The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Physicians generally do not have direct standing to bring a claim for benefits under an ERISA group health plan. Rather, a physician’s standing derives from the patient’s status as a plan participant and must be assigned....more
If you’re a TPA and you’re not talking to your small business clients about SEP-IRAs, you’re missing the plot. But if you’re only talking about SEP-IRAs, you’re missing the opportunity....more
If you’re a plan provider—advisor, TPA, recordkeeper, or pooled plan provider—you’ve probably heard the advice a million times: “Create content to stay top of mind with plan sponsors.” But what kind of content actually works?...more
Fifteen years ago, I walked away from the law firm treadmill, overhead, politics, billable hours, all of it, and went out on my own. I wanted to practice ERISA law in a way that actually added value, not just racked up hours....more
The world of health benefits is constantly evolving. Recent policy shifts and legislative developments are expected to impact the economic landscape and have significant implications for employer plan sponsors, insurers,...more
In a decision about ERISA’s fiduciary duties and transparency, the Sixth Circuit in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan held that Blue Cross Blue Shield of Michigan (BCBSM), a third-party administrator...more
I f you’re thinking of hiring your payroll provider to also serve as your 401(k) plan’s third-party administrator (TPA), stop. Think again. Then think again harder. I’ve been an ERISA attorney for more than 25 years. In that...more
Key Takeaways: A Florida-based Health Maintenance Organization (HMO) was fined for contracting with a Third Party Administrator (TPA) that was not licensed in Florida, violating its statutory obligation to ensure...more
Key Takeaways - The Delaware Department of Insurance (Department) is conducting targeted market conduct exams of Third Party Administrators (TPAs) for compliance with state insurance laws and regulations....more
Certain transactions between employee benefit plans and “parties in interest” are prohibited under the Employee Retirement Income Security Act of 1974, as amended (ERISA). ...more
Our lives are the sum of our choices, at least that is what the trailer for the next Mission Impossible moving is telling me. When I was a kid, I would read these Choose Your Own Adventure books where the story and outcome...more
I was very lucky that when I started as an ERISA attorney in 1998, I worked as a staff attorney for a third-party administrator (TPA). It gave me insight and experience that I could never have gotten as an attorney working...more
Recordkeepers and Third Party Administrators (TPAs) need to either scale up or innovate. The trend of consolidation in the TPA industry makes it increasingly difficult to compete against larger firms....more
At work and at home, one of the worst things I ever did was make a mistake and not accept responsibility for it. Instead of owning up, I would make excuses, turning the fight over the mistake into a bigger issue than the...more
As I have always said, the most important 401(k) plan provider you can hire is a Third-Party Administrator (TPA). That’s because a TPA does so much work, and their incompetence can lead to you getting penalized or forcing you...more
Friday, I was supposed to attend the New York Comic Con for a special session since I had a wholesale account with the leading comic book distributor. I’m sure the breakfast would have had some free giveaways and I was...more
As a plan fiduciary, I still can’t believe it. A Third Party Administrator (TPA) we terminated was trying to hold us up for valuations and a Form 5500 we paid for, as part of, annual administration. It was $80,000....more
“A lot of holes in the desert, and a lot of problems are buried in those holes. But you gotta do it right. I mean, you gotta have the hole already dug before you show up with a package in the trunk. Otherwise, you’re talking...more
The Kansas Insurance Department (“Department”) recently issued a Data Call to all Third Party Administrators (“TPAs”) licensed in the state of Kansas. Pursuant to the Data Call, the Department has requested information...more
The MTV reality series The Real World ended their opening intro with “to find out what happens… when people stop being polite… and start getting real.” As an ERISA attorney working with retirement plan clients, I often find...more
When I was a kid in day school in Brooklyn, we had a classmate whose shtick was that he was rich. He wasn’t rich, his father was a pa- thologist who worked at a city hospital, his mother didn’t work, and they rented a nice...more
Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront...more
A health plan’s fiduciaries are responsible for administering the health plan. Because most employers are not in the business of administering health benefits, they outsource the day-to-day health plan administration to a...more
On September 12, the IRS reminded plan sponsors to review and comply with IRS Notice 2024-02 (the “Notice”), which extended and consolidated deadlines for employers and others sponsoring 401(k), 403(b), 457(b) and other...more
When I was at law school, I was the editor-in-chief of the law school’s newsmagazine. My rise to the top probably had a lot to do with the free time I had by not making law review or any other of the law journals. I failed to...more