Archive for October, 2008

The ERISA and Non-ERISA Employee Benefit Implications of the Emergency Economic Stabilization Act of 2008

October 27th, 2008

On October 3, 2008, President Bush signed into law the Emergency Economic Stabilization Act of 2008 (EESA).  While most people are familiar with the “bailout” provisions applicable to the financial industry that are contained in the statute, many are not aware that it also contained numerous other provisions unrelated to the economic bailout.  Several of those other provisions are applicable to various employee benefit plans.

One of the most significant benefit provisions contained in the EESA is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.  Effective January 1, 2009, this act makes permanent the 1996 mental health parity provisions.  Additionally, it also makes certain enhancements to existing mental health parity provisions, including:

  • Requiring plans that provide mental health benefits to extend those benefits to substance abuse-related problems.
  • Mandating that the cost-sharing requirements for mental health and substance abuse benefits (such as deductibles, co-insurance, and out-of-pocket costs) may not be more restrictive than the cost-sharing requirements applicable to medical and surgical benefits.
  • Mandating that the benefits limitations requirements for mental health and substance abuse benefits (such as number of visits and maximum days covered) may not be more restrictive than the cost-sharing requirements applicable to medical and surgical benefits and there may not be separate limits for treatment applicable only to mental health and substance abuse benefits.
  • Mandating that participants can receive benefits for mental health and substance abuse treatments received out-of-network if out-of-network treatment is allowed for medical and surgical benefits under the plan.
  • Requiring Plan’s to furnish participants with the criteria used to determine medical necessity and the reason for denial of benefits for mental health and substance abuse claims.

The enhancements are generally effective for plan years beginning one year after October 3, 2009.  However, small employers (less than 50 employees) are excluded from the enhanced provisions.

Other provisions contained in the EESA that can impact employee benefit plans are detailed below:

  • The statute requires that any financial institution that directly sells troubled assets under the EESA, the financial institution must meet certain standards for executive compensation and corporate governance, including limits on compensation, recovery of bonus or incentive compensation, and prohibitions on certain “golden parachute” payments.
  • The statute details for applicable employers that participate in the Troubled Assets Relief Program (TARP), an amendment of the Internal Revenue Code (IRC) §162(m) and a denial of a tax deduction for the payment of compensation or other benefits in excess of $500,000 to executives or other highly compensated employees. The EESA also amends IRC §280G to apply the tax penalties for excess parachute payments to certain employers and their executives who participate in TARP.
  • The statute updates IRC §132(f) to allow employees to exclude employer reimbursements for bicycle commuting expenses from gross income.
  • The statute requires that “nonqualified entities” include in gross income for income tax purposes the employee compensation deferred under a nonqualified deferred compensation plan when there is no substantial risk of forfeiture of the rights to such compensation. A “nonqualified entity” is defined as any foreign corporation unless substantially all of its income is: (1) effectively connected with a trade or business in the U.S.; or (2) subject to a comprehensive foreign income tax.

Employers should consult with benefits counsel to decide whether any of the benefit-related provisions contained in EESA are applicable to their benefits programs.  Please contact our office for more information on the EESA and its benefit plan implications.

Discrimination Claims Under ERISA

October 13th, 2008

Most employers are aware of the common “discrimination” claims brought by employees or former employees like gender, race, disability, and age.  However, there is another not so well-known anti-discrimination/retaliation claim under the Employee Retirement Income Security Act (ERISA) that is becoming more and more prevalent.

ERISA §510 states that “It shall be unlawful for any person to discharge, fine, suspend, expel, discipline, or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan . . . or for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan”.  This provision provides protection to employees from adverse action by an employer in order to interfere with the attainment of rights under ERISA or in order to stop a participant from availing himself/herself of rights under ERISA.

Historically, ERISA §510 claims have been most often asserted in relation to retirement/pension plans.  However, recent cases have been brought under ERISA §510 in relation to health and welfare plans.  Claims for ERISA §510 violations occur most often when an employer has terminated an employee, and the employee claims that the termination was in anticipation of the employee making a claim under a benefit plan or becoming eligible for benefits under a benefits plan.

A recent case, Rodrigues v. The Scotts Co., LLC., involved an employer who had a company policy that prohibited its employees from smoking at any time.  One employee was terminated shortly after being hired after he tested positive for nicotine.  The employee brought several causes of action against the employer, one of which was a claim of an ERISA §510 violation.  The employer moved to dismiss the claim, but the district court denied the motion and allowed the case to proceed, stating that the key inquiry is whether the employment action was taken with the specific intent of interference with the right to a benefit.

In order for an employee to prevail under a claim of an ERISA §510 violation, he/she must prove that the employer’s adverse employment action was taken with the specific intent to interfere with the employee’s rights or benefits under an ERISA plan.  This means that the loss of benefits was the motivating factor behind the adverse employment action, not merely a consequence of the action.  As with other employment discrimination causes of action, if the employee can make an initial showing of a prima facie case for intentional interference, then the employer must prove that there was a legitimate, non-discriminatory basis for their action.  If the employer succeeds, then the employee is then required to offer proof that the employer’s legitimate, non-discriminatory reason is a mere pretext.  Because the requirements to maintain an ERISA §510 action mirror many other employment discrimination causes of action, they are often brought in conjunction with other causes of action.

As companies continue to explore ways to decrease their operational expenses, benefit costs may seem to be an easy area in which to realize cost savings.  However, employers need to be cautious in the criteria used for making benefit reduction decisions.  ERISA § 510 claims seem to go hand-in-hand with employment discrimination claims such as age discrimination.  Before making any decisions about reducing benefits costs, employer should consult with benefits counsel to ensure that any actions taken aren’t in violation of ERISA.