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The TPA was removed from the claim denial dispute because the court held such TPA received no discretionary authority from the plan. The fund claims adjudication authority was retained by the employer.

Artandi v. Buzark, 33 EBC 1439 (S.D. N.Y. 2004).

LTD Claims Denial

The participant was successful in showing that a minor accident (for which he was claiming Social Security disability) was the proximate cause of his depression, which qualified him for the plan’s disability benefits.

Buzzard v. Holland, 33 EBC 1446 (4th Cir. 2004).

Drug Reimportation War Heats Up

Some 14 pharmacies in California are suing most of the major Rx manufacturers alleging that such manufacturers are using anticompetitive practices to stop drug importation. Such practices allegedly include but are not limited to collusion, price-fixing, coercion, tying agreements, boycotting, etc. The antitrust law allegedly being violated is that of California.

HSA Topics

HSA Clarifications from the IRS

These issues have been settled:

  • Employer contributions to participant HSAs are not subject to FICA taxes.

  • An HSA is allowed for participants covered by an employer self-funded medical reimbursement plan with a qualifying high deductible.

  • Trustees are not required to determine if withdrawals are used for medical expenses.

  • Special rules are provided for determining the deductible for high-deductible family coverage.

  • In addition to banks and insurance companies, persons may be approved HSA custodians under the published guidelines.

  • An HSA trustee that does not sponsor the high-deductible health plan may, but is not required to, request proof or certification that someone is eligible to contribute to the HSA.

  • Otherwise eligible individuals without earnings may contribute to an HSA -- including the self-employed and unemployed.

© 2004 International Foundation of Employee Benefit Plans, Inc. All rights reserved.

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