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CAUTION:  Self-Funded Plan Documents – recent case decision

HitesmanLaw, PABlogMay 30, 2017

The Eighth Circuit may have significantly changed the self-funded world.  The majority in the Tovar v. Essentia Health (187 F. Supp. 3d 1055, 2016 U.S. Dist. LEXIS 62529 (D. Minn., May 11, 2016)) decision appears to say that where the self-funded document administered by a TPA is based upon the group insurance policy issued by the insurance carrier related to the TPA, the TPA can be sued for the plan language.  The dissent had it right by recognizing the difference between an insurance policy and insurer that administers it, and a self-funded plan, and roles of the plan sponsor and TPA.  Unfortunately, the dissent accentuates the erroneous position taken by the majority.

Watch those plan documents and watch the administrative services agreements.  Relying on ERISA and the role of the plan sponsor may not be enough.

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Blog

  • Important Relief for Filing 1094-1095 Forms for 2020 Calendar Year
  • April 22, 2020: DOL Ends Temporary Non-Enforcement of Paid Leave Protections to Help American Workers During Coronavirus Pandemic
  • CAUTION:  Self-Funded Plan Documents – recent case decision
  • EBIA’s 19th Annual Advanced Cafeteria Plans and Benefits Conference
  • 2018 HSA Contribution Amounts and HDHP Requirements

Client Alerts

  • Last Minute Relief: Interpretation of Delay Adds Lots of Work & Additional Exposure
  • Attention Employers that Sponsor an ICHRA!!!
  • Upcoming EBIA Webinars: Self-Audit Your Group Health Plan Compliance | Governmental and Church Group Health Plans: What Rules Apply?
  • The CAA: The Legislative Gift that Keeps on Giving
  • Important Relief for Filing 1094-1095 Forms for 2020 Calendar Year

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About HitesmanLaw

As a leader in employee benefits law, Darcy Hitesman founded HitesmanLaw in order to help public and private employers, insurers and third-party administrators nationwide stay informed and minimize the risk of non-compliance issues.

HitesmanLaw provides a wealth of legal experience to their clients in the areas of ERISA, COBRA, HIPAA, Health Care Reform, welfare plans, cafeteria plans, HRAs, and VEBAs.

Client Alerts

  • Last Minute Relief: Interpretation of Delay Adds Lots of Work & Additional Exposure
  • Attention Employers that Sponsor an ICHRA!!!
  • Upcoming EBIA Webinars: Self-Audit Your Group Health Plan Compliance | Governmental and Church Group Health Plans: What Rules Apply?
  • The CAA: The Legislative Gift that Keeps on Giving

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