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Health & Welfare Plans/HIPAA

Company-sponsored health benefit plans and welfare plans and welfare plans such as group health plans, disability insurance, and paid time off for illness or leaves of absence are among the most complex—and costly—benefit programs that any business will implement.  Miles & Stockbridge’s benefits lawyers understand the laws and regulations that apply to these plans, and we work with our clients’ benefits personnel and consultants to enhance their plans in order to achieve business objectives, avoid costly investigations and lawsuits, and structure them to save time and money in their administration.

Our lawyers draft and review plan documentation for managed care programs, self-insured health plans, cafeteria plans, executive health benefit plans, long-term care plans, medical spending accounts, vision plans, wellness programs, and supplemental health benefit programs to enable our clients to comply with the complex assortment of federal and state laws and regulations that govern these plans.  We also provide guidance on the legal aspects of health benefit plan funding, including the proper use, evaluation, and enforcement of cafeteria plans, taxable and tax-exempt trusts, captive insurance, and other funding arrangements. 

Plan administration is a particular focus of our practice.  Our lawyers regularly review our clients’ plans to help them:

  • Manage legal exposures and implement plans that comply with  the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code,  the Patient Protection and Affordable Care Act (PPACA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA), COBRA, the Social Security Act, and federal and state employment discrimination regulations;

  • Draft, amend, review, and evaluate welfare benefit design proposals, plan documents, summary plan descriptions, employee benefit communications materials, vendor agreements, and other related documents;

  • Evaluate, audit, and enforce insurance and other vendor contracts and arrangements;

  • Design claims processes, investigate and process claims and appeals of claim denials, interpret and enforce plan documents, and properly coordinate welfare benefit arrangements with other sources of reimbursement and coverage;

  • Determine that funding options comply with applicable tax laws;

  • Create and disseminate training programs, prototype documents, administrative forms, and other materials;

  • Design efficient plan administration procedures; and

  • Establish record retention, privacy, and security procedures to comply with the documentation, confidentiality, and privacy requirements of HIPAA, ERISA, the Internal Revenue Code, and other applicable laws and regulations.

Miles & Stockbridge’s benefits lawyers are fully informed on all new legislation, regulations, and court decisions affecting health benefit plans, including the requirements of HIPAA’s Privacy and Security Rules and the HITECH Act.  We regularly counsel our clients on processes and technology to meet federal standards concerning the privacy and security of individually identifiable health information.  We conduct HIPAA audits and structure compliance programs, and we draft written policies and procedures that incorporate and implement safeguards to preserve the privacy, confidentiality, and availability of protected health information and health records.