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Health and Fringe Benefit Plans

Competitive health and fringe benefits are an important recruiting and retention tool, but your health care costs are probably the second highest cost to your company.

These costs are continuing to increase at an alarming pace and the Patient Protection and Affordable Care Act—health care reform—is probably not helping. In addition to the cost of benefits, basic compliance with the increasing regulation of health and welfare plans add to the cost of providing benefits, both in terms of time and money. The alphabet soup of ERISA, PPACA, HIPAA, COBRA, GINA, USERRA, ADA, FMLA, and HITECH challenge even the most seasoned human resources professionals. Ice Miller's Workplace Solutions Group can help.

Since the passage of health care reform in 2010, we have provided clients with timely updates and comprehensive analyses as an ongoing series of regulations have been issued.  Our health care reform work includes:

  • "Grandfathered" health plan determinations
  • Drafting and amending plan documents for new coverage mandates such as covering adult children, new claims and appeals processes, coverage of clinical trials, elimination of pre-existing condition limitations, and first-dollar coverage for preventive care benefits
  • Summary of Benefits Coverage drafting and review
  • Preparing employers for potential penalties they could face for not providing health coverage to certain employees or for providing substandard coverage
  • Working with employers to help them understand how to determine the employees to whom they must provide coverage to avoid assessments and to discuss workforce restructurings
  • Advising clients about health insurance exchanges

In addition to our extensive health care reform work, we regularly assist both private sector and public sector clients with innovative plan designs and eligibility features such as:

  • Health reimbursements arrangements (HRAs)
  • Health savings accounts (HSAs)
  • Internal Revenue Code Section 401(h) accounts
  • Section 115 trusts
  • Voluntary employee benefit associations (VEBAs)
  • Flexible spending accounts (FSAs)
  • Same-sex spouse and domestic partner benefits

Wellness programs and on-site health clinics are continually evolving as a method to curb employee health claims on a long-term basis. We assist employers on design and compliance issues for wellness programs and have analyzed these programs to ensure that they comply with HIPAA's wellness program and nondiscrimination rules, the Americans With Disabilities Act, the Genetic Information Nondiscrimination Act and other applicable federal and state laws. Furthermore, we do extensive tax analysis on whether various wellness program rewards must be included in an employee's income (such as premium reductions, deductible discounts, retail gift cards, and even frequent flier miles).

Our employee benefits lawyers work with clients to draft and review plans and internal policies and procedures to provide practical roadmaps to comply with the increasing regulatory requirements applicable to health and welfare plans which include:

  • The Employee Retirement Income Security Act (ERISA)
  • The continuation coverage requirements of COBRA
  • HIPAA Privacy and Security Requirements, including new requirements under HITECH such as privacy breach reporting and business associate agreements
  • The Women's Health and Cancer Rights Act
  • The Mental Health Parity and Addictions Equity Act
  • The Americans With Disabilities Act
  • Veterans rights under the Uniformed Services Employment and Reemployment Rights Act (USERRA)
  • Cafeteria Plan requirements including election change procedures and nondiscrimination testing
  • Nondiscrimination testing for health plans, dependent care accounts, life insurance, and flexible spending accounts

We regularly review administrative service agreements, pharmacy benefit manager agreements and other administrative contracts with both local and national third-party administrators with an eye toward protecting the rights of plan sponsors and reducing their liability through careful negotiation of provisions related to indemnification, confidentiality, allocation of liabilities, definition of services and coordination with benefit plans.

Representative Experience

  • Performed a comprehensive review for a 32,000-employee/24-hospital health care system that involved reviewing multiple health plans for PPACA compliance, amending all of those plans for PPACA's coverage mandates, and advising on day-to-day implementation questions
  • Assisted a major California city and county on the design and restatement of its Section 125 cafeteria plan for several related governmental units, which involved a detailed analysis of the proposed Section 125 regulations, implementation of flex credits, document drafting, and comprehensive nondiscrimination testing.
  • Helped another major West Coast city apply for PPACA's Early Retiree Reinsurance Program, which resulted in the receipt of $5.9 million in reimbursement from the Federal government for retiree health costs. 
  • Helped a large mid-western college in the analysis of classifying adjunct professors, student employees, resident assistants, and other unique employment classifications for purposes of PPACA's employer penalty provisions.


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