Under ERISA, a plaintiff must file a lawsuit within six years of an alleged breach of fiduciary duty, or within three years if the plaintiff had “actual knowledge” of the breach. There has been a longstanding split among the circuits regarding what constitutes “actual knowledge” for purposes of determining whether ERISA’s three-year limitations period should apply. On February 26, 2020, the Supreme Court settled this issue in Intel Corp. Investment Policy Committee v. Sulyma, 140 S. Ct. 768 (2020). 
Continue Reading Actual Knowledge under the Supreme Court’s Intel Decision: Can the DOL’s New Electronic Disclosure Regulations Bridge the Divide?

On May 14, 2020, the Department of Health and Human Services issued a final rule stating that group health plans, including employer-sponsored health plans, are not required to count the value of drug manufacturer coupons toward participant deductibles and out-of-pocket maximums.  The Final Rule, published in HHS’s Notice of Benefit and Payment Parameters for 2021, allows group health plans to exclude the value of drug manufacturer coupons from participant annual cost-sharing amounts even where no medically appropriate generic drug is available. 
Continue Reading HHS Rule is Good News for Prescription Drug Accumulator Programs

The IRS has issued final regulations amending the hardship distribution rules for qualified retirement plans, including 401(k) and 403(b) plans, as well as for 457(b) plans. The final regulations are substantially similar to the proposed regulations that were issued in November 2018, but provide a few clarifications.  Plans that have been complying with the proposed regulations will satisfy the final regulations.
Continue Reading IRS Issues Final Regulations Relaxing 401(k) Hardship Distribution Rules

For at least one more year, health plans, including employer-sponsored plans, will be able to exclude the value of drug manufacturer discounts from participant deductibles and out-of-pocket maximums, even where no medically appropriate generic drug is available. 
Continue Reading Government Hits Pause on HHS Prescription Drug Rule Set to Take Effect January 1, 2020

The IRS recently updated the FAQs on its website regarding the employer mandate to provide some details on the process it will use to impose penalties for failure to provide coverage to “ACA full-time” employees (those working 30 or more hours per week) in accordance with Section 4980H of the Code (often referred to as the “employer mandate”).
Continue Reading IRS Indicates That Employer Mandate Penalty Letters Are Coming Soon

On May 4, the House of Representatives passed the American Health Care Act, which is aimed at repealing and replacing portions of the Affordable Care Act. While many of the changes do not affect employer-sponsored coverage, there are several changes in the bill that are likely to be of interest to employers.
Continue Reading The American Health Care Act: What It May Mean for Employers

The IRS has issued final versions of Forms 1095-C and 1094-C as well as updated final instructions on completing these forms. While the instructions and forms remain similar to those used last year, there are a few key changes worth noting.
Continue Reading ACA Update: IRS Issues Final Versions of 2016 Forms 1094-C and 1095-C and Instructions

Earlier this year, the Department of Health and Human Services Office of Civil Rights published final rules implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability by healthcare providers and group health plans that receive federal financial assistance. The rules include restrictions on discrimination relating to gender identity, as well as requirements regarding accessibility for individuals with limited English and with disabilities.
Continue Reading ACA Update: New HHS Nondiscrimination Rules Applicable to Certain Employee Health Plans