ThomsonReuters

JANUARY 7, 2021

ANSWER: “Transparency in coverage” refers to an Affordable Care Act provision that requires health plans and insurers to disclose certain cost-sharing information to participants, beneficiaries, enrollees, and, in some cases, the public. But “grandmothered” health plans are required to comply. Accumulated Amounts. In-Network Rate.

98

98

ThomsonReuters

APRIL 20, 2023

In Braidwood , a federal trial court held that the members of USPSTF—but not HRSA or ACIP—lacked the authority to determine the preventive services that must be covered by private health plans (see our Checkpoint article ). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1

98

98

IVSC

MARCH 22, 2022

In particular, the authors have highlighted the following themes under which certain differences between the two standards exist today: Core Principles of Valuation Standard Setting and Valuation. Definitions. . Core Principles of Valuation Standard Setting and Valuation. Assumptions and Special Assumptions.

Compliance 244

Compliance Discounted Cash Flow Fair Market Value Liquidation Value 244

ThomsonReuters

NOVEMBER 12, 2020

This case considered whether a benefits committee had properly delegated discretionary authority to a service representative to make an adverse benefit determination for accidental death benefits, so that the court could apply a deferential standard of review.

Compliance 52

Compliance 52

ThomsonReuters

DECEMBER 9, 2021

QUESTION: Since we changed our company’s ERISA-covered major medical plan from fully insured to self-insured this year, do we have more flexibility in administering the plan’s terms? Those claims will have to be paid without the backstop of stop-loss insurance.

Compliance 52

Compliance 52

Reynolds Holding

JANUARY 1, 2024

That elaborate template authorizes, conditions, and limits channeling orders in specific ways and applies only to mass-asbestos cases. Much expert analysis suggests that the Court will significantly narrow, or perhaps reject, bankruptcy-court authority to issue channeling orders functioning as nonconsensual third-party releases.

64

64

ThomsonReuters

FEBRUARY 18, 2021

QUESTION: Our company is planning to change our ERISA-covered health plan from an insured plan to a self-insured plan. Even if you intend to keep the covered benefits the same, certain information in the SPD must change to reflect the plan’s self-insured status.

Compliance 59

Compliance 59

ThomsonReuters

JUNE 16, 2022

An entity may be a functional fiduciary to the extent it exercises discretionary authority or control over plan management, or any authority or control over management or disposition of plan assets. The court next considered whether the TPA had authority or control over plan assets. Blue Cross Blue Shield of Mass.,

Compliance 52

Compliance 52

ThomsonReuters

MAY 25, 2023

pdf After an employer-sponsored self-insured health plan denied claims for continued residential mental health treatment for a participant’s child, the family sued the plan and the plan’s claims administrator. Coverage was authorized for an initial 90 days but denied beyond that. United Behavioral Health, 2023 WL 3443353 (10th Cir.

Compliance 52

Compliance 52

Reynolds Holding

MARCH 23, 2023

Surprisingly, some of the citations were not only inaccurate but non-existent, specifying fake titles and arbitrarily crediting them to authors. In particular, not all risks are externalities; some are governed by contractual terms and conditions or otherwise subject to negotiations.

Compliance 92

Compliance Marketability Technology 92

Reynolds Holding

MARCH 19, 2023

This year’s Nobel prize-winning economists proposed two solutions to a “panic” run: deposit insurance and a lender-of-last-resort. Deposit insurance in the multi-millions of dollars raises obvious moral hazard problems, meaning it would create irresistible temptation for a bank to take outsize risks.

Banking 114

Banking Finance Marketability Equity 114

Reynolds Holding

JULY 9, 2023

The expanded removal provisions would apply to the senior executives of every insured bank in the country, even well-managed and well-capitalized banks. the duty of care or loyalty) owed to an insured depository institution, if the breach is determined to require grossly negligent, reckless, or willful conduct.

Banking 45

Banking Finance 45

ThomsonReuters

NOVEMBER 5, 2020

The IRS, DOL, and HHS have jointly issued final regulations that require most group health plans and insurers to make certain disclosures to participants, beneficiaries, enrollees, and, in some cases, the public. Here are some highlights: Required Disclosures. Estimated Cost-Sharing. Negotiated Rates. Out-of-Network Allowed Amount.

Compliance 52

Compliance 52

ThomsonReuters

JANUARY 28, 2022

If you spend a lot of time hiring temporary employees just to help with tax season, you could be missing out on a lot of potential talent—those employees who are looking for long-term positions. Insurance sales. Selling insurance is another natural fit for many tax accountants and professionals. Find better office space options.

Accounting Firms 102

Accounting Firms Start-ups Finance Marketability 102

ThomsonReuters

JULY 15, 2021

An employee and child—both covered under a self-insured group health plan—sued the plan’s claims administrators for denying coverage for the child’s long-term residential mental health treatment. United Behavioral Health, 2021 WL 2554109 (D. Utah 2021).

Compliance 52

Compliance 52

Peak Business Valuation

FEBRUARY 13, 2024

This is important when working with insurance companies, government entities, and equipment transactions. An official equipment valuation is often a requirement for lenders, lawyers, insurance brokers, or the government. Even though worthwhile long-term investments, these activities can be expensive.

Appraisal 52

Appraisal Business Valuation Fair Market Value Liquidation Value 52

Peak Business Valuation

MARCH 21, 2024

In some cases, it can increase your chances of securing favorable financing terms. Insurance Coverage for Electrical Equipment Having accurate insurance coverage is crucial for protecting your electrical equipment. An electrical equipment appraisal ensures that you have adequate insurance coverage.

Appraisal 52

Appraisal Business Valuation Fair Market Value Marketability 52

Peak Business Valuation

APRIL 3, 2024

This is key for stakeholders, including investors, creditors, and regulatory authorities. Buyers can know what prices to expect and terms to negotiate. For the lessee, an equipment appraisal helps in negotiating fair lease terms. This assurance increases the likelihood of securing favorable terms and rates.

Appraisal 52

Appraisal Business Valuation Fair Market Value Finance 52

ThomsonReuters

JULY 8, 2021

A participant in her employer’s self-insured ERISA group health plan sued the plan’s claims administrator and a subcontractor that provided access to chiropractic and other services, challenging certain billing practices. See also EBIA’s Self-Insured Health Plans manual at Section XXIII.C (“Service Provider Compensation”).

Compliance 52

Compliance 52

ThomsonReuters

MARCH 25, 2021

The claims administrator of a self-insured health plan was sued by the parent of a child with autism spectrum disorder over the plan’s exclusion of Applied Behavior Analysis (ABA) and Intensive Behavioral Therapies (IBT). See also EBIA’s Self-Insured Health Plans manual at Section XIII.E (“Coverage Limitations and Exclusions”).

Compliance 52

Compliance Equity 52

ThomsonReuters

DECEMBER 9, 2021

Highlighting these procedural problems, the court determined that the claims administrator failed to provide “an explanation of the scientific or clinical judgment for the determination, applying the terms of the plan to the claimant’s medical circumstances” as required by the claims procedure regulations.

Compliance 52

Compliance 52

Reynolds Holding

NOVEMBER 13, 2023

13] The Council determined that these prerequisites to designation “are not legally required, are not useful or appropriate, and would unduly hamper the Council’s ability to use the statutory designation authority in relevant circumstances.” [14]

Treasury 40

Treasury Finance Marketability Equity 40

Reynolds Holding

MAY 4, 2023

6] As the Kentucky AG notes when citing this piece of scholarship, “ESG investing is an ‘umbrella term that refers to an investment strategy that emphasizes a firm’s governance structure or the environmental or social impacts of the firm’s products or practices.’” [7] What goes unsaid is a complete depiction of the umbrella. 3°C by 2100. [25]

Systematic Risk 117

Systematic Risk Finance Marketability Equity 117

Reynolds Holding

APRIL 24, 2023

1] The Policy Statement outlines the CFPB’s approach to analyzing whether an act or practice may be abusive and provides examples, which the Policy Statement also notes may be used by state attorneys general or other agencies that are authorized to enforce the prohibition on abusive practices. [2] 18] B.

Banking 45

Banking Marketability 45

Appraisal Rights

AUGUST 10, 2017

In a recent article on PolicyHolder Pulse attorneys from Pillsbury explore whether Directors and Officers (“D&O”) insurance covers, or could be considered to cover, Delaware appraisal claims. They also suggest Securities Claim coverage may be available, depending on the terms of the specific policy.

Appraisal 40

Appraisal 40

Audit Board

DECEMBER 18, 2022

SOSSA focuses on new requirements for federal agencies under CISA’s authority. SOSSA also charges CISA to coordinate with non-federal entities on measures ensuring the protection and long-term safety of open-source software, and to support federal and non-federal efforts to bolster supply chain security.

Compliance 98

Compliance Start-ups 98

ThomsonReuters

APRIL 8, 2021

Q/A-8 emphasizes that an initial focus on the four specified NQTLs does not limit the agencies’ authority to request or review different or additional NQTL analyses and that plans should perform and document analyses for all NQTLs imposed.

Compliance 52

Compliance Equity 52

ThomsonReuters

DECEMBER 22, 2020

Plans adopting any of these voluntary changes must be amended by the end of the first calendar year beginning after the end of the plan year in which a change took effect, and must be operated in accordance with the amendment’s terms beginning on its effective date. Mental Health Parity Expansion.

Compliance 90

Compliance 90

ThomsonReuters

DECEMBER 3, 2020

The plan’s summary plan description (SPD), which the parties agreed was a plan document, incorporated by reference “certificates of coverage,” defined in the SPD as plan booklets describing benefits and the terms and conditions for receiving those benefits. The Ninth Circuit upheld the trial court’s award of damages to the hospital.

Compliance 52

Compliance 52

Reynolds Holding

NOVEMBER 1, 2023

Around the world, international competition authorities have picked up the pace in cartel enforcement. Courts in two EU member states—Greece and Turkey—recently allowed the subjects of investigations to push back on an enforcer’s dawn raid authorities, and another company is petitioning to do the same in the EU.

Compliance 40

Compliance Marketability Technology 40

Reynolds Holding

MAY 9, 2024

Before engaging in digital financial asset business activity with a California resident, a service provider must disclose to consumers terms such as schedule of fees, whether the service is covered by any insurance against potential loss, each party’s liability for unauthorized transactions, etc. Consumer disclosures.

Compliance 45

Compliance Banking Marketability Finance 45

Reynolds Holding

JULY 19, 2022

Voyager’s counsel offered their view that the crypto assets held on its platform are “assets of the estate” pursuant to the terms of the customer agreements, which authorizes Voyager to hold crypto assets in commingled accounts and to use them on the customer’s behalf. [13] link] (July 11, 2022, 9:50 PM). [14]

Banking 49

Banking Marketability Finance 49

ThomsonReuters

JANUARY 14, 2021

For 2021, the procedure permanently incorporates IRS guidance that temporarily authorized electronic submission of requests for letter rulings and other guidance by email instead of by fax. 5 (“IRS Guidance”), and EBIA’s Self-Insured Health Plans manual at Section V.B.4 Most submissions may also be made on paper.)

52

52

Reynolds Holding

APRIL 3, 2023

Expand the definition of custody to include discretionary trading authority. The Proposal would explicitly include an Adviser’s discretionary authority to trade client assets within the definition of “custody.” Is subject to oversight by a foreign government or financial regulatory authorities. 2 Definition of custody.

Banking 45

Banking Compliance 45

Reynolds Holding

JUNE 21, 2022

a minimum of 80% of a fund’s assets must be consistent with its name) to apply to fund names that incorporate terms related to investment strategy, such as “growth” or “value,” and proposes circumstances under which deviations from the 80% policy are temporarily permitted. UK regulation.

Marketability 83

Marketability Treasury Finance Compliance 83

Audit Board

MAY 24, 2022

Candace Jackson: In April of 2021, the Department of Labor came out with what they’re terming cybersecurity best practices. I wouldn’t have expected to see monitoring of both authorized and unauthorized activity, but that’s absolutely important and certainly would be present in a mature cybersecurity environment.

Start-ups 52

Start-ups Marketability 52

Farrel Fritz

DECEMBER 4, 2023

For those in RULLCA states, whose LLC statutes authorize judicial dissociation a/k/a expulsion of an LLC member, the additional lesson is not to underestimate the importance of the equities, both as to the circumstances justifying expulsion and the potential consequences that flow from expulsion.

Start-ups 59

Start-ups Equity Business Enterprise Marketability 59