Overview
As healthcare costs continue to rise and more Americans rely on employer-sponsored health plans for coverage, offering market-leading health and welfare benefit plans can help you recruit and retain top talent—giving you a competitive edge. Welfare plans of all stripes have been the subject of complex—and often opaque—regulation and increasing government scrutiny, which can raise your costs, expand overhead and escalate compliance risks.
Our experienced team provides practical advice and innovative solutions to address these challenges and optimize your benefit plans and strategy. With a deep understanding of the market, applicable laws and regulations and employers’ day-to-day business needs, we help you tackle a full range of issues including:
- Advising on emerging issues and laws and collaborating to find strategic solutions
- Designing and implementing new health and welfare benefit plans
- Conducting audits of existing plans
- Ensuring compliance with reporting obligations and notice requirements
- Negotiating service provider agreements
- Counseling digital health and healthcare companies on developing health plan products and services
- Drafting summary plan descriptions and participant communications
- Updating health and welfare plans as needed with the release of new federal and state guidance
- Counseling on Health Insurance Portability and Accountability Act (HIPAA) compliance for group health plans
- Advising on compliance for non-Employee Retirement Income Security Act (ERISA) church plans
- Winding down retiree medical plans and Voluntary Employees’ Beneficiary Association (VEBA) trusts
- Representing companies before government and regulatory agencies to negotiate favorable outcomes
We partner closely with your HR and benefits department and in-house legal team to recommend cost-effective methods for enhancing benefits and to apply systems to ensure ongoing compliance with guidance from the Internal Revenue Service (IRS), Department of Labor (DOL), Health and Human Services (HHS) and other federal and state regulatory bodies.
Our work with employers (including many Fortune 100 companies) and across industries gives you insights on best practices for mitigating risk, avoiding litigation and handling benefits issues such as mental health parity compliance, reproductive health and prescription drug reporting, among others. We recommend practical options, share how other companies are confronting challenges and outline the risks of each approach to give you the information you need to make critical business decisions. Then we guide you through each step of the process.
When needed, we team up with top-ranked colleagues in our Health, Employment and Transactions practices to address these issues holistically. We are also equipped to support you if litigation becomes unavoidable.
Our nationally recognized health and welfare benefit lawyers concentrate exclusively on health and welfare benefit plan compliance issues. This focus gives us the capacity to provide you with consistent, reliable content on breaking news affecting welfare plan benefits, programs and arrangements of interest to employers, fiduciary committees and others. We are also routinely invited to speak at bar, industry, and trade events.
Related Capabilities
AFFORDABLE CARE ACT (ACA)
We help you understand, navigate and comply with the ACA. From employer shared responsibility requirements and employer reporting to plan coverage and notice obligations, we advise you on the resulting opportunities and challenges and guide you through benefit design strategies.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA), CYBERSECURITY AND OTHER PRIVACY LAWS
We help you understand and comply with the complex set of limitations and rules governing the use of an individual’s protected health information under HIPAA for your group health plans. As part of our industry-leading best practices, we conduct privacy audits, develop customized compliance plans, draft administrative policies and procedures for privacy and security, deliver training sessions and educational materials, and draft a range of contracts and consent and authorization forms for use with plan participants and business associates.
In addition to HIPAA compliance, health and welfare plans often sit at the intersection of multiple data privacy and cybersecurity laws, at both the state and federal level. Working with our Global Privacy & Cybersecurity team, we identify key issues affecting your plans and work with you to reach actionable solutions and mitigate risk.
ON-SITE CLINICS
Our team helps you navigate the establishment of on-site employee clinics; the development of wellness, prevention and disease management programs and telehealth initiatives; direct contracting between employers and providers to create accountable care; medical home and shared savings strategies; and implementation of account-based plans such as health reimbursement arrangements and health savings accounts.
DIGITAL HEALTH AND HEALTHCARE COMPANIES
We frequently guide digital health and healthcare companies through providing offerings to employers, health plans and insurers. Collaborating closely with our world-class Health practice, we provide comprehensive solutions for designing and expanding health and wellness products and services.
RETIREE MEDICAL BENEFITS
We advise private and public companies, nonprofits and other clients on the design and administration of retiree medical benefit plans. That includes strategies for reducing or eliminating post-retirement benefit obligations and maximizing tax advantages, such as the funding of those arrangements. We are also experienced in establishing novel benefit delivery models for retiree medical benefits, such as private exchanges, account-based plans and employer group waiver plans (EGWPs) that enable employers to continue to provide benefits to former employees while maximizing and leveraging other payors in the system.
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)
Elements of the employer-employee relationship can last long after the termination of an employment situation. This is particularly true of group health benefits, in which employees, their spouses, domestic partners and dependents may continue to have access to employer-sponsored health plans for a period following an employee’s voluntary or involuntary separation from the company through COBRA and similar state laws. We advise clients on their responsibilities under COBRA and state law and help resolve disputes involving qualifying events, COBRA eligibility, and coverage periods and elections.
CAPTIVE INSURANCE
A captive insurance company is one that provides insurance to, and is controlled by, its owners: essentially a self-insuring vehicle against losses emanating from the parent company. Many benefits flow from this arrangement, including reduction and stabilization of premiums, direct access to reinsurance markets, tax benefits and improved risk management. Although employers may self-insure certain employee benefit risks such as retiree medical benefits, employers may also fully insure such risks through the purchase of commercial insurance. We regularly advise on a wide range of innovative captive insurance structures, tax, coverage, reinsurance and related matters, including the use of a captive insurance company to fund benefits. This includes fiduciary issues, prohibited transactions and other ERISA Title I matters, along with other issues.
GROUP CAPTIVE ARRANGEMENTS
Group captive arrangements offer a novel and effective way to manage reinsurance risk. These arrangements can provide significant healthcare cost savings under the right circumstances, and they are increasingly being enabled by targeted state insurance laws. Our lawyers have experience in establishing and advising single and multi-state group captive arrangements of all sizes and structures.
