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Health & Welfare Plans

We work with the stakeholders to overcome administrative hurdles and navigate governmental regulations.

While many employees don’t fully understand the value of their retirement benefits until they are nearing retirement age, access to health and welfare benefits is critical now.  Group Health Plans face their own legislative hurdles under ERISA, the Internal Revenue Code, Patient Protection and Affordable Care Act (PPACA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Mental Health Parity and Addiction Equity Act (MHPAEA), Genetic Information Nondiscrimination Act (GINA), Families First Coronavirus Relief Act and CARES Act along with recent changes to these laws through agency and executive actions.  Let our compliance experts assist you in navigating this complex environment to avoid penalties, fines, and legal action from plan participants. 

How our team can help

Our attorneys assist with group health plans, dental and visions plans, life insurance and accidental death benefits, weekly sick and accident benefits, Health Reimbursement Arrangements, Retiree Medical Trusts, wellness benefits and clinics. We draft and review plan and trust documents that provide the foundation of the health benefits, and assist the Plan Sponsor in designing their health and welfare benefit programs.  We prepare filings with the IRS to receive a favorable determination letter and draft materials for participants to explain the benefits they will receive.  

For existing plans, our attorneys provide the Plan Sponsors with advice relating to the maintenance and operation of the health and welfare plan -- including updates on relevant law and regulations. We are well-versed in health and welfare plan design, operation and fiduciary issues.  We work with the other plan professionals to maintain plan compliance, including:

  • Drafting Annual Disclosures on Benefits and Open Enrollment Materials

  • Reviewing and negotiating of service agreements with plan vendors including insurance companies, third party administrators, prescription benefit managers, onsite clinic providers and other health care consultants

  • Monitoring and reviewing vendors hired to provide the benefits 

  • Preparing of the policies and procedures necessary to document compliance in areas such as:

    • Claims and Appeals Procedures

    • COBRA Compliance

    • HIPAA Privacy and security Policies and Procedures

    • Mental Health and Substance Abuse Benefit Review for Parity and Equity

    • Dependent Eligibility Review

    • Wellness Program Compliance

 

Our attorneys work with the plan sponsors, actuaries and auditors to set up specifically tailored fringe benefit plans, including: vacation pay programs, supplemental unemployment benefit plans, employee assistance programs and wellness clinics. We offer advice on how to structure these programs to allow these benefits to be adopted for collectively bargained employees.