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About This Blog

Bloomberg BNA's Pension & Benefits Blog is a special resource offered by Bloomberg BNA to provide commentary and insight on news and trends reported in our publications: Pension & Benefits Daily, Pension & Benefits Reporter, and the Benefits Practice Resource Center. The authors of the blog are members of our Benefits Practice Resource Advisory Board and members of staff (who contribute summaries of some of their recent stories). 

The ideas presented here are those of individuals, and Bloomberg BNA bears no responsibility for the appropriateness or accuracy of the communications between group members. We reserve the right not to post comments that are abusive or otherwise objectionable.

Communications regarding the Pension & Benefits Blog may be directed to Dana Domone via e-mail to ddomone@bna.com.

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Category : Health Benefits


February 26, 2014

Guidance on ACA 90-Day Waiting Periods Issued in Tri-Agency Final, Proposed Rules

Group health plans or health insurance issuers offering group health insurance coverage can't apply a waiting period that exceeds 90 days for individuals to be eligible for benefits coverage under terms of their plans, according to new final regulations under the Affordable Care Act and released jointly by three federal agencies.          

December 27, 2013

IRS, DOL, HHS Propose to Expand Types of Excepted Benefits Under ACA

The Departments of Treasury, Labor, and Health and Human Services issued proposed rules (REG-143172-13; RIN 1210-AB60; CMS-9946-P) that would amend the regulations on excepted benefits regarding vision and dental benefits, as well as employee assistance programs.   

December 20, 2013

IRS Issues Guidance on Application Of Windsor Decision on FSAs, HSAs

Cafeteria plans can permit midyear election changes for plan participants who were legally married to same-sex spouses as of June 26, the date of the U.S. Supreme Court's decision in United States v. Windsor, the Internal Revenue Service said in Notice 2014–1, issued Dec. 16.

November 21, 2013

Fourth Circuit: No Deferential Review Despite Plan's ‘Satisfactory to Us' Language

Language in a Prudential Insurance Co. of America disability policy requiring claimants to submit proof of disability that is “satisfactory to Prudential” didn't constitute an unambiguous grant of discretionary authority that would entitle Prudential to deferential judicial review of an adverse benefit determination, the U.S. Court of Appeals for the Fourth Circuit ruled.  

November 13, 2013

Treasury Tackling Final Issues Under the ACA, Agency Official Says

  The Treasury Department is hammering out final issues with Affordable Care Act compliance, from employer reporting requirements to health insurer fees, and should have some guidance out soon, Treasury's benefits tax counsel said.

November 8, 2013

IRS Not Out to Trap Employers That Make Plan Adjustments Post-Windsor, Official Says

The Internal Revenue Service and Treasury Department expect to get guidance out to cafeteria plans “very, very soon” on the retroactive application of the Supreme Court's Windsor decision, a Treasury official said.

October 23, 2013

HRA Guidance Tied Employers' Hands, Has Some Re-Examining Plans, Attorneys Say

Employers hoping to offer health reimbursement arrangements to employees to give them money to spend on the Affordable Care Act health insurance marketplaces have found their hands tied following guidance issued Sept. 13 by the Internal Revenue Service and the Department of Labor, attorneys said during a session of the Groom Law Group's Employee Benefits Seminar.

October 1, 2013

Should Employers Pay or Play? Podcast by Littler Mendelson Attorneys Steven Friedman and Ilyse Schuman

Podcast (stream or download) by Steven Friedman and Ilyse Schuman: On Oct. 1, the Affordable Care Act marketplaces open for business. Then, starting in 2015, employers have a choice of whether to “pay or play,”-- to provide health care coverage or pay a penalty.

March 21, 2012

Summary of Benefit Coverage Rules – The Devil is in the Details

During the February 28, 2012 ALI-ABA Video Broadcast program on Health Plans some representatives from the government provided us with their personal insights on how the Summary of Benefits and Coverage (“SBC”) rules and templates should operate. Earlier this week the DoL posted FAQ VIII on its ACA website regarding the SBC that provided additional flexibility for employers.  This is just a highlight of some of the important information learned during such program and from FAQ VIII.  

July 14, 2011

PPACA--A Poison Pill for State Budgets?

For many states, the fastest increasing budget item is Medicaid. In states like Utah, Medicaid in a matter of years will become the largest single budget item, surpassing education which for decades has been the state’s largest expenditure.  Other states are in a similar position. At a recent meeting of the National Governors Association, CNN reported that Governors have proposed spending $15.9 billion more in fiscal 2012 on Medicaid than in fiscal 2011 and at the same time are slashing higher education by $5 billion and K-12 education by $2.5 billion.

September 14, 2010

Non-Discrimination in Insured Health Care Plans, No More Executive Health Benefit Plans?

The provision of the PPACA is deceptively simple: "A group health plan (other than a self insured plan) shall satisfy the requirements of section 105(h)(2) of the Internal Revenue Code of 1986 (relating to prohibition on discrimination in favor of highly compensated individuals)." *** "Rules similar [my emphasis] to the rules contained in paragraphs (3),(4) and (8) of section 105(h) of such Code shall apply."

September 10, 2010

Essential Health Benefits Include . . .

Health reform has many employers stretched to try to meet all of the requirements applicable for the first plan year beginning on or after Sept. 23, 2010. One of the many difficulties faced by employers is determining what constitutes an essential health benefit on which there can be no annual or lifetime dollar limits on the value of benefits.

July 29, 2010

PPACA's Impact on Claim and Appeal Procedures

PPACA imposes new requirements on both insured and self-insured plans regarding their claim and appeal procedures, including a new requirement for an external appeal. The Departments of Labor, Treasury and HHS jointly issued interim final regulations on July 23 providing guidance on the new requirements (140 PBD, 7/23/10).

June 1, 2010

The New VEBAs

The VEBA Trust has three separate accounts, each holding assets transferred or to be transferred by one of the respective companies and was, at its inception on January 1, 2010, one of the nation’s largest health care operations.

April 8, 2010

The Fiduciary Decision to Choose the ERISA Plan Auditor

Since many ERISA plans are in the process of preparing their audited financials for the 2009 Form 5500, this is a good time to to reflect on the nature and responsibilities that the plan administrator has in connection with the audit process. (As chair of the Audit Subcommittee for the committee that is the plan sponsor and plan administrator of the Goodyear Retiree VEBA, I had to think through these issues for our plan.)

June 2, 2009

A Modest Proposal Regarding Same-Sex Marriage

It is not being controversial to say that there is a trend in the states in favor of permitting same-sex marriage.  Previously, a broad array of employers had begun provide benefits for their employees' domestic partners.  See generally Libert, Oringer & Raskin, "Same-Sex Marriage and Employee Benefits: The Approaching Revolution," 63 Empl. Ben. Plan Rev. 22.

December 12, 2008

Automakers' Insolvency Opens All the Benefit Cutback Targets and Problems

The insolvency (whether or not in Chapter 11 reorganization) of the three automakers brings “legacy costs” back to the center stage of ERISA cutback negotiation and litigation.

September 30, 2008

9th Circuit Holds San Francisco Ordinance Not Preempted: Is There a Conflict in the Circuits?

Today's decision on the merits by the 9th Circuit in the Golden Gate Restaurant Association v. San Francisco case upholding the employer spending requirements of the San Francisco ordinance as not preempted by ERISA is a most interesting read.

September 8, 2008

Looking Back, Looking Forward

While December is when most of us look back on the year coming to end and make plans and resolutions for the year about to begin, September is another one of those times for me. After all, it’s an important month in its own right—the start of the academic year (even if classes now begin in August), the official beginning of the race in election years like this one, the unofficial end of summer with Labor Day and lest we forget, the anniversary of ERISA’s passage.