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
- 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
July 22, 2021
Guidance Reminds Health Plans to Check Up on Preventive Care Compliance
By Greta Cowart
On July 19, 2021, the Internal Revenue Service, U.S. Department of Labor, and the U.S. Department of Health and Human Services issued new frequently asked questions (FAQs) regarding the implementation of the Affordable Care Act that provide plans and issuers with enforcement relief until September 17, 2021.
June 17, 2021
What the Supreme Court’s Ruling on the Affordable Care Act Means for Employers
By Greta Cowart
In a 7-2 vote, the U.S. Supreme Court on June 17, 2021, decided that Texas and the other states challenging the Patient Protection and Affordable Care Act (ACA) did not have standing to challenge the ACA as they lacked an injury in fact. While the analysis of standing is an important issue for lawyers to debate, the importance of this decision for employers to take away is that the ACA is still the law.
May 24, 2021
American Rescue Plan Act’s COBRA Premium Assistance – A New Ball Game and New Rules
By Greta Cowart
The IRS has provided additional guidance on the the American Rescue Plan Act’s COBRA premium assistance. This article summarizes the top 10 takeaways of Notice 2021-31 specifically related to group health plans subject to federal COBRA.
May 10, 2021
The American Rescue Plan Act’s COBRA Subsidy – Déjà Vu But Different: Considering the Guidance Issued Through April 30, 2021
In the Bloomberg BNA Tax Management Compensation Planning Journal, Greta Cowart authored an article on the American Rescue Plan Act’s COBRA subsidy.
April 7, 2021
COBRA Subsidy Forms and Guidance Issued
By Greta Cowart | The Employee Benefits Security Administration has released the Model COBRA Subsidy forms mandated under the American Rescue Plan Act (ARPA), including four new model forms and an alternative form. In addition, the EBSA issued sets of FAQs for employers, workers, and their families.
March 15, 2021
How the American Rescue Plan Act Affects COBRA Health Coverage
~5 minutes | Signed into law on March 11, 2021, the American Rescue Plan Act of 2021 affects a number of issues surrounding employer-provided health coverage. ERISA partner Greta Cowart explains some of the key changes related to COBRA coverage for employees who lost their jobs or had a reduction in hours since November 2019.
March 12, 2021
American Rescue Plan Act and the COBRA Subsidy – Déjà Vu All Over Again
In the American Rescue Plan Act, a subsidy was added to permit eligible individuals to elect COBRA at no cost to the individual for a six-month period of premium assistance.