Health & Welfare Plans

Jackson Walker employee benefits and executive compensation attorneys regularly advise and strategize with employers on the creation, administration, and cost-containing strategies related to maintenance of health and welfare plans and programs. We advise clients on various alternatives for complying with statutory and regulatory requirements, such as those under Health Care Reform, COBRA, HIPAA, GINA, and the Mental Health Parity and Addiction Equity Act. We counsel clients regarding new tools and strategies available such as individual coverage health care reimbursement arrangements and ways to de-risk benefits to avoid financial statement fluctuations. We also work with clients on how to design health and welfare plans and programs that will provide the most relevant benefits to the applicable workforce or segments of the workforce in the most cost-effective way for the employer, considering the applicable legal constraints.

In addition to helping clients comply with the law, we regularly assist clients with handling errors like HIPAA privacy issues and security breaches when they occur. We assist clients in review and negotiation of various administrative services agreements, direct contracting with health care providers, stop-loss insurance arrangement agreements, pharmacy benefit manager agreements, and other contracts related to the provision of health and welfare benefits. We also address benefit claims that often arise under these plans, and navigate our clients through ERISA claims procedures. Finally, we represent clients in investigations, audits, and other interactions with the U.S. Department of Labor, the Internal Revenue Service, inquiries from the Center for Medicare and Medicaid Services on Medicare Secondary Payer and other Medicare related issues and with other federal and state agencies.

Health and welfare benefits vary widely from one employer to another; however, we regularly assist clients with the following benefits:

  • Group health benefits
  • Health reimbursement arrangements including Individual Coverage Health Reimbursement Arrangements
  • Voluntary employees’ beneficiary associations
  • Long term disability benefit plans
  • Multiple employer welfare associations
  • Retiree health benefits
  • Telemedicine
  • Direct contracting with health care providers, specialty pharmacies and other service providers
  • Employee assistance plans
  • Dental and vision insurance plans
  • Life and accidental death & dismemberment insurance
  • Short-term and long-term disability insurance
  • Vacation and holiday policies
  • Wellness programs and related incentives
  • On-site medical clinics and daycare
  • Education assistance plans in a variety of forms
  • Adoption assistance plans
  • “Wrap” plans for consolidation of reporting requirements
  • Section 125 (cafeteria or flexible benefit) plans
  • Flexible spending accounts (medical and dependent care) and health savings accounts
  • Commuter benefits
  • Severance benefits, including outplacement services
  • Designed health plans for large private employer using multiple service providers, including direct contracting with health care providers to provide benefits in a cost effective manner
  • Negotiated with collective bargaining units regarding health benefits outsourcing and retiree medical benefits
  • Advised clients regarding handling of demutualization proceeds
  • Collaborated with clients regarding transition to defined contribution retiree medical benefits structure, including employee communications, nondiscrimination issues, VEBA issues and contracting for necessary services
  • Collaborated with clients regarding moving from self -insured long term disability plans to a fully-insured arrangement and through de-risking of self-insured long term disability plans to reduce benefit obligations
  • Developed streamlined approach for HIPAA Privacy and Security compliance
  • Counseled publicly-traded company through impact of spin-off on its various health and welfare benefits, including analyzing contract issues and separating benefits plans
  • Negotiated health plan administrative services agreements with major carriers saving employers significant costs and addressing practices challenged in pending litigation
  • Represented large employer through IRS team audit of all benefit plans, including health and welfare and cafeteria plan
  • Negotiated with Center for Medicare and Medicaid Services related to Medicare Secondary Payor claims and claim processing issues
  • Represented large publicly-traded employer through U.S. Department of Labor audits of health plans
  • Conducted an internal audit of large restaurant chain’s health and welfare plans and programs, identifying duplicative coverages and cost-savings measures
  • Reviewed and negotiated administrative services agreements and broker agreements for cost savings to employers