The U.S. District Court for the Southern District of New York, in Rhodes v. First Reliance, has ruled that an insurer’s denial of a long-term disability (“LTD”) claim must be reviewed under the de...
Law Alert
Departments Consider Potential Safe Harbor for Nonquantitative Treatment Limitations under the Mental Health Parity and Addiction Equity Act Regarding Network Adequacy
By Dannae Delano, Roberta Casper Watson and Barry Salkin On July 25, the Departments of Treasury, Labor, and Health and Human Services (the “Departments”) issued proposed regulations and other...
Agencies Issue Proposed Regulations on Mental Health Parity Implementation
HHS, DOL and IRS (collectively, the “Agencies”) have jointly issued proposed regulations to provide guidance on the implementation of the requirements of the Mental Health Parity and Addiction...
CMS Recommends Extension of Special Enrollment for Individuals Losing Medicaid and CHIP
By Roberta Watson, Dannae Delano and Barry Salkin Employers frequently provide group health plan coverage for their employees through pre-tax contributions to a cafeteria plan. Elections under a...
Departments Issue Guidance on No Surprises Act and Limitations on Cost Sharing Under the Affordable Care Act
By Dannae Delano, Roberta Watson and Barry Salkin In FAQ Part 60, the Departments of Health and Human Service, Treasury, and Labor (the “Departments”) addressed limitations on cost sharing under the...
Danger Will Robinson, Esq. – A Cautionary Note to Lawyers Regarding Engagement Letters
Buried in the recent decision in Supercooler Technologies, Inc. v. The Coca Cola Company, No. 6:23-cv-187-CEM-RMN (M.D. Fl. July 17, 2023), is a set of circumstances that amount to a cautionary tale...
Plan Penalized for Failure to Follow Its Own Provisions
In Laake v. Benefits Committee, Western & Southern Financial Group Co., the U.S. Court of Appeals for the Sixth Circuit determined that the de novo standard of review applies where an employer’s...
IRS Issues Transitional Guidance for Required Minimum Distributions
By Jon Schultze and Barry Salkin In response to changes made by the SECURE 2.0 Act of 2022 (SECURE 2.0) to the required minimum distribution (“RMD”) rules of the Internal Revenue Code (the “Code”),...
Departments Propose Regulations on Short-Term Limited Duration Insurance and Indemnity Insurance Excepted Benefits
By Dannae Delano, Roberta Casper Watson and Barry Salkin On July 7, the Departments of Health and Human Services, Labor, and Treasury (the “Departments”) issued proposed regulations modifying the...
Significant Changes Made to IRS Employee Plans Compliance Resolution System
By Dannae Delano, Seth Gaudreau and Barry Salkin The SECURE 2.0 Act of 2022, Division T of Public Law No. 117-328 (“the Act”) includes dozens of provisions that affect retirement plans and...
Reservists Must Receive Paid Administrative Leave Benefits
In Myrick v City of Hoover, the U.S. Court of Appeals for the 11th Circuit has ruled that military reservists must be treated as if they were on paid leave for purposes of the Uniformed Services...
Plan May Exclude Certain Specified Emergency Services
The U.S. Court of Appeals for the Eighth Circuit has ruled, in Shafer v. Zimmerman Transfer, that a group health plan does not have to pay for emergency services specifically excluded by the plan...
IRS Issues HDHP Guidance for End of COVID Emergency Period
In response to the ending of the COVID-19 public health emergency and national emergency, the IRS has issued Notice 2023-37, which modifies its prior guidance on benefits relating to the testing and...
SEC’s Recent Marketing Rule Risk Alert Identifies Additional Areas of Focus During Compliance Examinations
By Seth Gaudreau and Stephen Wilkes On June 8, 2023, the Securities and Exchange Commission’s (“SEC”) Division of Examinations (the “Division”) published a risk alert (the “Risk Alert” - found here)...
IRS Releases Guidance Denying Favorable Tax Treatment to Certain Wellness Program Incentive Payments
IRS has released guidance, in the form of Chief Counsel Memorandum Number: 202323006 (the “Memorandum”), denying favorable tax treatment to wellness incentive program payments provided through...
DOL Provides Guidance About Holidays During FMLA Leave
The Department of Labor (“DOL”) has issued Opinion Letter FMLA 2023-2-A (the “Letter”) to clarify how the amount of leave used is calculated when an employee takes Family and Medical Leave Act...
Massachusetts Division of Insurance Provides Special Enrollment Period for Loss of COBRA Coverage
By Dannae Delano, Barry Salkin and Roberta Casper Watson As we have previously described in client alerts, the end of the National Emergency and the cessation of the outbreak period on July 10,...
Coverage Requirements for COVID-related Services Post-Public Health Emergency
The COVID-19 national emergency (“NE”) and public health emergency (“PHE”) officially ended on April 10 and May 11, 2023, respectively. The end of the emergencies provides group health plan sponsors...
IRS Announces 2024 HSA and HRA Limits
The IRS has announced the 2024 calendar year dollar limits for health savings account (“HSA”) contributions, the minimum deductible amounts and maximum out-of-pocket expenses for high deductible...
Employer Can Select Individuals Who Receive Severance Benefits
The U.S. Court of Appeals for the Seventh Circuit has ruled, in Carlson v. Northrop Grumman Severance Plan, that an employer can use its discretion to individually select which terminated employees...
The DOL Accepts a FAQ-Out and Rolls Over . . . for Now – Appeal of ASA v. DOL Is Abandoned
By Andrew Oringer It was reported yesterday, on May 15, 2023, that the U.S. Department of Labor (the “DOL”) has abandoned its appeal in American Securities Association [“ASA”] v. U.S. Department of...
Claims Appeals Procedures Must be in Formal Plan Documents
In Yates v. Symetra Life Insurance, the U.S. Court of Appeals for the Eighth Circuit has ruled that a life insurance beneficiary need not exhaust a plan’s claims appeals procedures when the plan...
The Pregnant Workers Fairness Act (PWFA): What Employers Need to Know Before Summer 2023
By Katherine Brustowicz and David Gabor Introduction: It has long been the law that Title VII, the Age Discrimination in Employment Act (ADEA), and the Family Medical Leave Act (FMLA) protect...
IRS Chief Counsel Discusses Cafeteria Plan Substantiation Rules
The IRS Office of Chief Counsel has issued Memorandum Number 202317020 (the “Memorandum”) to explain the substantiation rules for claims made under health and dependent care FSAs by means of six...
Government Plan Not Covered by ERISA
In Pue v. New Jersey Transit Authority, the U.S. Court of Appeals for the Third Circuit has dismissed an ERISA-based lawsuit because government plans are not covered by ERISA. Law. ERISA section...
TPA Subject to Nondiscrimination Rules
The Federal District Court for the Western District of Washington has ruled, in C.P. vs. Blue Cross Blue Shield of Illinois, that an insurer acting as a third party administrator (“TPA”) is covered...
Board Resolution Insufficient to Terminate Severance Pay Plan
The U.S. Court of Appeals for the Fourth Circuit has ruled, in Messer v. Bristol Compressors, that a Board of Directors resolution intended to terminate a severance pay plan was insufficient because...
Agencies Issue Guidance Regarding Effect of the End of the COVID-19 Public Health Emergency (PHE) and National Emergency (NE) on Benefits
By Barry Salkin, Dannae Delano and Roberta Casper Watson On January 31, 2020, the Department of Health and Human Services (HHS) declared that a nationwide public health emergency (PHE) had existed...
IRS Issues Guidance on Nonfungible Tokens (“NFTs”) in IRAs and Tax-Qualified Individual Account Plans
By Barry Salkin and Jon Schultze Unlike ERISA, the Internal Revenue Code (“Code”) places almost no restrictions on the manner in which plan assets of individual retirement plans or tax-qualified...
IRS Requires Most Employee Benefit Plans to File Forms Electronically
The IRS has issued final regulations that will require almost all employee benefit plan filings to be made electronically. Background. Generally, Applicable Large Employers are required to file...
IRS Provides Guidance on the Definition of “Medical Expenses”
The IRS has issued a series of Frequently Asked Questions (“FAQs”) to provide guidance as to whether certain costs related to nutrition, wellness, and general health are medical expenses that may be...
IRS Issues Proposed Regulations Regarding Use of Forfeitures in Tax-Qualified Plans
By Jon Schultze and Barry Salkin Some of the IRS regulations dealing with tax-qualified plans predate ERISA and subsequent federal tax legislation, and have become outdated. However, sometimes it...
SECURE Act 2.0 Modification to Controlled Group and Affiliated Service Group Requirements
By Jon Schultze and Barry Salkin One of the less-discussed provisions of the recently enacted SECURE Act 2.0 makes two changes to the “family attribution” rules under Section 414 of the Internal...
Departments Issue Guidance Requiring First Annual “Gag” Attestation by December 31, 2023
By Dannae Delano, Roberta Casper Watson and Barry Salkin The Consolidated Appropriations Act of 2021 (“CAA”) is the most significant compliance challenge for employer health plan sponsors since the...
DOL Distinguishes Between FMLA and ADA Rights With Regards to Required Overtime
The Department of Labor (“DOL”) has issued Opinion Letter FMLA 2023-1-A with regards to employees who have health conditions that prevent them from working more than 40-hours per week. DOL was asked...
FMLA Rights For Employees Who Telework
The Department of Labor (“DOL”), in Field Assistance Bulletin No. 2023-1 (“FAB”), has explained how to apply the eligibility rules under the Family and Medical Leave Act (FMLA) when employees...
Jury Must Determine “Comparability” Under USERRA
The U.S. Court of Appeals for the Ninth Circuit, in Clarkson v. Alaska Airlines, has determined that a jury must decide whether an employer offered “comparable,” non-military, paid leave, and was...
Was the DOL FAQed Out and Rolled Over? Second Court Rejects DOL’s Interpretation of ERISA’s Fiduciary Rule
By Andrew Oringer Two recent federal courts, in Carfora v. TIAA, No. 1:21-cv-08384 (S.D.N.Y. Sept. 27, 2022) and American Securities Association [“ASA”] v. U.S. Department of Labor, No....
DOL Announces Indexed Penalties for Health and Welfare Plans
The Department of Labor (“DOL”) has announced the inflation-adjusted penalties for certain health and welfare plan violations. The new amounts are effective for penalties assessed after January 15,...
Who’s Liable When a Plan Participant is a Victim of Identity Theft
By Jordan Mamorsky and Barry Salkin Because of the scarcity of case law and regulatory guidance on the issues, any case that analyzes the liability of ERISA plan sponsors and service providers...
Only One Notice Required for Intermittent FMLA Leave
The U.S. Court of Appeals for the Sixth Circuit, in Render, v. FCA US, LLC, has ruled that only one FMLA-qualified notice is required from an employee for intermittent FMLA leave. Law. The FMLA...
Proposed IRS Regulations Would Make Permanent the Availability of Remote Spousal Consent Elections
By Barry Salkin Longstanding Internal Revenue Service (“IRS”) regulations with respect to spousal consent to a waiver of benefits require an election to be witnessed in the physical presence of a...
2024 ACA Out-of-Pocket Limits
The U.S. Department of Health and Human Services (HHS) has announced the inflation-adjusted maximum out-of-pocket (OOP) limits that will apply to non-grandfathered plans for plan years beginning in...
Congress Enacts Respect for Marriage Act
By, Barry Salkin, Roberta Watson and Jon Schultze n the ordinary course, we would not be advising clients that a statute that a Supreme Court held unconstitutional nine years ago was being removed...
ERISA Group Health Plan’s Self-Help Provision is Enforceable
The Ninth Circuit Court of Appeals, in Mull v. Motion Picture Industry Health Plan; Board of Directors of Motion Picture Industry Health Plan, has determined that an ERISA-covered group health plan...
DOL Rule Permits Consideration of Climate and ESG Factors and Codifies Proxy Voting Responsibilities
By Stephen Wilkes, Izzy Goldowitz and John Sohn On November 22, 2022, the Department of Labor (“DOL”) issued a final rule modernizing and revising the long-standing Investment Duties Regulation....
Secure Act 2.0 Brings a Litany of Retirement Changes
By Roberta Watson, Barry Salkin and Alex Olsen The SECURE Act 2.0 of 2022 (“SECURE 2.0”, or the “Act”) became law as part of the Consolidated Appropriations Act of 2023. SECURE 2.0 builds on the...
IRS Publishes Registered Apprenticeship Guidance
By Stephen Wilkes and Seth Gaudreau On November 30, 2022, the Internal Revenue Service (“IRS”) and the Department of the Treasury (“Treasury”) published Notice 2022-61 (the “Notice”) in the Federal...
Federal Agencies Issue Group Health Plan Guidance
By Roberta Watson, Barry Salkin and Dannae Delano On December 23, 2022, new guidance applicable to group health plans was issued by federal agencies, as described more fully below. The Center for...
IRS Finalizes Delayed Effective Dates for ACA Filing Requirements
In past years, the IRS has extended the deadlines for employer and group health plan Affordable Care Act (“ACA”) reporting. In lieu of the deadline extensions, the IRS has now issued final...