tax advice in any particular matter. Blog posts and comments reflect the personal views of their respective authors - not those of ERISAPros. Transmission of this information does not create an attorney-client relationship. ERISAPros, LLC is not a law firm and is not giving legal or tax advice. It does not warrant and is not responsible for errors or omissions in the content on its website or in its newsletters. ERISA is a complicated and confusing law. Summary Plan Descriptions (SPDs), Wrap Plan Documents, and Form 5500s require review and updating by qualified ERISA compliance professionals.


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