ERISA Compliance for Health & Welfare Plans
Abrogating Precedent, Fourth Circuit Narrows Equitable Remedies for Fiduciary Breach
A 27-year-old who needed a heart transplant requested approval of the procedure from his employer’s self-insured health plan. After the plan denied his request and subsequent appeals, he died—shortly before an external reviewer overturned the claim denials. The participant’s mother (acting on behalf of his estate) sued the employer, plan,…
Rose v. PSA Airlines, Inc., 2023 WL 5839282 (4th Cir. 2023)
Available at https://www.ca4.uscourts.gov/opinions/212207.p.pdf
Health Care Reform
IRS Announces Annual PCOR Fee Adjustment
The IRS has announced the annual increase in Patient-Centered Outcomes Research (PCOR) fees that must be paid by health insurers and self-insured health plan sponsors. PCOR fees were established by the Affordable Care Act (ACA) and are used to support clinical effectiveness research. Because the ACA provision included an expiration…
IRS Notice 2023-70 (Oct. 18, 2023)
Available at https://www.irs.gov/pub/irs-drop/n-23-70.pdf
Final Forms and Instructions for IRS’s 2023 ACA Reporting Available
The IRS has released final forms and instructions for Affordable Care Act (ACA) information reporting for 2023. As a reminder, Forms 1094-B and 1095-B are filed by minimum essential coverage providers (such as health insurers and employers sponsoring self-insured health plans) to report coverage information in accordance with Code…
2023 Forms 1094-B, 1095-B, 1094-C, and 1095-C; 2023 Instructions for Forms 1094-B and 1095-B; 2023 Instructions for Forms 1094-C and 1095-C
Question of the Week
Can We Use a “Sampling” Approach to Reviewing Claims Under Our Health FSA and DCAP?
QUESTION: Do we need to review every claim that is submitted under our cafeteria plan’s health FSA and DCAP before providing reimbursement? We do this now, but we could save time and administrative costs by automatically reimbursing claims for very small dollar amounts without review, or by reviewing only…
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