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Illinois Imposes Group Health Coverage Disclosure Requirements

"The Illinois Consumer Coverage Disclosure Act, which went into effect on August 27, 2021, requires an employer to notify employees in Illinois who are eligible for its group health plan whether such plan does or does not cover each of the essential health benefits identified by the Illinois [DOL].... Because this is a disclosure requirement and not a benefits mandate, the Illinois DOL maintains that this requirement also applies to self-funded group health plans regulated by ERISA."

Do You Have California Employees? Action Required by January 1, 2015 to Comply with California's New Paid Sick Leave Law

"The law treats accrual and use differently. Although employees begin to accrue paid sick leave immediately, employers may prevent employees from using their paid sick leave until the 90th day of employment. Employers may also cap the use of paid sick leave to 24 hours (3 days) per year. In other words, although a full-time employee could theoretically accrue a maximum of up to 8.6 paid sick days per year (or 6 days if the employer sets an accrual cap), the employer may cap the employee's use of that time to 3 days per year. Employers may also establish minimum usage blocks of up to 2 hours."

Which Plans are Subject to the DOL's Final Rules for Disability Claims Procedures?

"The DOL noted that nearly two-thirds of all ERISA litigation involves claims under long-term disability plans, and the final rules are intended to improve the 'full and fair review' of disability claims ... by expanding the procedural requirements.... In order for the new rules to apply, both of the following must be true: [1] the plan must make disability determinations affecting plan benefits; and [2] the plan must be subject to ERISA's claims procedures."

Network Providers May Be Entitled to ERISA Claims Procedures When Overpaid Claims are Recouped

"Although the scope of this decision is not clear, or whether it is an aberration, the court's opinion indicates that provisions in a plan document that provide for in-network claims to be paid directly to providers may afford such providers with 'beneficiary' status under ERISA, thus requiring the plan to follow ERISA's notice and appeals procedures when seeking to recover overpayments made to such providers. A plan sponsor should consider adding language to the plan to preclude this type of claim." [Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, No. 09 C 5619 (N.D. Ill. Mar. 28, 2014)]

Recent Ruling Highlights Importance of ERISA Document Disclosures

"A recent federal district court decision highlights the importance of making sure all necessary information has been disclosed, which may be more than just the summary plan description or underlying plan document.... [P]lan sponsors should consider incorporating certain details of plan administration, such as the delegation of claims administration and decision-making duties, into the governing plan document and summary plan description." [M.S., L.S., and C.J.S. v. Premera Blue Cross, Microsoft Corp., and the Microsoft Corp. Welfare Plan, No. 19-199 (D. Utah Aug. 10, 2021)]

Reminder: Employer Obligations Regarding Employee Life Insurance Coverage

"[Two recent court cases remind employers to] ensure their plan documents, summary plan descriptions, and other benefit descriptions accurately reflect life insurance coverage provisions, especially for provisions on continued eligibility during a leave of absence and when coverage ends after termination of employment, and confirm who is responsible for sending conversion notices when coverage is lost."

Blanket Release Might Not Protect Against All ERISA Claims

"Because the employer did not deny the life insurance coverage until after the release was executed, the court held the employee's ERISA claim was not within the scope of the release and denied the employer's motion to dismiss." [Anastos v. IKEA Property, Inc., No. 19-3702 (N.D. Ga. Mar. 17, 2021)]

Annual Reporting and IRS Filing for ISO Exercises and ESPP Stock Transfers

"For ISO exercises and ESPP transfers occurring in calendar year 2019, companies must file the applicable forms with the IRS no later than February 28, 2020 for paper filers, and no later than April 1, 2020 for electronic filers ... Companies must also provide the employees (or former employees) the information statements (Copy B of the applicable form) no later than January 31, 2020."

Puerto Rico Treasury Announces Qualified Retirement Plan Limits for 2017

"For plans qualified in Puerto Rico and for those plans dual qualified in the United States and Puerto Rico, only the limits on annual benefits, annual contributions, and plan compensation have changed for 2017."

IRS Releases Final Instructions for Forms 1094-B/1095-B and 1094-C/1095-C

"The IRS recently released final instructions for the 2016 Forms 1094 and 1095.... While a few of the items are 'neutral' and merely reflect pre-programmed changes under the [ACA] that were already known and set to occur, many of the changes and clarifications are welcome news."