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Business Insights, Research & Perspectives

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March 22, 2011

HRB 31 - Delay in Claims and Appeals Enforcement

March 22, 2011 --  One of the provisions of the Patient Protection and Affordable Care Act (PPACA) is the expansion of the internal claims and appeal, and external review rules.  The PPACA not only augments the internal claims and appeals rules applicable to ERISA plans by adding an external review requirement, among other things, but it also extends these rules to plans exempt from ERISA, such as state and local government plans, and church plans.  These rules apply to non-grandfathered plans (those not in existence on 3/23/10), as well as to plans that lose grandfathered status.  

March 2, 2011

Delay of Service Provider Fee Disclosure

Last summer, the DOL issued interim final regulations relating to service provider fee disclosure (see Retirement Plan Fee Disclosure Continuum, from the August 2010 edition of Benefit Beat).  These rules are part of a 3-prong effort by the DOL to ensure that retirement plan sponsors and participants have the requisite information to make informed plan decisions.  The service provider rules specifically require that service providers disclose certain information to plan sponsors. 

March 2, 2011

IRS Issues Guidance on 403(b) Plan Termination Provisions

In Revenue Ruling 2011-7, the IRS begins to clarify how a 403(b) plan can be terminated and how a distribution can occur on a tax-favored basis.  A 403(b) plan can be sponsored by not-for-profit entities and public schools.

March 2, 2011

Marriage - Where Does It Stand?

Even without a full blown philosophical discussion of the meaning of marriage, the issues surrounding this concept are fraught with uncertainty.  On February 23, 2011, in a letter to John Boehner, Speaker of the U.S. House of Representatives, and by an Official Statement, Attorney General Eric Holder, on behalf of the Department of Justice (DOJ), indicated that the DOJ will no longer defend the Defense of Marriage Act (DOMA).  DOMA is a federal law, enacted in 1996 (codified at 1 U.S.C. §7 and 28 U.S.C. §1738C), that defines marriage as, “a legal union between one man and one woman as husband and wife, and the word “spouse” refers only to a person of the opposite sex who is a husband or a wife”.

March 2, 2011

IRS Clarifies Lactation Expenses Qualify as Medical Care Expenses

The IRS recently issued an Announcement relating to the excludability of breast pumps and nursing equipment.  IRS Announcement 2011-14 affirms that the cost of breast pumps and lactation aids are deemed to be medical care under IRC §213(d) in that, “like obstetric care, they are used for the purpose of affecting a structure or function of the body”.  Therefore, expenses relating to breast pumps and lactation supplies are excludable from an employee’s income, and can be purchased with tax-favored dollars through a flexible medical spending account, a health reimbursement arrangement or a health savings account.  This ruling is consistent with the trend toward wellness, and general health and well-being.

March 2, 2011

IRS Reviews 401(k) Questionnaires and Outlines Next Steps for Compliance

Last summer, the IRS began a process of sending out random questionnaires to 401(k) plan sponsors for purposes of determining potential compliance issues or plan operational issues (see IRS’ Compliance Questionnaire: 401(k) Plans, from the June, 2010 edition of Benefit Beat).  In the Winter, 2010 edition of an IRS newsletter, Monika Templeman, the Director of the IRS’ Employee Plan Examination division, indicated the next steps in this process.  Of particular note, the IRS intends to conduct full-scope examinations of those plans whose sponsor failed to respond to the 401(k) Questionnaire.  The IRS encourages plan sponsors to review the Questionnaire’s instructions (available on-line here) as an internal control tool; and, then utilize available IRS correction programs to fix errors.  It is important for a plan administrator that receives the audit request to attend to it carefully.

February 9, 2011

COBRA Process Important

Several recent court decisions remind us of how important it is to have a COBRA procedure that is well documented and followed meticulously.

February 9, 2011

Benefit Plans Impacted by Evolving World of Recognized Relationships

The landscape of recognized relationships continues to evolve.  Illinois becomes the newest in the line of states sanctioning “alternative relationships” to traditional marriage between a man and a woman. 

January 31, 2011

2010 Tax Relief/Job Creation Act

President Obama signed a multi-billion dollar tax cut package, the Tax Relief, Unemployment Insurance Reauthorization and Job Creation Act of 2010 (2010 Tax Relief Act) (P.L. 111-312), on December 17, 2010.

January 10, 2011

HRB 30 - Limited Relief for Debit Card Purchases of OTC Medications

January 10, 2011 --  As part of the Patient Protection and Affordable Care Act, over-the-counter (OTC) medications, excluding insulin, cannot be reimbursed from medical spending accounts, such as flexible medical spending accounts, health reimbursement arrangements, or health savings accounts, unless a prescription for the OTC medication has been issued.  Medical supplies, such as crutches, band-aids, or blood sugar test kits, can continue to be reimbursed from medical spending accounts, without a prescription.  According to IRS Notice 2010-59, after January 15, 2011, debit cards can no longer be used for the purchase of these items, given the complexity of proving (substantiating) the prescription (see
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