EBIA Weekly Newsletter

Court Allows Provider to Proceed With Claim That Plan Violated Cost-Sharing Limit


   July 5, 2018

Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., 2018 WL 2445349 (N.D. Cal. 2018) Available at https://www.gpo.gov/fdsys/pkg/USCOURTS-cand-5_17-cv-07076/pdf/USCOURTS-cand-5_17-cv-07076-0.pdf A federal district court has denied a self-insured group health plan’s motion to dismiss an out-of-network hospital’s claim that the plan violated health care reform’s cost-sharing limit by underpaying the billed charges for medical care … Read More


For Purposes of the Form 5500 Small Plan Filing Exemption, How Do We Show That Our Welfare Benefit Plan Is Going Above or Dropping Below the 100-Participant Threshold?


   July 5, 2018

QUESTION: Our welfare benefit plan had over 100 participants at the beginning of the 2017 plan year. However, it had fewer than 100 participants at the beginning of the 2018 plan year, so it is now a small welfare benefit plan exempt from filing Form 5500. Do we need to file something to show that the … Read More


July 10–12: Join Us in Seattle for the 20th Annual EBIA Advanced Conference!


   June 28, 2018

Don’t miss the perfect opportunity to catch up on recent employee benefits developments, network with peers, learn from a panel of experts, and enjoy Seattle in July! The EBIA Advanced Cafeteria Plans and Benefits Conference brings you two and a half days packed with the latest information and insights for employer plan sponsors, third-party administrators, … Read More


Reporting Form Released for Plan Sponsors of Limited Wraparound Coverage


   June 28, 2018

Reporting Form for Plan Sponsors Offering Limited Wraparound Coverage Available at https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Limited-Wraparound-Coverage-Qs-Instructions.pdf CMS has released a form for use by plan sponsors offering limited wraparound coverage to satisfy the reporting required for the coverage to qualify as an excepted benefit. As background, limited wraparound coverage—employer-sponsored coverage intended to supplement (i.e., wrap around) … Read More