In Hansen v. Lab. Corp. of America, the United States District Court for the Eastern District of Wisconsin ruled that an employer’s attempt to combine its short term disability (“STD”) plan with...
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Health & Welfare
CMS Announces Medicare Part A Deductibles and Part B Premiums for 2025
The Centers for Medicare & Medicaid Services (“CMS”) has announced the 2025 premiums, deductibles and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part A covers...
Claims Processor Is Not ERISA Plan Fiduciary
The U.S. District Court for the District of Massachusetts, in Shea v. Unum Life Ins. Co, has ruled that a claims processor is not an ERISA fiduciary because it does not have discretionary powers...
Employee May Take FMLA Leave to Participate in Clinical Trial
The Department of Labor’s (“DOL’s”) Wage and Hour Division has issued Advisory Opinion FMLA 2024-01-A, which provides that an employee may use leave under the Family and Medical Leave Act (“FMLA”)...
IRS Releases 2025 Welfare Benefit Plan Limits
The IRS has released Revenue Procedures 2024-25, 2024-40 and Notice 2024-80, which set forth the 2025 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used...
IRS Expands Definition of “Preventive Care” for HDHPs
The IRS has issued Notices 2024-71 and 2024-75 (the “Notices”) to expand the definition of “preventive care” for high deductible health plans (“HDHPs”). Law. In general, individuals are eligible to...
2026 ACA Out-of-Pocket Limits
The Centers for Medicare & Medicaid Services (“CMS”) has announced the proposed maximum out-of-pocket (“OOP”) limits that will apply to non-grandfathered plans for plan years beginning in 2026. ...
CMS Issues Medicare Reporting Penalty Rules
The Centers for Medicare & Medicaid Services (“CMS”) has issued final rules on the penalties imposed when Responsible Reporting Entities (“RREs”) fail to meet their Medicare as Secondary Payer...
IRS Releases ACA Affordability Rates for 2025
The Internal Revenue Service has issued Revenue Procedure 2024-35 to implement the 2025 index adjustments for certain Affordable Care Act (“ACA”) applicable contribution percentages used to...
Seemingly “Minor” Mistake in Claims Procedure Administration Costs Employer
In Witt v. Intel Corp. Long-Term Disability Plan, the United States District Court for the District of Oregon refused to dismiss a long term disability (”LTD”) benefits lawsuit when the plan...
Court Applies “But For” Standard to LTD Mental Health Benefit Limitation
In Weyer v. Reliance Standard Life Insurance Company, the U.S. Court of Appeals for the Eighth Circuit has determined that the “but-for” causation standard is appropriate for determining whether...
Employer Need Not Seek Second Medical Decision for FMLA Request
In Perez v. Barrick Goldstrike Mines, the U.S. Court of Appeals for the Ninth Circuit has ruled that the Family and Medical Leave Act (“FMLA”) does not require an employer to present contrary...
Group Health Insurer Need Not Cover Certain Autism Treatments
The U. S. Court of Appeals for the Seventh Circuit, in Hensen v. Group Health Plan Cooperative of South Central Wisconsin, has ruled that the Mental Health Parity and Addiction Equity Act (“MHPAEA”)...
HHS Issues Model HIPAA Attestation Form
The Department of Health and Human Services (“HHS”) has issued a model attestation form for any “Requested Use or Disclosure of Protected Health Information Potentially Related to Reproductive...
Failure to Follow FMLA Regulations Could Cost Employer
n Mook v. City of Martinsville, the U.S. District Court for the Western District of Virginia has ruled that an employer’s failure to follow the procedure set forth in the Family and Medical Leave...
Father Not Entitled to Prenatal FMLA Leave
In Tanner v. Stryker, the U.S. Court of Appeals for the Eleventh Circuit has ruled that an employee’s parental Family and Medical Leave Act (“FMLA”) rights do not begin until the actual birth of his...
Jury Must Make Factual Determinations in FMLA Lawsuit
In Crispell v. FCA, the U.S. Court of Appeals for the Sixth Circuit determined that a jury must decide whether an employee’s failure to follow her employer’s leave procedures was due to “unusual...
Appeals Court Issues Split Ruling on ACA’s Preventive Services Requirements
In Braidwood Management, Inc. v. Becerra, the U.S. Court of Appeals for the Fifth Circuit has issued a “mixed bag” of rulings with regards to the preventive services requirements of the Affordable...
IRS Issues FAQs on Educational Assistance Programs
The IRS has issued a fact sheet (FS-2024-22) to provide Frequently Asked Questions (“FAQs”) regarding educational assistance programs. Background. An educational assistance program is a written...
Employer May Rely on Address Provided by Employee
In Anaya v. Birck, the United States District Court for the Northern District of Illinois ruled that an employer met its COBRA notification requirements even though it did not send a terminated...
Transportation Fringe Benefit Contributions May Not Be Reimbursed to Employee
In Information Letter 2024-004, the IRS has reiterated that contributions to a qualified transportation fringe benefits plan may not be reimbursed, even if the employee could not commute because of...
DOL Issues Warnings About the Use of AI in FMLA Administration
The Department of Labor (“DOL”) has issued Field Assistance Bulletin (“FAB”) 2024-1 which contains guidance and warnings on the use of artificial intelligence (“AI”) when administrating various...
DOL Revokes Association Health Plan Regulations
The Department of Labor (“DOL”) has revoked its Association Health Plan (“AHP”) regulations and expects to replace them with stricter standards that provide additional employee protections....
Group Health Plans Must Take Action to Comply with Changes to HIPAA Privacy Rules Designed to Protect Reproductive Healthcare Privacy
By Dannae Delano In further response[i] to the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, the U.S. Department of Health and Human Services...
Insurer May Rely on In-House Advisors’ Disability Determination
In Harmon v Unum Life, the U.S. Court of Appeals for the Sixth Circuit has ruled that an insurer may rely on its own medical advisors in denying long term disability (“LTD”) benefits, as long as the...
Work-Life Referral Services Not Taxable Benefits
The IRS has issued Fact Sheet 2024-13 (the “Fact Sheet”) to confirm that work-life referral (“WLR”) services provided by an employer are non-taxable, de minimis fringe benefits. Background. A WLR...
Notice for Fixed Indemnity Insurance Revised
The Internal Revenue Service, Department of Labor, and Department of Health and Human Services (the “Agencies”) have issued a revised, mandatory notice for fixed indemnity insurance coverage....
Employee Must Provide Adequate Notice of Need for FMLA Leave
The U.S. Court of Appeals for the Fifth Circuit has ruled, in Cerda v. Blue Cube Operations, that an employee was not protected by the Family and Medical Leave Act (“FMLA”) when she never gave the...
Agencies Revise Short-Term Health Insurance Regulations
HHS, DOL and IRS (the “Agencies”) have jointly issued revised final regulations reducing the maximum duration of short-term, limited-duration health insurance (“STLDHI”) coverage. Background. ...
COBRA Compliance: Employer Tips From Audit Guidelines and Class Action Litigation
COBRA Compliance: Employer Tips From Audit Guidelines and Class Action Litigation - Dannae Delano and Linda Stuessi, panelists, Lorman Education Services live CLE webinar, May 15, 2024, 1:00 - 2:05...
Insurer May Be Liable Under ERISA for Unauthorized Premium Increases
The U.S. Court of Appeals for the First Circuit, in Parameter v. Prudential Insurance and Tufts University, has ruled that an insurer may have breached its fiduciary duty through unauthorized...
IRS Warns Companies are Making False Statements About Health Plan Reimbursements
In IR-2024-65 (the “IR”), the IRS warns taxpayers that some companies are misrepresenting the circumstances under which food and wellness expenses can be paid or reimbursed under health flexible...
LTD Plan Must Consider Future Harm from Stress
In Aisenberg v. Reliance Standard Life Ins. Co., the United States District Court for the Eastern District of Virginia has ruled that a long term disability (“LTD”) plan must take into account...
Court Finds Health Plan Not Required to Furnish Administrative Service Agreements in Response to ERISA Document Request
In Zavislak v. Netflix, Inc., the U.S. District Court for the Northern District of California has largely rejected a plaintiff’s assertion that an employer/plan administrator for an ERISA...
IRS Announces Decreased 2025 Employer Shared Responsibility Penalties
In Revenue Procedure 2024-14, the IRS has announced the 2025 penalty rates for violations of the employer shared responsibility provisions of the Affordable Care Act (“ACA”). Background. Under the...
ICHRAs: The New Health Care Benefit for Advisors to Learn in 2024
ICHRAs: The New Health Care Benefit for Advisors to Learn in 2024 - Thomas Clark, Jr., 401(k) Specialist Magazine, February 5, 2024 (PDF)
DOL Updates FMLA Fact Sheets
To assist in employer and employee compliance, the Department of Labor (“DOL”) has issued several revised Family and Medical Leave Act (“FMLA”) Fact Sheets, including Fact Sheet 28D: Employer...
Johnson & Johnson Case Signals Employee Drug Price Suits to Come
Johnson & Johnson Case Signals Employee Drug Price Suits to Come - Roberta Casper Watson, Bloomberg Law, February 9, 2024 (PDF)
Agencies Update Non-English Language Requirements
The Departments of Labor and Health and Human Services, and the IRS (“the Agencies”) have issued Frequently Asked Questions About Affordable Care Act (“ACA”) and Consolidated Appropriations Act,...
DOL Announces Indexed Penalties for Health and Welfare Plans
The Department of Labor released a final rule that provides new figures reflecting the adjusted civil penalty amounts for 2024, for certain health and welfare plan violations. The DOL is required...
Workers Poised to Get Benefits as Rule Creates ‘Employees’
Workers Poised to Get Benefits as Rule Creates ‘Employees’ - Roberta Casper Watson, Bloomberg Law, January 29, 2024 (PDF)
Plan Insurer Held Liable for Failure to Follow Claims Procedures
The U.S. District Court for the District of Utah, in R.E. v. Blue Cross Blue Shield, has ruled that the failure to properly follow ERISA’s claims procedures may result in a reversal of a claims...
State Law Claims Preempted By ERISA
In Steigleman v. Symetra Life, the U.S. District Court for the District of Arizona has ruled that a small business owner could not sue an insurance company under state law for long term disability...
DOL Sues Blue Cross Blue Shield Minnesota for Collecting $66.8M in Provider Tax
DOL Sues Blue Cross Blue Shield Minnesota for Collecting $66.8M in Provider Tax - Andrew Oringer, PLANSPONSOR, January 17, 2024 (PDF)
LTD Insurer May Subsequently Reverse Disability Determination
The U.S. District Court for the Southern District of Florida has ruled, in Delucca v. The Guardian Life Insurance Company of America, that a long term disability (“LTD”) plan was not bound by prior...
Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits
Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits - Dannae Delano, panelist, Strafford live CLE webinar, January 4. 2024 - Click here for...
DOL Proposes Rescission of Association Health Plan Rules
The Department of Labor (“DOL”) has proposed that the Association Health Plan (“AHP”) regulations be revoked and replaced with stricter standards that provide additional employee protections....
Eleventh Circuit Adopts Strict Standard for FMLA Claims
The Eleventh Circuit Court of Appeals, in Lapham v. Walgreen Co., has ruled that the “but for” legal standard applies to Family and Medical Leave Act (“FMLA”) retaliation claims. Law. The FMLA...
DOL Proposes to Rescind 2018 Association Health Plan Rule
DOL Proposes to Rescind 2018 Association Health Plan Rule - Roberta Casper Watson, PLANSPONSOR, December 22, 2023 (PDF)
Plan Must Consider All “Independent Grounds” for Claims Coverage
The U.S. Court of Appeals for the Tenth Circuit, in Ian C. v. UnitedHealthcare Ins. Co., has ruled that a group health plan violated ERISA’s claims procedures by failing to separately evaluate each...
2025 ACA Out-of-Pocket Limits
The U.S. Department of Health and Human Services (“HHS”) has announced the proposed maximum out-of-pocket (“OOP”) limits that will apply to non-grandfathered plans for plan years beginning in...
Participant May Sue Plan for Facial Feminization Surgery Coverage
The United States District Court for the Eastern District of Pennsylvania, in Doe v. Independence Blue Cross, declined to dismiss a participant’s lawsuit claiming that a group health plan covered...
IRS Announces PCORI Fee
IRS has released Notice 2023-70, which provides the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“ PCORI” ) fee for plan years ending before October 1, 2024....
CMS Announces Medicare Part A Deductibles and Part B Premiums for 2024
The Centers for Medicare & Medicaid Services (“CMS”) has announced the 2024 premiums, deductibles and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part A covers...
IRS Notice on Treatment of Leave-Based Donation Programs
In response to an extreme need for charitable relief by victims of the Hawaiian wildfires that began on August 8, 2023, the IRS has issued Notice 2023-69 (the “Notice”) to provide guidance under the...
Participant May Receive Monetary Damages for Plan’s Failure to Approve Procedure
In Rose v. PSA Airlines, Inc., the Fourth Circuit Court of Appeals ruled that a self-funded group health plan may be sued for monetary damages for failure to approve a medical procedure for a plan...
Court Rules ERISA Preempts Oklahoma Law Regulating PBMs
The U.S. Court of Appeals for the Tenth Circuit, in Pharmaceutical Care Management v. Mulready, has ruled that a state law regulating pharmacy benefit managers (“PBMs”) is preempted by the Employee...
Guidelines for Mental Health and Medical/Surgical Claims Need Not Be Identical
The U S District Court for the District of Utah has ruled, in L.D. v. United HealthCare, that a group health plan does not violate the Mental Health Parity and Addiction Equity Act (“MHPAEA”) if it...
COBRA Notice Need Not Be Single Notification
In deciding Bryant v. Walgreen Co., the U.S. District Court for the Northern District of Illinois addressed several important aspects of the COBRA notification requirements. Law. Employers must...
Claims Denial Overturned for Failure to Follow Claims Procedures
The U.S. Court of Appeals for the Tenth Circuit, in David P. v. United Healthcare Ins. Co., has reversed a group health plan’s benefits claim denial because the plan’s claims administrator failed to...
HHS Issues Warning About Online Tracking
The Office of Civil Rights (“OCR”) at the U.S. Department of Health and Human Services (“HHS”) and the Federal Trade Commission (“FTC”) have issued a letter, dated July 20, 2023 (the “Letter”),...
DOL Revises Medicaid/CHIP Model Notice
The Department of Labor (“DOL”) has released a revised Model Notice for employers to use to inform employees about the potential for them to receive state-provided premium assistance subsidies to...
Failure to Follow Claims Regulations Results in De Novo Review
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...
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...
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...
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...
FAQ Clarifies Status of In-Network Providers, Facility Fees
FAQ Clarifies Status of In-Network Providers, Facility Fees - Roberta Casper Watson, PLANSPONSOR, July 10, 2023 (PDF)
EBSA Publishes Regulatory Update on Health Facility Fees, Provider Networks
EBSA Publishes Regulatory Update on Health Facility Fees, Provider Networks - Roberta Casper Watson, planadviser, July 7, 2023 (PDF)
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...
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...
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...
IRS Requires Most Employee Benefit Plans to File Forms Electronically
IRS Requires Most Employee Benefit Plans to File Forms Electronically - The Wagner Law Group, LexisNexis Practical Guidance, April 2023
HIPAA Enforcement Suspended During Pandemic to Resume With 90 Day Transition Period for Telehealth
By Dannae Delano U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) issued the following four pieces of guidance announcing enforcement discretion during the COVID-19...
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 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...
The Wagner Law Group Ranked Among the Largest Women-Owned Businesses in Massachusetts
The Wagner Law Group Ranked Among the Largest Women-Owned Businesses in Massachusetts - March 15, 2023
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...
The Largest Women-Owned Businesses in Massachusetts
The Largest Women-Owned Businesses in Massachusetts - Boston Business Journal, February 24, 2023
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...
District Court Once Again Invalidates No Surprises Act Regulations
By Roberta Casper Watson, Dannae Delano and Barry Salkin The No Surprises Act directs the Departments of Treasury, Labor, and Health and Human Services (the “Departments”) to establish a Federal...
Rule Proposes Removing Moral Exemption to Contraception Mandate
Rule Proposes Removing Moral Exemption to Contraception Mandate - Marcia Wagner, SHRM, January 30, 2023 (PDF)
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,...
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...
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...
Attorney Andrew Oringer Joins The Wagner Law Group
Attorney Andrew Oringer Joins The Wagner Law Group - January 2, 2023
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...
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...
First Circuit Illustrates the Importance of the Fiduciary Responsibilities of Health and Welfare Plan Sponsors and Severance Providers Under ERISA
First Circuit Illustrates the Importance of the Fiduciary Responsibilities of Health and Welfare Plan Sponsors and Severance Providers Under ERISA - Dannae Delano, Barry Salkin and Roberta Casper...
Trade Association’s Insurance Program Not Covered by ERISA
Ninth Circuit Court of Appeals has ruled, in Steigleman vs. Symetra Life, that neither an employer nor its trade association created an ERISA-covered plan merely because the employer paid for long...
Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators
Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators - Roberta Casper Watson, panelist, Strafford live CLE webinar, January 4, 2023, 1:00 - 2:30 PM (EST) - Click here for...
Pre-existing Condition Exclusion Enforceable Despite Employer Misrepresentation
The Fifth Circuit Court of Appeals, in Bunner v. Dearborn Nat’l Life Ins. Co., has held that a disability insurer properly denied a claim for long-term disability (“LTD”) benefits based on the...
Plan Administrators May Not Adopt Rationales for Benefit Denials Not Raised During the Claims Review Process
The Ninth Circuit Court of Appeals, in Collier v. Lincoln Life Assurance Co. of Boston, has held that when a district court engages in a de novo review of an ERISA plan administrator’s denial of...
IRS Announces Increase in PCORI Fee
The IRS has released Notice 2022-59 to announce the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“PCORI”) fee for plan years ending before October 1, 2023....
The Wagner Law Group Signs Letter to Congress on Crucial HSA Issue
During the pandemic, Congress allowed telehealth services to be provided to HSA-eligible individuals without cost-sharing and without regard to whether they had met their deductibles under their...
New IRS Regulations Resolve “Family Glitch” Issue
The IRS has issued final regulations amending the Affordable Care Act (“ACA”) rules regarding eligibility for the law’s premium tax credit (“PTC”). The new rules provide that the “affordability” of...
Despite TPA’s Contractual Obligation, Employer May Still Be Liable for COBRA Notice Violation
An Alabama district court, in Howard v. Ivy Creek of Tallapoosa, LLC, has held that an employer could not avoid liability for failing to provide a COBRA election notice to a plan participant at the...
Independent Review Prevents “Cat’s Paw” Liability in FMLA Retaliation Claim
The Tenth Circuit Court of Appeals, in Parker v. United Airlines, Inc., has held that the “cat’s paw” theory of liability for FMLA retaliation or interference claims does not apply if the employer...
IRS Releases 2023 Welfare Benefit Plan Limits
The IRS has released Revenue Procedure 2022-38, which sets forth the 2023 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination...
Agencies Request for Comments on Issues Related to New Disclosures Under the No Surprises Act Indicate the Importance of Informing Marginalized Populations and Maintaining Privacy of Advance Health Care Information
By Roberta Casper Watson, Dannae Delano and Barry Salkin It should come as no surprise that most Americans do not have the information available to them that is necessary to make informed decisions...
Court Finds Employer’s Evidence of COBRA Notice Mailing Procedures Insufficient
An Illinois federal district court, in Earl v. Jewel Food Stores, Inc., has concluded that an employer failed to show it made a good faith effort to provide a COBRA election notice to a terminated...
Insurer Must Make “Reasonably Proximate” Coverage Determinations
The U.S. Court of Appeals for the First Circuit has ruled, in Shields v. United of Omaha, that an insurer must make a coverage determination for a plan participant within a reasonable period of time...
Court Defers to Insurer’s Discretionary Authority
The Eleventh Circuit Court of Appeals, in Stewart v. Hartford Life & Accident Insurance Company, has upheld a lower court’s decision to deny a plaintiff’s appeal for long-term disability (“LTD”)...
Ninth Circuit Requires Lower Court to Consider New Evidence in LTD Suit
The Ninth Circuit Court of Appeals, in Kay v. Hartford Life and Accident Insurance Company, has reversed a lower court’s decision upholding an insurer’s termination of long-term disability (“LTD”)...
Federal Court Finds Key Part of ACA’s Preventive Service Mandate Unconstitutional
A Texas federal district court, in Braidwood Management, Inc. v. Becerra, has held that the Affordable Care Act’s (“ACA’s”) requirement that most group health plans and health insurers cover certain...
ERISA Lawsuit Time-Barred Due to Plan’s Limitations Period
The Eleventh Circuit Court of Appeals, in Bakos v. Unum Life Insurance Company of America, has upheld the dismissal of a lawsuit for wrongful denial of long-term disability (“LTD”) benefits because...
Interaction Between FMLA and Mental Health Conditions
Interaction Between FMLA and Mental Health Conditions - Marcia Wagner, 401(k) Advisor, July/August 2022
No Surprises in Agencies’ Reproposal of Independent Dispute Resolution Regulations on No Surprise Act Billing Arbitration
By Danae Delano, Roberta Watson and Barry Salkin Last November, we published a law alert regarding the first two rounds of regulatory guidance on the No Surprise Billing portion of the Consolidated...
Court Finds Employee-Paid LTD Policy Was Part of Employer’s ERISA Plan
A federal district court in the Middle District of Tennessee has held, in Insurance Company of America, that a long-term disability (“LTD”) policy offered under an employer’s group health plan was...
Labor Opinions are Fair Game for Litigation After Circuit Ruling
Labor Opinions Are Fair Game for Litigation After Circuit Ruling - Roberta Watson, Bloomberg Law, August 19, 2022 (PDF)
McDonald’s Settles Lawsuit Over Deficient COBRA Notices
McDonald’s Settles Lawsuit Over Deficient COBRA Notices - SHRM, August, 17. 2022 (PDF)
Inflation Reduction Act’s Impact on Group Health Plans
On August 16, 2022, President Biden signed into law the Inflation Reduction Act (“IRA”). The new legislation contains several provisions impacting group health plans. Below is a description of...
HHS Again Proposes Nondiscrimination Regulations under Section 1557 of the Affordable Care Act
By Dannae Delano, Roberta Casper Watson and Barry Salkin Section 1557 of the Affordable Care Act (“ACA”) prohibits discrimination on the basis of race, color, national origin, sex, age or disability...
IRS Releases ACA Affordability Rates for 2023
The Internal Revenue Service has issued Revenue Procedure 2022-34 to implement the 2023 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
Agencies Issue Guidance on Contraception Coverage Requirements
The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies” ) have issued Frequently Asked Questions 54 (“FAQs”) regarding the contraception coverage requirements...
WEBINAR: Overturning Roe v. Wade: Impact on Employee Benefit Plans and Next Steps for Plan Sponsors and Administrators
Overturning Roe v. Wade: Impact on Employee Benefit Plans and Next Steps for Plan Sponsors and Administrators - Roberta Casper Watson, panelist, Strafford webinar, September 7, 2022, 1:00 - 2:30 PM...
Employer Cannot Terminate Employee’s Vested Retiree Life Insurance Benefits
The U.S. Court of Appeals for the Fourth Circuit, in Bellon v. The PPG Employee Life, has ruled that an employer cannot terminate retiree life insurance coverage of employees for whom it had...
HHS Issues Guidance on HIPAA Protections
In response to the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, the U.S. Department of Health and Human Services (“HHS”) has issued new HIPAA...
Employer Responses to Overturning of Roe v. Wade
Employer Responses to Overturning of Roe v. Wade - Roberta Casper Watson and Dannae Delano, LexisNexis Practical Guidance, July 11, 2022
UBS, Edward Jones And Others Keep Mum About Covering Abortion Travel Costs
UBS, Edward Jones And Others Keep Mum About Covering Abortion Travel Costs - Roberta Watson, ADVISORHUB, July 7, 2022 (PDF)
IRS Announces Decreases in ACA Affordability Threshold and Increases in ACA Employer Shared Responsibility Penalties for 2022 Plan Years
The IRS has recently updated its Questions and Answers on Employer Shared Responsibility Provisions under the Affordable Care Act to reflect 2022 indexing adjustments for the ACA’s affordability...
Mandated Benefits: 2022 Compliance Guide Mid-Year Update
Mandated Benefits: 2022 Compliance Guide Mid-Year Update – Katherine Brustowicz, Dannae Delano, David Gabor, Virginia Peabody, Barry Salkin, Marcia Wagner and Roberta Casper Watson, Wolters Kluwer,...
Asset Managers Affirm They’ll Pay for Travel
Asset Managers Affirm They'll Pay for Travel - Marcia Wagner, Pensions & Investments, July 4, 2022 (PDF)
Employers Providing Abortion Benefits Should Address Compliance Questions
Employers Providing Abortion Benefits Should Address Compliance Questions - Roberta Watson, SHRM, June 29, 2022 (PDF)
Employer Responses to Overturning of Roe v. Wade
Many employers are considering how to respond to the recent ruling overturning Roe v. Wade, which has given states the leeway to outlaw abortion. Employers may have employees who are on either side...
Delay in Final Claims Appeal Determination Excuses Claimant from ERISA’s Exhaustion of Administrative Remedies Requirement
The Second Circuit Court of Appeals, in McQuillin v. Hartford Life & Accident Ins. Co., has ruled that a claimant exhausted his plan’s administrative remedies and was, therefore, entitled to sue...
Plan’s Lawsuit Deadline Not Enforceable Unless Communicated in Final Claims Denial
In two recent cases, a judge in the United States District Court for the District of Utah has ruled that, if an ERISA welfare benefit plan sets a time limit on when a claimant may file a civil...
Employer Can Interfere with FMLA Rights Without Denying FMLA Leave
The United States Court of Appeals for the Seventh Circuit, in Ziccarelli vs. Dart, has ruled that an employer need not deny FMLA leave to an employee in order to interfere with his FMLA rights....
Companies Urged to Review Abortion Coverage With Roe in Balance
Companies Urged to Review Abortion Coverage With Roe in Balance - Roberta Watson, Bloomberg, News, June 8, 2022 (PDF)
Interaction Between FMLA and Mental Health Conditions
The Department of Labor (“DOL”) has released Fact Sheet 280 (“Fact Sheet”) and a series of FAQs with regards to the interplay between the FMLA and mental health conditions. Law. Under the FMLA,...
Small Employer Did Not Commit Itself to FMLA Leave Requirements
In Jones v. Wireless Time of Alabama, the U.S. District Court, Southern District of Alabama ruled that an employee was not entitled to FMLA leave despite the fact that her employer referred to the...
Insurer Breached Fiduciary Duty to Maintain Effective Benefit Enrollment System
The Eighth Circuit Court of Appeals, in Skelton v. Radisson Hotel Bloomington, has upheld a district court’s decision that an insurer acted as a fiduciary in determining eligibility and conducting...
IRS Announces 2023 Limits for HSAs, HDHPs and Excepted Benefit HRAs
The IRS has announced the cost-of living adjustments to the applicable dollar limits for health savings accounts (“HSAs”), high deductible health plans (“HDHPs”) and excepted benefit health...
Employers Cautioned as Suits Over COBRA Coverage Notices Add Up
Employers Cautioned as Suits Over COBRA Coverage Notices Add Up – Roberta Watson, Bloomberg News, April 29, 2022 (PDF)
IRS Announces Spike in 2023 Limits for HSAs and High-Deductible Health Plans
IRS Announces Spike in 2023 Limits for HSAs and High-Deductible Health Plans – SHRM, April 29, 2022 (PDF)
Employers Act as Fiduciaries When Managing Premium Payments for Benefit Plan
The Sixth Circuit Court of Appeals, in Chelf v. Prudential Insurance Company of America, has determined that a district court erred in dismissing a claim for breach of fiduciary duty based on...
IRS Proposes Change in Eligibility Provisions for ACA Premium Tax Credit
The IRS has issued a proposal that would amend the existing Affordable Care Act (“ACA”) regulations regarding eligibility for the law’s premium tax credit (“PTC”) to provide that the affordability...
HHS Increases Civil Monetary Penalties for Certain HIPAA and ACA Violations
The Department of Health and Human Services (“HHS”) has published updated civil penalties. The new penalty amounts, which became effective March 17, 2022, apply to violations occurring on or after...
Firing After FMLA Leave Did Not Violate FMLA
The Seventh Circuit Court of Appeals, in Anderson v. Nations Lending Corporation, has ruled that an employer’s decision to terminate an employee after returning from FMLA leave did not violate the...
Ninth Circuit Finds Welfare Plan Did Not Abuse Its Discretion In Denying Benefits
The Ninth Circuit Court of Appeals, in Alves v. Hewlett-Packard Comprehensive Benefits Plan, has found that a welfare benefit plan’s claims administrator did not abuse its discretion in denying a...
President Continues COVID Extensions
Reasoning that “the COVID-19 pandemic continues to cause significant risk to the public health and safety of the Nation,” President Biden has extended the COVID-19 National Emergency, which was...
Employer’s Recertification Requirement Doesn’t Interfere with Employee’s FMLA Rights
The U.S. Court of Appeals for the Eighth Circuit, in Whittington v. Tyson Foods, Inc., has concluded that an employer may require recertification of an employee’s need for leave under the Family and...
IRS Releases Revised Guidance on Medical and Dependent Care Expenses
The IRS has released the 2021 editions of Publication 502, “Medical and Dental Expenses” and Publication 503, “Child and Dependent Care Expenses.” Publication 502 (“Pub. 502”). Pub. 502 defines...
Employer Must Provide Retroactive Coverage and Pay Penalties for COBRA Election Notice Violations
The U.S. District Court of Michigan, in Buford v. General Motors, L.L.C., has concluded that an employer’s conduct violated COBRA election notice requirements and warranted the imposition of...
COVID-19 Long-Haulers May Have Tough Time Getting Long-Term Disability Benefits
COVID-19 Long-Haulers May Have Tough Time Getting Long-Term Disability Benefits – Marcia Wagner, SHRM, February 11, 2022 (PDF)
FMLA-Eligible Employee May Be Terminated for Violating Employer’s Leave Policy
In Koch v. Thames Healthcare Group, the United States Court of Appeals for the Sixth Circuit has ruled that an employee may be terminated for violating her employer’s leave policy despite the fact...
Insurer Cannot Terminate LTD Benefits Without Additional Information
The United States Court of Appeals for the Eighth Circuit has determined, in Roehr v. Sun Life Assurance Co. of Canada, that long term disability (“LTD”) benefits cannot be terminated by an insurer...
EEOC Issues COVID FAQs
The EEOC has issued Frequently Asked Questions (“FAQs”) on the enforcement of various Equal Employment Opportunity (“EEO”) laws with regard to COVID. These laws include the Americans with...
HIPAA Privacy and COVID-19 Vaccinations
The Department of Health and Human Services (“HHS”), in a series of Qs & As, has stated that the HIPAA Privacy Rules do not prohibit covered entities and business associates from asking whether...
Court Finds “No Harm No Foul” Where Employee Fails to Show She Suffered Harm from FMLA Violation
The U.S. District Court of Montana, in Jergens v. Marias Medical Center, has dismissed an employee’s claim for FMLA violations by her former employer because the employee failed to show that she...
Court Decision Highlights Importance of Complying with ERISA’s “Other Instruments Rule” for Document Disclosures
The U.S. District Court of Utah has confirmed, in M.S. v. Premera Blue Cross, that a plan administrator for a self-insured group health plan violated ERISA’s disclosure requirements in its response...
IRS Releases ACA Affordability Rates for 2022
The Internal Revenue Service has issued Revenue Procedure 2021-36 to implement the 2022 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
AD&D Plan Not Subject to State Health Insurance Law
The U.S. Court of Appeals for the Eighth Circuit has ruled, in Williams v. Unum Life, that a state law regulating health insurance policies does not apply to an accidental death and dismemberment...
Mental Health Parity is Finally Being Enforced
On August 12, 2021, the U.S. Department of Labor (“DOL”) issued a press release regarding a groundbreaking settlement reached with United Healthcare Insurance Co., United Behavioral Health and...
Employer’s Leave Policies Required It to Provide Paid Military Leave
The Third Circuit Court of Appeals has ruled, in Travers v. Federal Express, that the Uniformed Services Employment and Reemployment Rights Act (“USERRA”) requires employers to provide paid leave to...
FSA Debit Card Substantiation Rules
The IRS has released Information Letter 2021-0013 to reconfirm the substantiation rules for debit card use in health care flexible spending account plans (“FSAs”). Law. Health care FSAs may issue...
IRS Sheds Some Clarity on COBRA Premium Assistance
The American Rescue Plan Act of 2021 (ARPA) provides for a six-month period between April 1, 2021 and September 30, 2021, during which certain participants eligible for COBRA continuation coverage...
Court Settles Dispute When Employer Switches LTD Insurer
The Fifth Circuit Court of Appeals has determined, in Talamantes v Metropolitan Life Insurance Company, that a long-term disability (“LTD”) insurer was responsible for benefit payments even though a...
Agencies Issue Regulations Restricting Surprise Billing
The Biden administration, through HHS, DOL, IRS and the Office of Personnel Management (collectively, the “Agencies”), issued an interim final rule that aims to restrict excessive out-of-pocket...
Court Rejects Health TPA’s Cross-Plan Offsetting Practice
The U.S. District Court for the District of New Jersey, in Lutz Surgical Partners PLLC v. Aetna, Inc., has ruled that a group health plan administrator (“TPA”) cannot offset overpayments made to a...
DOL Says Claimant May Request Phone Call Recordings Relevant to Benefits Claim
The DOL has stated in a June 14, 2021 Information Letter, that under ERISA claims procedures, a participant must be given audio recordings of telephone conversations that are relevant to his claim...
Court Says No Specific Wording Required in Plan Document to Give Plan Discretionary Claims Authority
The Second Circuit Court of Appeals, in Tyll vs. Black and Decker Life Insurance Program, has ruled that a plan document is not required to use any specific language in order to give the plan...
IRS Announces 2022 HSA and HRA Limits
The IRS has announced the 2022 calendar year dollar limits for health savings account (“HSA”) contributions, the minimum deductible amounts and maximum out-of-pocket expenses for high deductible...
Court Confirms Participant Must Exhaust Administrative Remedies Before Filing a Suit
The U.S. District Court for the Southern District of New York, in Benson vs. Tiffany and Company SPD, has ruled that a participant in an ERISA-governed group health plan may not proceed with her...
IRS Finally Releases Guidance Implementing COBRA Subsidies but Leaves Important Questions Unanswered
On May 18, 2021, the IRS issued Notice 2021-31 providing highly anticipated guidance for employers who must implement the COBRA rules under ARPA (as we described in our publication on March 17,...
Employer Has Separate Obligations Under Workers’ Compensation and FMLA
The U.S. Court of Appeals for the Eleventh Circuit has ruled, in Ramji vs. Hospital Housekeeping Systems, that complying with the state’s workers’ compensation laws does not absolve an employer from...
Court Finds Project Completion Incentive Plan Not an ERISA-Covered Severance Plan
The U.S. Court of Appeals for the Fifth Circuit has ruled in Atkins vs. CB&I, LLC, that a Project Completion Incentive (“PCI”) plan which offered a bonus to employees upon termination of...
IRS Says Personal Protective Equipment Expenses are Qualified Medical Expenses
The IRS has issued Announcement 2021-7, which confirms that personal protective equipment (“PPE”) such as masks, hand sanitizer, and sanitizing wipes purchased “for the primary purpose of preventing...
Court Says Group Health Plan May Not Exclude Specified Autism Treatments
The District Court for the Northern District of California has ruled, in Doe v. United Behavioral Health, that the exclusion of certain specified procedures related to the treatment of autism...
American Rescue Plan Act Extends Tax Credits for COVID-19 Leave
On March 11, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (“ARPA”). Among other provisions aimed at economic recovery, ARPA extends employer tax credit opportunities...
Important Benefit Plan Provisions of the American Rescue Plan Act of 2021
By Dannae Delano, Israel Goldowitz, Barry Salkin and Roberta Casper Watson Although not the primary focus of the American Rescue Plan Act of 2021 (“ARPA”) and, at least with respect to the...
Court Says Welfare Plan Fiduciary Breached Duties by Misusing Participant Contributions
A federal district court in the Western District of Virginia has held, in Hammer v. Johnson Senior Ctr., that the fiduciary for a welfare plan violated its duties of loyalty, care and prudence by...
Surprise DOL Guidance on Conclusion of One-Year ERISA Compliance Relief Period
By Dannae Delano and Barry Salkin Even with widespread bipartisan support, it can be difficult to draft legislation to address all possible contingencies. In the wake of the events of September 11,...
IRS Guidance on Flexible Spending Account Relief Under CAA
The IRS has issued Notice 2021-15 (“Notice”) to provide clarification on the flexible spending account (“FSA”) relief contained in the Consolidated Appropriations Act, 2021 (“CAA”). The Notice also...
Employer Failed to Adequately Notify Participant of Group Life Insurance Conversion Rights
The Ninth Circuit Court of Appeals, in Estate of Foster v. American Marine Servs. Group Benefits Plan, has held that an employer failed to provide a former employee with adequate notice of the...
CMS Creates Additional Marketplace Special Enrollment Period
The Centers for Medicare & Medicaid Services (“CMS”) has determined that the COVID-19 emergency presents exceptional circumstances for consumers in accessing health insurance, and will be...
EEOC Explains Application of ADEA to ICHRAs
On January 7, 2021 the Equal Employment Opportunity Commission (“EEOC”) issued an opinion letter explaining the application of the Age Discrimination in Employment Act (“ADEA”) to individual...
FAQs Discuss Expiration of Paid Sick and Family Leave Requirements
The Department of Labor has issued additional FAQs regarding the expiration of the requirement that employers provide paid sick and family leave under the Families First Coronavirus Response Act...
EEOC Issues Proposed Regulations on Employer Wellness Programs
The Equal Employment Opportunity Commission (“EEOC”) has issued two sets of proposed regulations that would change certain rules on how employer-sponsored wellness programs that require employees to...
DOL Clarifies Use of Telemedicine for Purposes of FMLA Leave
The Department of Labor (“DOL”) has issued Field Assistance Bulletin (“FAB”) 2020-8 to provide guidance regarding the use of telemedicine in establishing a “serious health condition” under the...
Stimulus Package Makes Major Changes with Respect to Employer Sponsored Benefit Plans
By Dannae Delano, Barry Salkin and Roberta Casper Watson In a year-end piece of legislation intended to fund the federal government, especially one that is 5,593 pages in length, there is always the...
DOL Field Assistance Bulletin for FMLA Electronic Notices
The Department of Labor (“DOL”) has issued Field Assistance Bulletin (“FAB”) 2020-7 to provide guidance on when, as a matter of enforcement policy, it will consider the electronic posting of the...
Arkansas Pharmacy Law Not Preempted by ERISA
In Pharmaceutical Care Management Association v. Rutledge, the U.S. Supreme Court has held that ERISA does not preempt an Arkansas statute that imposes rules on pharmacy benefits managers (“PBMs”)....
Agencies Issue Final Grandfathered Group Health Plan Regulations
The Department of Labor, Department of Health and Human Services, and the IRS (collectively, the “Agencies”) have issued final regulations providing greater flexibility to plan sponsors that wish to...
IRS Explains “Qualified Health Plan Expenses” for Purposes of FFCRA Tax Credit
The IRS has issued FAQs to help employers determine the amount of “qualified health plan expenses” for purposes of determining their tax credit under the Families First Coronavirus Response Act...
IRS Confirms Options for Unused Qualified Transportation Benefits Due to COVID-19
Facts. The IRS released Information Letter 2020-0024 in response to an inquiry it received from a qualified transportation plan participant with unused transit benefits due to COIVD-19. In...
2021 Medicare Parts A & B Premiums and Deductibles
The Centers for Medicare & Medicaid Services (“CMS”) has announced the deductibles, premiums and coinsurance amounts for Medicare Part A and Part B for 2021. Medicare Part A covers inpatient...
Agencies Issue Final Regulations Regarding Health Care Transparency
By Barry L. Salkin, Roberta Casper Watson, and Dannae Delano Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments...
Agencies Issue Guidance on Coronavirus Diagnostic Testing and Immunizations
Section 6001 of the Families First Coronavirus Response Act (FFCRA) required group health plans and health insurance issuers to provide coverage for certain items and services including in vitro...
IRS Releases 2021 Welfare Benefit Plan Limits: Health FSA and HSA Limits Increase
The IRS has released Revenue Procedures 2020-45 and 2020-32, which set forth the 2021 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain...
Courts Decides ACA’s Individual Out-Of-Pocket Limits Do Not Apply Retroactively
The U.S. District Court for the Southern District of New York, in Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family...
Courts of Appeal Split on Circumstances Where it is Appropriate to Override the Arbitrary and Capricious Standard of Review
The U.S. Court of Appeals for the Eighth Circuit has ruled, in McIntyre v. Reliance Standard Life, that a claims decision will be judged under the arbitrary and capricious standard despite the fact...
IRS Again Extends Deadline for ALEs to Furnish ACA Reporting Forms to Employees
The IRS has issued Notice 2020-76, which provides an automatic deadline extension for Applicable Large Employers’ (“ALE”) reporting obligations to employees under the Affordable Care Act’s (“ACA”)...
Plan Participants Must be Informed of Plan Documents and Standards of Review
The Tenth Circuit Court of Appeals has ruled, in Lyn M. v. Premera Blue Cross, that the “arbitrary and capricious” standard cannot be applied to a plan administrator’s denial of a participant’s...
Employer May Be Held Liable for Service Provider’s Error
The Second Circuit Court of Appeals, in Sullivan-Mestecky v. Verizon Communications, Inc., has held that a plaintiff properly pled her breach of fiduciary duty claim for equitable relief against an...
DOL Responds to Decision of Southern District of New York Invalidating Four Provisions of the Family First Coronavirus Response Act
By Dannae Delano, Barry Salkin and Roberta Casper Watson On August 3, 2020, the District Court for the Southern District of New York ruled that four parts of the temporary rules adopted by the DOL...
Additional COVID-19 FAQs from the DOL About School Reopenings
The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave under the Families First Coronavirus Response Act...
Massachusetts Extends Annual Payroll Tax Exemption for Insured Plans
The Massachusetts Department of Family and Medical Leave has announced that the “annual” payroll tax exemptions received by employers for insured plans under the Paid Family and Medical Leave Law...
Ninth Circuit Rejects Request for Attorney’s Fees in ERISA Administrative Appeal
The Ninth Circuit Court of Appeals has held, in Castillo v. Metropolitan Life Ins. Co., that ERISA does not authorize an award of attorney’s fees incurred during the administrative phase of the...
DOL Releases New FMLA Forms
The U.S. Department of Labor (“DOL”) has released updated Family and Medical Leave Act (“FMLA”) forms. Background. Certain posters and forms are required under the FMLA to inform employees of their...
Federal District Court Invalidates Portions of the Final DOL Rules Implementing the Paid Leave Provisions of the Family First Coronavirus Response Act (FFCRA)
By Dannae Delano, Barry Salkin and Roberta Casper Watson The federal District Court for the Southern District of New York invalidated parts of the DOL’s final rules implementing the paid leave...
Employees May Choose Between Profit Sharing Plan and HRA Contributions
In Private Letter Ruling 202023001, the IRS has ruled that collectively bargained employees can allocate employer contributions between a profit sharing plan and a health reimbursement arrangement...
IRS Releases ACA Affordability Rates for 2021
The Internal Revenue Service has issued Revenue Procedure 2020-36 to implement the 2021 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
Additional COVID-19 FAQs from the DOL
The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave (“EPSL”) and Emergency Family and Medical Leave (“EFMLA”)...
Agencies To Provide More Flexibility for Grandfathered Group Health Plans
The Department of Labor, Department of Health and Human Services (“HHS”), and the IRS (collectively, the “Agencies”) have issued proposed regulations that would provide greater flexibility for plan...
COVID-19 Leave and Summer Camp Closures
The Department of Labor (“DOL”) has issued Field Assistance Bulletin No. 2020-4 ("FAB 2020-4") to provide guidance on when an employee may take paid leave under the Families First Coronavirus...
Agencies Issue Further Guidance on COVID-19
The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions #43 (“FAQs”) regarding implementation of the Families First...
1557 Rule Changes and Bostock
The Department of Health and Human Services (“HHS”) announced on June 12, 2020, as part of a new final regulation (the “Final Rule”), that it had eliminated Obama-era nondiscrimination rules under...
Massachusetts Announces Individual Mandate Figures for 2021
Although the penalties under the Affordable Care Act’s individual mandate were eliminated in 2017, Massachusetts has continued its own individual health insurance mandate as well as associated...
IRS Issues Guidance on COVID-19 Leave Donation Programs
The IRS has issued Notice 2020-46 to explain the tax consequences of employer-based COVID-19 leave donation programs. Background. The IRS recognized that, in response to the need to provide relief...
ACA Out-of-Pocket Limit and PCORI Fee Announced
HHS and IRS have announced inflation-adjusted out-of-pocket (“OOP”) limits that will apply to non-grandfathered health plans for plan years beginning in 2021, and the indexed PCORI fee. The OOP...
DOL and IRS Extend Certain Deadlines for Welfare Plans and Participants
The DOL and IRS have issued COVID-19 related guidance that temporarily extends certain deadlines applicable to welfare plans and their participants and beneficiaries. COVID-19 Related Guidance. In...
IRS Announces 2021 HSA Limits
The IRS has announced the 2021 calendar year dollar limits for health savings account (“HSA”) contributions, and the minimum deductible amounts and maximum out-of-pocket expenses for high deductible...
IRS Relaxes Rules for Cafeteria Plan Mid-Year Election Changes
The IRS, in Notice 2020-29, has relaxed the mid-year election change rules for cafeteria plans due to the nature of the public health emergency imposed by COVID-19, extended grace and carryover...
DOL Issues Revised COBRA Notices
The Department of Labor (“DOL”) has issued updated versions of its model general notice and model election notice to ensure that qualified beneficiaries better understand the...
Federal Agencies Extend Deadlines for COBRA and Health Plan Claims, Appeals, and Special Enrollments
In coordination, the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (collectively, the “Agencies”) have extended deadlines for multiple events...
IRS Extends Deadlines for Certain Filings and Actions for Employee Welfare Benefits Plan
The IRS has issued Notice 2020-23 to provide employers, employees and retirement plan service providers with relief from business disruptions from the COVID-19 pandemic. Notice 2020-23 automatically...
Further Guidance from DOL on the Families First Coronavirus Response Act
The Department of Labor (“DOL”) has issued additional FAQs that provide further guidance for employers and employees on the administration of the Emergency Paid Sick Leave (“EPSL”) Act and the...
Agencies Issue FAQs on Group Health Plan COVID-19 Coverage Requirements
HHS, DOL and IRS (the "Agencies") have jointly issued FAQ 42 to provide guidance on the implementation of the COVID-19 coverage requirements of the Families First Coronavirus Response Act ("FFCRA")...
IRS Releases Guidance on Requirements for Employers to Claim EPSL and EFMLA Tax Credits Under FFCRA
The IRS has issued guidance for employers with under 500 employees explaining how to claim a tax credit for emergency paid sick leave ("EPSL") and expanded FMLA ("EFMLA") under the Families First...
DOL Issues Guidance on Emergency Paid Sick Leave and Paid FMLA Under Families First Coronavirus Response Act
The DOL has issued a series of FAQs that provide guidance for employers administering the Emergency Paid Sick Leave ("ESPL") and the Emergency Family and Medical Leave Act ("EFMLA") under the...
HDHPs May Pay for COVID-19 Testing and Treatment
The IRS has issued Notice 2020-15 permitting High Deductible Health Plans ("HDHPs") to cover testing and treatment for COVID-19, without affecting the status of a person as an "eligible individual"...
Agencies Issue Proposed Rules Regarding Health Care Transparency
By Roberta Casper Watson and Barry Salkin Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments on how providers,...
No Statute of Limitations Protection Gained from Filing Forms for Employer Shared Responsibility Penalties
The IRS Office of Chief Counsel has released a memorandum stating that employers are not protected by a statute of limitations from the ACA's employer shared responsibility penalties ("ESRP"), even...
CMS Proposes Reporting Penalty Rule
The Centers for Medicare & Medicaid Services ("CMS") has proposed methods to calculate and impose civil penalties when a group health plan ("GHP") or a non-group health plan fails to comply with...
DOL Confirms Limited Partnership’s Health Plan is Not an ERISA-Covered Single Employer Plan
The United States Department of Labor ("DOL") has issued guidance (i.e., Advisory Opinion 2020-01A) to confirm that a limited partnership's health-benefit programs were not ERISA-covered group...
Agencies Release FAQs on Updated 2021 Summary of Benefits and Coverage Template
HHS, DOL and IRS (collectively, the "Agencies") have released FAQs discussing the recently updated version of the Summary of Benefits and Coverage ("SBC") template and related materials (i.e.,...
Cafeteria Plan Need Not Provide Mid-Year Election Changes
The IRS has reiterated, in IRS Information Letter 2019-0028, that while a Section 125 cafeteria plan may allow participants to make a mid-year pre-tax contribution election change because of the...
De Novo Standard Does Not Save Participant’s Claim
Although the Fifth Circuit Court of Appeals, in Ariana v. Humana Health Plan of Texas, held that the "de novo" standard of review applies to a denial of benefits, this was not sufficient to save a...
Evidence of Employer’s Mailing Procedures Does Not Prove COBRA Compliance
The United States District Court for the Middle District of Louisiana, in Randolph v. Baton Rouge Parish Sch. Bd., has ruled that an employer's declaration about its general business practices was...
Employees Need Not Expressly Request FMLA Leave
The United States District Court for the District of Maine, in Waterman v. Paul G. White Interior Solutions, has ruled that a terminated employee may continue his Family and Medical Leave Act...
Retiree Medical Benefits Vest for Life and Survived CBA Termination
The Seventh Circuit Court of Appeals, in Stone v. Signode Industrial Group, LLC, has upheld a district court's decision that an employer was obligated to continue providing lifetime health care...
New Laws Impact ACA and Employer-Sponsored Health Plans
President Trump has signed into law a spending package which includes the Further Consolidated Appropriations Act, (the "Act"), and contains a number of provisions related to employer-sponsored...
Federal Circuit Court Determines ACA’s Individual Mandate is Unconstitutional
The Fifth Circuit Court of Appeals, in Texas v. United States, has upheld a district court ruling that the individual mandate provision of the Affordable Care Act ("ACA") is unconstitutional....
IRS Issues Qs&As on the ACA’s Individual Shared Responsibility Provisions
The IRS has issued a set of Qs&As explaining the Individual Shared Responsibility provisions of the ACA after the elimination of the individual shared responsibility penalty. Background....
Increased Penalties for HIPAA Noncompliance
HHS has issued final regulations containing inflation adjustments to the civil penalties for violations of HIPAA's "administrative simplification" rules. Background. The inflation adjustments are...
IRS Extends Deadline for ALEs to Furnish ACA Reporting Forms to Employees
The IRS has issued Notice 2019-63, which provides an automatic deadline extension for Applicable Large Employers' ("ALEs") reporting obligations under the Affordable Care Act's ("ACA"s) Employer...
2020 Medicare Part A Deductibles and Part B Premiums
The Centers for Medicare & Medicaid Services ("CMS") has announced the Medicare Part A deductibles and Part B premiums for 2020. Medicare Part A covers inpatient hospital and hospice care, while...
IRS Releases 2020 Limits for Welfare Benefit Plans: Health FSA and HSA Limits Increase
The IRS has released the 2020 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests. Health FSAs. The limit for employee...
DOL Says FMLA Leave Runs Concurrently with Paid Leave
The U.S. Department of Labor ("DOL") has issued Opinion Letter FMLA2019-3-A, which confirms that the terms of a leave policy provided under a collective bargaining agreement ("CBA") cannot supersede...
Employers with California Employees who sponsor Flexible Spending Accounts May Have New Notice Requirements
A new California law (AB 1554) imposes a new notice mandate on employers with employees in California. The law requires employers, beginning in 2020, to notify their flexible spending account (FSA)...
Final Regulations Rescind HIPAA Health Plan Identifier Rules
The Department of Health and Human Services ("HHS") has rescinded earlier regulations governing the health plan identifiers ("HPIDs") that group health plans were required to obtain and use in...
LTD Claim Denial Subject to Stricter Standard of Review Due to Untimely Decision
The Seventh Circuit Court of Appeals, in Fessenden v. Reliance Standard Life Ins. Co., has held that a plan administrator's decision to deny a participant's claim for long-term disability ("LTD")...
Participant May Sue Insurer Before Exhausting Administrative Remedies
The U.S. District Court for the District of Arizona has ruled, in Greiff vs. Life Insurance Company of North America, that a long-term disability plan participant need not exhaust an insurer's...
IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules
The IRS has issued proposed regulations to clarify the application of the ACA's employer shared responsibility provisions under Section 4980H of the Internal Revenue Code (the "Code") and certain...
Genetic Testing May Include Medical Expenses
The IRS has ruled, in Private Letter Ruling 201933005, that portions of the cost of a genetic testing service may be considered medical expenses and may, therefore, be reimbursed by a health care...
Agencies Issue Final FAQs on Mental Health Parity Implementation
HHS, DOL and IRS have issued final FAQs on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act ("MHPAEA"). The MHPAEA requires that the financial requirements...
CHIP Notice Revised
The Department of Labor ("DOL") has released a revised and updated model notice that employers can use to inform employees of the potential for state premium assistance subsidies for the purchase of...
Single Document Can Serve as ERISA Plan Document and SPD
The Eighth Circuit Court of Appeals, in MBI Energy Services v. Hoch, has held that a self-insured medical plan is entitled to reimbursement because its summary plan description ("SPD") was also the...
Agencies Issue Guidance on Impact of Drug Manufacturer Coupons on ACA’s Out-Of-Pocket Limits
DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing...
ERISA Plan Administrator Denies STD Claim Too Quickly
The United States District Court for the District of Nevada, in Speca v. Aetna Life Ins. Co., has ruled that a ERISA plan administrator did not provide a full and fair review when it denied a short...
Attending Children’s Special Education Meetings Covered by FMLA
The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2019-2-A confirming that an employee may take leave under the Family Medical Leave Act of 1993 ("FMLA") to attend special...
Requirements for Requesting FMLA Leave Cannot Be More Onerous than for Requesting Non-FMLA Leave
The United States District Court for the Southern District of Alabama, in Moore v. GPS Hospitality Partners IV, LLC, etc., has ruled that an employer's notice and procedural rules for requesting...
Plan Administrator Deemed an ERISA Fiduciary
The Fourth Circuit Court of Appeals, in Dawson-Murdock v. Nat'l Counseling Group, Inc., has allowed a life insurance beneficiary to sue her husband's employer for breach of fiduciary duties...
IRS Releases ACA Affordability Rates for 2020
The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine...
IRS Expands List of Preventive Care Benefits
IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to...
A Sigh of Relief For Employers Subject to Potential ACA Disparate Impact Discrimination Claims
In the aftermath of Title VI of the Civil Rights Act of 1964, litigants have pressed courts on what conduct meets the criteria for a disparate impact discrimination claim. Typically, a disparate...
Was The Court of Claims Correct for the Wrong Reason?
In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA")...
Court Finds an Employee’s Vacation While On FMLA Leave is Acceptable
The Massachusetts Supreme Judicial Court ("SJC"), in DaPrato v. Mass. Water Resources Authority, has affirmed a jury's finding that an employee was wrongfully terminated for taking a vacation to...
Apprenticeship Training Programs Must File Electronic Notice to be Exempt from ERISA’s Reporting and Disclosure Requirements
The U.S. Department of Labor ("DOL") has issued new regulations requiring apprenticeship training programs to file electronically in order to take advantage of an exemption from ERISA's reporting...
HHS Guidance on When One Health Plan May Share PHI of Individuals with Another Health Plan
HHS has issued FAQs that provide guidance on the circumstances under which HIPAA's Privacy Rule allows for one health plan to share protected health information ("PHI") about individuals who "have a...
Beneficiary May Sue Trustees of One ERISA Plan for Fiduciary Breaches Causing Loss of Benefits under Another ERISA Plan
The U.S. District Court for the Southern District of New York, in DeRogatis v. Bd. of Trustees of the Cent. Pension Fund of the Int'l Union of Operating Engineers, has held that ERISA allows a...
Agencies Expand HRA Availability to Provide Coverage
In response to an Executive Order from President Trump, the DOL, HHS, and the IRS proposed new regulations to expand the use of HRAs to pay for certain medical expenses. They now have released...
Massachusetts Delays the Start of Paid Family and Medical Leave Program by Three Months
Delayed Contribution Date: On Friday, June 14, 2019. the Commonwealth of Massachusetts has delayed Paid Family and Medical Leave (PFML) contributions from employers and employees. The new start...
HHS Proposes Revised ACA Section 1557 Regulations
HHS has issued proposed regulations that, if finalized, would significantly revise existing regulations issued under Section 1557 of the Affordable Care Act ("ACA"). The proposed regulations would...
IRS and HHS Release Certain Limits for Welfare Benefit Plans in 2020
The IRS and HHS have released some of the 2020 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests. Health Savings...
Forfeiture of Transportation Benefits
In Information Letter 2019-002, the IRS has confirmed that unused transportation benefits will be forfeited when an employee terminates employment. Qualified transportation fringe benefits include:...
Guidance on When Employers Can Prorate Bonuses of Employees on FMLA Leave
The Second Circuit Court of Appeals, in Clemens v. Moody's Analytics, Inc., has held that an employer did not unlawfully interfere with an employee's rights under the Family and Medical Leave Act...
HHS Reduces Maximum Penalty Amounts for Certain HIPAA Violations
The Department of Health and Human Services ("HHS") has lowered the maximum civil monetary penalty amounts for most violations of the Health Insurance Portability and Accountability Act ("HIPAA")...
Current Association Health Plan Contracts Safe
The Department of Labor ("DOL") has announced that it will not take action against association health plans ("AHPs") that comply with its final regulations, even though these regulations were...
State Law Claims Not Preempted by ERISA
The U.S. Court of Appeals for the Ninth Circuit, in The Depot, Inc. vs. Caring for Montana, has ruled that state law claims of fraud and misrepresentation are not preempted by ERISA. Facts: Three...
Participant’s Disability Claim is Time-Barred
The U.S. Court of Appeals for the Second Circuit has ruled, in Arkun v. Unum Group, that a plan participant could not sue to restore her long-term disability ("LTD") benefits because the suit was...
Relative of 2-Percent Shareholder May Deduct Cost of Health Insurance
Certain individuals who receive health care coverage from an S corporation must include the cost of the coverage in their income because of their relationship to the owner of the S corporation....
Plan May Deny Coverage for Bariatric Surgery
The U.S. Court of Appeals for the Fifth Circuit, in Rittinger v. Healthy Alliance Life Insurance Company, has ruled that a plan administrator that has been granted discretionary authority with...
Court Upholds LTD Insurer’s Claim Denial Based on Failed Validity Tests
The Eighth Circuit Court of Appeals, in Johnston v. Prudential Ins. Co., has affirmed a lower court's ruling that the defendant insurer acted appropriately in terminating the plaintiff's long...
Federal Judge Strikes Administration’s Regulations Expanding Access to Association Health Plans as Illegal
A federal judge in Washington, D.C., ruled last Thursday that the current administration's attempt to broaden the types of health plans that can avoid the coverage rules under Title I of ERISA...
Claims Denial Appeal Period Begins on Date of Denial, Not Date Benefits Cease
The First Circuit Court of Appeals has ruled, in Fortier v. Hartford Life and Accident Insurance Company, that a long term disability ("LTD") plan's 180 day period for claims denial appeals begins...
DOL Says Employees Cannot Decline FMLA Leave When Absence is Covered by FMLA
The U.S. Department of Labor ("DOL") has issued Opinion Letter FMLA2019-1-A clarifying that neither an employer nor an employee may delay designating paid leave as Family and Medical Leave Act...
LTD Benefit Denial Overturned
The Ninth Circuit Court of Appeals, in Kott v. Agilent Technologies Inc. Disability Plan, has determined that a plan administrator abused its discretion in denying long-term disability ("LTD")...
Plans Cannot Prevent Participant from Appointing an Authorized Representative
In a letter dated February 27, 2019, the Department of Labor ("DOL") has reiterated that an ERISA-covered plan cannot prevent a plan participant from appointing an authorized representative for...
Firing After Leave Request Denial May Be FMLA Violation
The United States District Court for the Southern District of Texas, in Byrd v. City of Houston, has determined that a plaintiff-employee's Family and Medical Leave Act ("FMLA") claim should be...
DOL Guidance on ERISA Preemption
The United States Department of Labor ("DOL") has issued an Information Letter confirming that state laws requiring employers to obtain written consent before withholding amounts from employees'...
IRS Provides Additional Examples Where Employers May Recover HSA Contributions
The IRS has issued Information Letter 2018-0033, which provides details on certain situations that allow an employer to request the return of Health Savings Account ("HSA") contributions it made on...
Proposed Regulations Implementing Massachusetts’ Paid Family and Medical Leave Law
The Massachusetts Department of Family and Medical Leave (the "Department") has released proposed regulations explaining the rights and responsibilities of employers and employees under...
Employer Allowed to Deny Employee Pay Differential Due to FMLA-Related Absences
The United States District Court for the Eastern District of Arkansas, in Flowers v. McCartney, has determined that an employer did not violate the Family and Medical Leave Act ("FMLA") when it...
Court Rejects Third-Party Administrator’s Cross-Plan Offsetting Practice
The Eighth Circuit Court of Appeals, in Peterson v. UnitedHealth Group Inc., has upheld a district court's decision that a third-party administrator ("TPA") cannot engage in cross-plan offsetting to...
FMLA Leave Cannot be Assessed if Employee Not Required to Report to Work
The U.S. District Court for the District of Alaska, in Acosta v. State of Alaska, has held that an employer could not count the time that a rotational employee was not scheduled to work as part of...
Guidance on Parking Expenses as Qualified Transportation Fringe Benefits
The IRS has released Notice 2018-99 to provide guidance to taxpayers on determining the amount of parking expenses for qualified transportation fringe benefits that is nondeductible and/or subject...
Insurer’s Acceptance of LTD Insurance Premiums Does Not Guarantee Coverage
A federal district court has ruled, in Ward v. Aetna Life Insurance Company, that a long-term disability ("LTD") insurer's denial of the plaintiff's benefit claim was appropriate even though the...
2019 Medicare Part A Deductibles and Part B Premiums
The Centers for Medicare & Medicaid Services ("CMS") has announced the Medicare Part A deductibles and Part B premiums for 2019. Medicare Part A covers inpatient hospital and hospice care, while...
Federal Court Rules Affordable Care Act Unconstitutional
A federal district court, in the Northern District of Texas, has ruled, in Children's Hospital Association of Texas v. Azar et. al., that the individual mandate provision contained in the Affordable...
FMLA Claim Viable Even Though Employee Not Yet Eligible for FMLA Leave
The U.S. District Court for the Eastern District of Wisconsin, in Reif v. Assisted Living by Hillcrest LLC, has confirmed that a Family and Medical Leave Act ("FMLA") claim may be triggered when an...
IRS Extends Deadline for ALEs to Distribute 2018 ACA Reporting Forms to Individuals
The IRS has issued Notice 2018-94, which provides a 30-day extension to the deadline for Applicable Large Employers ("ALEs") to distribute the 2018 Affordable Care Act ("ACA") reporting forms to...
IRS Issues Additional Guidance on Proposed HRA Regulations
The IRS has issued Notice 2018-88 to provide guidance on its proposed Health Reimbursement Account ("HRA") regulations and their application to two Internal Revenue Code requirements: the Affordable...
IRS Releases 2019 Limits for Welfare Benefit Plans: Health FSA and HSA Limits Increase
The IRS has released the 2019 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests. Health FSAs. The limit for employee...
Failure to Promote is Viable Basis for FMLA Discrimination Claim
A federal district court, in Browett v. City of Reno, has determined that a plaintiff's claim of discriminatory interference under the Family and Medical Leave Act ("FMLA") could be based on his...
Massachusetts Unveils New Reporting Requirement
Massachusetts has sent emails to many employers in the state, informing them that they are responsible for completing the new Health Insurance Responsibility Disclosure ("HIRD") form by the end of...
Proposed Regulations Expand Employers’ Use of HRAs
HHS, DOL and IRS (the "Agencies") have jointly issued proposed regulations intended to expand the use of health reimbursement arrangements ("HRAs") by employers. Background. HRAs are...
No Breach of ERISA Fiduciary Duty for Employer’s Failure to Provide Notice of Life Insurance Conversion Rights
The Sixth Circuit Court of Appeals, in Vest v. Resolute FP US Inc., has affirmed a district court's decision to dismiss a breach of fiduciary duty claim based on a sponsoring employer's failure to...
HHS’s Final Rule Increases Penalty Amounts for HIPAA Noncompliance
HHS has issued a final rule, effective October 11, 2018, to implement certain inflation adjustments to the civil monetary penalties imposed on violations of the administrative simplification rules...
ERISA Does Not Preempt State’s Unfair Trade Practices and Mental Health Parity Laws
In Hansen v. Group Health Plan Cooperative, the Ninth Circuit Court of Appeals ruled that a state's unfair trade practices and mental health parity laws will not be preempted by ERISA unless certain...
IRS Provides Additional Guidance on Paid Family and Medical Leave Tax Credit
The IRS has issued Notice 2018-71 which provides additional guidance on the paid Family and Medical Leave Act ("FMLA") tax credit which was created by the Tax Cuts and Jobs Act of 2017. Background...
Individual Policies May Create ERISA-Covered Plan
The federal district court for the Eastern District of California has ruled, in Bommarito v. Northwestern Mutual Life, that a group of individual insurance policies are an ERISA-covered plan because...
Agreement Required District Court to Consider Information from Post-Complaint Internal Review Process
The First Circuit Court of Appeals, in Doe v. Harvard Pilgrim Health Care ("HPHC"), has held that the district court erred in upholding a benefit claim denial because it neglected to enforce an...
Certain Employers Receiving IRS Letters to Request Information on ACA Reporting
The IRS has been sending letters to certain employers to request information about whether they satisfied their ACA reporting obligations for 2015 and 2016. Specifically, the letter is entitled...
DOL Confirms that Organ Donors Can Qualify for FMLA Leave
The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2018-2-A confirming that organ donation surgery can qualify as a "serious health condition" that is eligible for protection...
Unwanted Employer-Paid Life Insurance Taxable to Employee
The Fifth Circuit Court of Appeals, in Ramsay v. Commissioner of Internal Revenue, has upheld the Tax Court's determination that the value of employer-paid group term life insurance was taxable...
Court Says Administrator’s Denial of Disability Benefit Claim Was Arbitrary and Capricious
The Tenth Circuit Court of Appeals, in McMillan v. AT&T Umbrella Benefit Plan No. 1, has affirmed a district court's decision to reverse a plan administrator's denial of short-term disability...
Agencies Issue Final Rule that Expands Duration of Short-Term, Limited-Duration Health Insurance
HHS, DOL and IRS (the "Agencies") have jointly issued a final rule on August 3, 2018 (Fed. Reg., V. 83,8/3/18 p. 38212) that expands the availability of short-term, limited-duration health...
Medicare and ERISA Preempt Arkansas Pharmacy Benefits Manager Law
The Eighth Circuit Court of Appeals, in Pharmaceutical Care Management Association v. Rutledge, has held that Medicare Part D and ERISA preempt an Arkansas statute that imposed regulations on...
Anti-Assignment Provision Does Not Prevent the Grant of Power of Attorney
Although the Third Circuit Court of Appeals ruled in American Orthopedic & Sports Medicine vs. Independence Blue Cross Blue Shield, that a group health plan's anti-assignment provision was...
Employee Must Renew Request for Intermittent FMLA Leave Annually
The U.S. District Court for the Middle District of Pennsylvania has ruled, in Feistl v. Luzerne Intermediate Unit, that an employee on intermittent leave is not protected by the Family and Medical...
Health Plan Must Cover Room and Board During Residential Treatment for Mental Illness
The Ninth Circuit, in Danny P. v. Catholic Health Initiatives, has ruled that a group health plan violated the Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA") when it denied...
IRS Releases ACA Affordability Rates for 2019
The Internal Revenue Service has issued Revenue Procedure 2018-34 to implement index adjustments for 2019 for certain Affordable Care Act ("ACA") contribution percentages used to determine...
Massachusetts Paid Medical Leave Law
Massachusetts has enacted a mandatory statewide paid family and medical leave program which will be administered by a newly created Department of Family and Medical Leave (the "Department") within...
Association Health Plan Final Regulations
The US Department of Labor ("DOL"), after consultation with the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Department of the Treasury and the IRS,...
Employer Created ERISA Covered Plan by Endorsing LTD Policy
A federal district court, in Stolebarger v. Prudential Insurance Company of America, ruled that long-term disability ("LTD") benefits were covered by ERISA because the employer had "endorsed" the...
Insurer’s Payment of Reduced Benefit Not a Fiduciary Breach
The Fourth Circuit Court of Appeals, in Gordon v. CIGNA Corp., has affirmed a lower court's determination that an insurance company did not breach its fiduciary duty under ERISA when it paid an...
Sixth Circuit Decision Highlights Importance of Firestone Language for Plan Interpretation
The Sixth Circuit Court of Appeals, in Clemons v. Norton Healthcare Retirement Plan, held that certain doctrines of contract interpretation did not apply to resolve ambiguities in an ERISA plan once...
ERISA Plan’s Anti-Assignment Provision Bars Healthcare Provider’s Benefit Claim
The Ninth Circuit Court of Appeals, in Eden Surgical Center v. Cognizant Technology Solutions Corp., dismissed a healthcare provider's lawsuit against a group health plan in which the provider...
Severance Plan Not Covered by ERISA
The Third Circuit Court of Appeals has ruled, in Girardot v. The Chemours Company, that an employer's severance plan is not a welfare benefit plan as defined under ERISA and, therefore, plan...
IRS Announces 2019 HSA Limits
The IRS has announced the 2019 calendar year dollar limits for health savings account ("HSA") contributions, and the minimum deductible amounts and maximum out-of-pocket expenses for high deductible...
Post-FMLA Leave Not Required Under ADA
The U.S. Supreme Court has declined to review Severson v. Heartland Woodcraft, Inc., which leaves standing a Seventh Circuit Court of Appeals decision concerning the availability of extended leave...
IRS FAQs Provide Guidance About the Paid Family and Medical Leave Tax Credit
The IRS has issued FAQs that provide guidance to employers on the Paid Family and Medical Leave Tax Credit which was created by the Tax Cuts and Jobs Act of 2017. Background. The FMLA Tax Credit, as...
Agencies Issue Proposed FAQs on Mental Health Parity Implementation
HHS, DOL and IRS (the "Agencies") have jointly issued proposed FAQs to provide guidance on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act of 2008 (the...
Employee Awarded Benefits Due to Employer’s Flawed Administrative Procedures
In Frye v. Metropolitan Life Insurance Co., a federal district court in Arkansas has held that an employee is entitled to proceeds from dependent life and accidental death and dismemberment...
Employee’s ADA and FMLA Claims Dismissed Due to Attendance Issues
In Wolf v. Lowe's Companies, Inc., a federal district court in Texas dismissed a former employee's Americans with Disabilities Act ("ADA") Family and Medical Leave Act ("FMLA") discrimination claims...
Sixth Circuit Finds Disability Claimant Wasn’t Deprived of a Full and Fair Review
In Castor v. AT&T Umbrella Plan No. 3, the Sixth Circuit rejected an employee's claim that the administrator for her employer's disability plan had violated the DOL's claims procedure...
Participant Has Burden of Proof in LTD Claim
In Castor v. AT&T Umbrella Plan No. 3, the Sixth Circuit rejected an employee's claim that the administrator for her employer's disability plan had violated the DOL's claims procedure...
Fifth Circuit Adopts Standard of Review for ERISA Benefit Denial Claims
The Fifth Circuit Court of Appeals, in Ariana v. Humana Health Plan of Texas, has held that the "de novo" standard of review applies to ERISA denial of benefits claims involving challenges to a...
Supreme Court Says Retiree Health Benefits Ended When CBA Expired
The U.S. Supreme Court, in CNH Industries N.V. v. Reese, has ruled that certain retiree health benefits provided under a collective bargaining agreement ("CBA") terminated when the CBA expired. In...
IRS Reduces HSA Contribution Limits for Family HDHP Coverage
The IRS has released Revenue Procedure 2018-18 to implement certain changes under the Tax Cuts and Jobs Act ("Act"). One of the changes affecting health and welfare plans is a change to the...
Agencies’ Proposed Rule Expands Duration of Short-Term Health Insurance
HHS, DOL and IRS (the "Agencies") have jointly issued a proposed rule that expands the availability of short-term, limited-duration health insurance. The proposed rule would allow consumers to buy...
Federal Court Explains What Constitutes FMLA Interference
An Illinois federal district court, in Hall v. Board of Education of the City of Chicago, has determined that an employer may have interfered with a teacher's FMLA rights when it requested that she...
Sick Pay Is Not “Wages” under Massachusetts Law
The Massachusetts Supreme Judicial Court, in Tze-Kit v. Massachusetts Port Authority, held that sick pay does not constitute wages under the Massachusetts Payment of Wages Law. Accordingly,...
Employee’s FMLA Retaliation Claim May Proceed to Trial Due to Close Timing of FMLA Request and Termination
A federal district court, in Walpool v. Frymaster, LLC, has allowed a terminated employee's Family and Medical Leave Act ("FMLA") retaliation claim to proceed to trial due to the close proximity...
Congress’ Spending Bill Delays Certain ACA Taxes and Extends CHIP
On January 22, 2018, President Trump signed into law a short-term spending bill (i.e., a "continuing resolution") that reopened and refunded the federal government for three weeks (i.e., until...
ERISA Doesn’t Preempt Montana’s Mental Health Parity Law
A federal district court, in Sand-Smith v. Liberty Life Assurance Company of Boston, determined that ERISA did not preempt Montana's mental health parity law and that the state law was therefore...
A Window into the DOL Wage and Hour Division: Opinion Letters Shed Light
The U.S. Department of Labor Wage and Hour Division ("WHD") is responsible for providing guidance regarding wage and hour questions that arise under the Fair Labor Standards Act ("FLSA")....
DOL Announces Applicability Date for Disability Claims Regulations
The DOL has announced April 1, 2018 as the effective date for its final disability claims procedure regulations. The regulations were originally slated to apply to disability claims filed on or...
DOL to Expand Association Health Plans
The Department of Labor has issued proposed regulations that would allow "bona fide groups or associations of employers" to more easily join together to form Association Health Plans ("AHPs") that...
IRS Extends Deadline for ALEs to Distribute 2017 ACA Reporting Forms to Individuals
The IRS has issued Notice 2018-06, which provides an automatic 30-day extension to the deadline for Applicable Large Employers ("ALEs") to distribute the 2017 Affordable Care Act ("ACA") reporting...
2018 Medicare Part A Deductibles and Part B Premiums
The Centers for Medicare & Medicaid Services ("CMS") has announced the Medicare Part A deductibles and Part B premiums for 2018. Medicare Part A covers inpatient hospital and hospice care, while...
TPA’s Recordkeeping Demonstrates Employer Met COBRA Notice Requirements
The Eleventh Circuit Court of Appeals, in DeBene v. Bay Care Health System, Inc., determined that an employer had met its COBRA notification requirements based solely on ample evidence of its...
“Lifetime” Retiree Health Benefits Ended When CBA Expired
The Sixth Circuit Court of Appeals, in Watkins vs. Honeywell International Inc., determined that an employer's promise to provide healthcare benefits for its retirees expired when the collective...
Employer Not Liable for Failure to Send COBRA Election Notice
In Sanders vs. Temenos, Inc. the U.S. District Court for the Southern District of Florida determined that an employer was not liable for a failure to provide a COBRA notice because its former...
IRS to Begin Assessing Penalties for Employer Shared Responsibility Provisions
The IRS has announced, through a series of questions and answers, that it will begin the process of assessing penalties for violations of the Affordable Care Act's ("ACA"s) employer shared...
ACA’s PCORI Fee Increases
IRS Notice 2017-61 provides that the latest Patient Centered Outcomes Research Institute ("PCORI") fee amount for policy and plan years that end on or after October 1, 2017, and before October 1,...
Massachusetts Increases Employers’ Health Care Assessments
Massachusetts Governor Baker has signed Bill H. 3822 "An Act Further Regulating Employer Contributions to Health Care" (the "Act"), which will temporarily increase fees for the state's Employer...
IRS Releases Guidance on QSEHRAs
The IRS has released guidance on the requirements for eligible small employers to offer qualified small employer health reimbursement arrangements ("QSEHRAs") to eligible employees. In Notice 2017-...
Employer’s Honest Belief of FMLA Abuse Defeats Employee’s Retaliation Claim
The Third Circuit Court of Appeals, in Capps v. Mondelez Global, LLC, has ruled that an employer's decision to terminate an employee based on its honest belief that the employee misused FMLA leave...
Disability Claims Regulations Delayed
The DOL has proposed a 90-day delay in the effective date of the new ERISA disability claims regulations. This would change the effective date of the regulations to April 1, 2018. Background. In...
IRS Guidance on Health Care Reporting Requirements for 2017 Income Tax Returns
The IRS has stated that it will not accept Forms 1040 for the 2017 tax year if the taxpayer does not report on the ACA's health coverage reporting requirements. This is the first year that the IRS...
New Agency Rules Expand ACA’s Contraceptive Coverage Exceptions
The IRS, DOL and HHS have released two interim final rules that implement President Trump's executive order exempting certain employers from the ACA's contraceptive coverage mandate. The interim...
No New COBRA Election Period for Incapacity
A California District Court, in Regents of the Univ. of Ca. v. Stidham Trucking, Inc., has ruled that while a COBRA election period may be tolled during a period of incapacity, being incapacitated...
ACA Does Not Prohibit Lifetime Benefit Caps for Retiree-Only Benefit Plans
The Ninth Circuit Court of Appeals, in King v. Blue Cross and Blue Shield of Illinois, has ruled that the ACA does not prohibit lifetime benefit maximums for retiree-only plans. However, the court...
Pregnancy is Not a Pre-existing Condition for Disability Insurance
The U.S. Court of Appeals for the Eleventh Circuit, in Bradshaw v. Reliance Standard Life Insurance Co., has rejected a disability insurer's decision to deny disability benefits to an insured who...
Individual Supervisor May be Liable under FMLA
A Massachusetts District Court, in Eichenholz v. Brinks Incorporated, et. al., has determined that an individual supervisor may be held personally liable for violating an employee's FMLA rights....
IRS Releases ACA Affordability Rates for 2018
The Internal Revenue Service has released Revenue Procedure 2017-36 to implement index adjustments in 2018 for certain Affordable Care Act ("ACA") contribution percentages used for purposes of...
IRS Guidance Clarifies Impact of Executive Order on ACA Mandate Penalties
The IRS recently released four information letters to clarify and confirm that the employer and individual mandate penalties of the Affordable Care Act ("ACA") continue to apply. The information...
DOL to Review Disability Claims Procedure Regulations
DOL recently announced that it will review ERISA's disability claims procedures regulations for questions of law and policy to determine if they should be amended, delayed, or withdrawn. The...
IRS Releases 2017 Draft Forms for ACA’s Employer Reporting Requirements
The IRS has released draft versions of the Forms 1094 and 1095 that employers will use to satisfy their ACA reporting obligations for the 2017 tax year. Background. The ACA amended the Internal...
Fifth Circuit Finds SPD to be Official Welfare Plan Document
The Fifth Circuit Court of Appeals, in Rhea v. Alan Ritchey, Inc. Welfare Benefit Plan, has confirmed that a welfare benefit plan's summary plan description ("SPD") could serve as the official plan...
“Cat’s Paw” Liability Theory Applies to FMLA Retaliation Claims
The Sixth Circuit Court of Appeals, in Marshall v. The Rawlings Company LLC, has issued a ruling that confirms the "cat's paw" is a valid theory of liability for FMLA retaliation or interference...
State Law Prohibiting Discretionary Clauses Not Preempted by ERISA
The Ninth Circuit Court of Appeals, in Orzechowski v. The Boeing Co Non-Union Long-Term Disability Plan, has ruled that ERISA preemption does not apply to a California law prohibiting discretionary...
Supreme Court Finds ERISA Exemption Applies to Religious Hospital Plan
The Supreme Court, in Advocate Health Care Network v. Stapleton, has ruled that ERISA's church plan exemption applies to employee benefit plans established by church-affiliated organizations. In...
New Fiduciary Rule Applies to HSAs
The Department of Labor ("DOL") has clarified that individuals who provide advice on health savings accounts ("HSAs") may be considered fiduciaries under its recently-released Fiduciary Rule if...
CMS Proposes Change in Small Employer Enrollment Procedure
The Centers for Medicare & Medicaid Services ("CMS") has proposed a change in the method used by small businesses and their employees to enroll in insurance coverage through the Federal...
Agencies Release FAQs on Mental Health Parity
DOL, HHS and IRS have released FAQs about Affordable Care Act Implementation Part XXXVIII. Specifically, FAQs XXXVIII address whether certain requirements under the Mental Health Parity and...
Federal Court Finds City, Not Staffing Agency, Employer for FMLA Purposes
The Fourth Circuit Court of Appeals, in Quintana v. City of Alexandria, has ruled that the primary employer for an employee claiming FMLA violations was a municipality and not the staffing agency...
Court: Employer Need Not Translate COBRA Election Notice into Non-English Language
A federal district court in Florida has ruled that COBRA does not require an employer, acting in its role as group health plan administrator, to translate COBRA Election Notices into terminated...
Court Determines Employer Not Required to Notify Employee of FMLA Rights
The Tenth Circuit Court of Appeals has ruled, in Branham v. Delta Airlines, that FMLA does not require an employer to notify an employee who may be eligible for FMLA leave about her rights...
Two HHS Settlements for HIPAA Violations Include Penalties Totaling over $5 Million
HHS has announced two major settlements it has reached with covered entities to resolve alleged violations of the HIPAA Privacy and Security Rules. The terms of each settlement agreement require...
IRS Guidance on Tax Treatment of Benefits Paid by Self-Funded Fixed-Indemnity Plans
The IRS has issued a Chief Counsel Advice addressing whether a benefit paid from an employer's self-funded, fixed-indemnity health plan is taxable when the average amount received by employees for...
House Passes ACA Reform Bill
The House of Representatives has passed a revised version of the American Health Care Act (the "AHCA") to implement certain changes to the Affordable Care Act ("ACA"). Although the ACHA was intended...
Covered Entity Agrees to Pay HHS $31,000 for Business Associate Agreement Failure
HHS has announced that a health care provider has paid $31,000 and agreed to implement a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability...
Employer Liable for Failing to Furnish Life Insurance Conversion Information
The United States District Court for the Western District of Pennsylvania recently ruled, in Erwood v. Life Insurance Company of North America and Wellstar Health System, Inc. Group Life Insurance...
HHS Releases Final Rule Intended to Lower Premiums and Stabilize ACA Marketplace
HHS has issued a final rule intended to implement certain changes that insurers contend are necessary to help lower premiums and provide stability to the Affordable Care Act individual health...
HHS Releases HIPAA Guidance on “Man-in-the-Middle” Attacks
HHS has issued guidance to advise covered entities and business associates about certain risks attendant to using HTTPS inspection products to prevent third-parties from intercepting and altering...
Federal Court Says Insurer’s Recoupment Practice is Illegal
The United States District Court for the District of Connecticut recently declared, in Connecticut General v. True View Surgery Center One LP, that ERISA prohibited a health insurer's practice of...
Federal Court Says Insurer’s Practice of Cross-Plan Offsetting is Illegal
The United States District Court for the District of Minnesota recently determined, in Peterson v. UnitedHealth Group, Inc., that a health insurer's practice of "cross-plan offsetting" was illegal...
IRS Clarifies the Rules for Disposal of Cafeteria Plan Forfeitures
The IRS has issued guidance on the rules for disposing of unused funds in a cafeteria plan where the plan's sponsor discontinues its business operations. In Information Letter 2016-0077, the IRS...
House Committees Release Proposals to “Repeal and Replace” ACA
Two House of Representatives Committees have each released separate budget proposals that, after review and mark-up, will form the American Health Care Act ("AHCA"), the first in a series of...
IRS Extends Deadline for Small Employers to Furnish QSEHRA Notice to Employees
The IRS has issued Notice 2017-20 to extend the deadline for employers who establish a qualified small employer health reimbursement arrangement ("QSEHRA") to send a required notice to employees...
Federal Court Finds FMLA Retaliation When Employer Revokes Telework Arrangement
The Seventh Circuit Court of Appeals recently determined, in Wink v. Miller Compressing Co., that an employer had retaliated against an employee in violation of the Family and Medical Leave Act of...
IRS Issues Proposed Regulations Redefining Dependent for Federal Tax Purposes
The Internal Revenue Service has issued proposed regulations that redefine the term "dependent" under the Internal Revenue Code. In particular, the proposed regulations implement the changes made to...
FMLA Notice Failure is FMLA Interference
The Sixth Circuit Court of Appeals recently determined, in Casagrande v. OhioHealth Corp., that an employer violated the Family and Medical Leave Act of 1993 ("FMLA") when it failed to notify an...
IRS Updates Guidance on ACA Information Reporting by Health Coverage Providers
The IRS has released updated Q&As to explain the information reporting requirements under the Affordable Care Act ("ACA"). Background. The ACA added Section 6055 to the Internal Revenue Code,...
Small Employers May Resume Offering Premium Reimbursement HRAs to Employees
The recently enacted 21st Century Cures Act (the "Act") will allow small employers that do not offer any group health plan to their employees to resume offering "qualified small employer" Health...
Court Determines Employer’s Severance Plan is Subject to ERISA
The Fifth Circuit Court of Appeals determined, in Gomez v. Ericsson, Inc., that an employer's severance plan was governed by ERISA because it required ongoing administration and allowed the employer...
IRS Releases Final Version of ACA Reporting Forms for 2016
The IRS has released final 2016 Forms 1094-C and 1095-C along with instructions for each. They confirm that the Affordable Care Act ("ACA") reporting requirements for 2016 are similar to those for...
Court Finds Employee Benefit Trust Fund’s Trustee, Legal Counsel Liable for Retaliating Against ERISA Whistleblower
A U.S. District Court has determined, in Perez v. Scott Brain, that an employee benefit trust fund's trustee and legal counsel engaged in illegal activity when they retaliated against a fund...
State Law May Prohibit Discretionary Clauses in ERISA-covered Plans
Despite ERISA's preemption clause, a federal district court has upheld, in Thomas vs. Aetna Life insurance Co., a California law prohibiting discretionary clauses in ERISA-covered plans. Background....
Court Rules that Employer Liable for Death Benefit
A U.S. District Court has determined, in Van Loo v. Cajun Operating Company, that an employer that self-administered a life insurance plan breached its fiduciary duty under ERISA when it...
Employee Classifications Irrelevant in Determining Shared Responsibility Penalties
The IRS has clarified that an employer's internal classifications and work-time restrictions are not taken into account for purposes of determining the employer's shared responsibility and...
Draft Instructions for 2016 ACA Reporting Forms
The IRS has released draft instructions for the 2016 Forms 1094-C and 1095-C. They confirm that the Affordable Care Act ("ACA") reporting requirements for 2016 are similar to 2015, except for...
Medicare-Enrolled Employees’ Impact on ACA’s Employer Mandate Penalty
The IRS has explained how employees enrolled in Medicare affect an employers' liability under the Affordable Care Act's ("ACA's") employer shared responsibility penalties. Under the ACA, employers...
IRS Confirms ACA Information Returns May Continue to be Electronically Filed without Penalty
The IRS has confirmed that ACA information return filers that failed to meet the June 30, 2016 deadline for electronically submitting Forms 1094-C (and related Forms 1095-C) via the IRS's ACA...
EEOC Issues Guidance on Notice Requirements for Wellness Programs that Solicit Medical Information
The EEOC has released a sample notice and corresponding Q&As to explain to employers the notice requirements applicable to wellness programs that include disability-related inquiries or medical...
Agencies Release Guidance on Application of ACA Rules to Expatriate Health Plans
IRS, DOL, and HHS have issued proposed regulations on expatriate health plans, expatriate health issuers and qualified expatriates under the Expatriate Health Coverage Clarification Act of 2014...
EEOC Issues Final Regulations on Employer Wellness Programs
The Equal Employment Opportunity Commission ("EEOC") has issued two sets of final regulations that provide guidance on how employer-sponsored wellness programs that require employees to answer...
IRS Releases ACA Affordability Rates for 2017
The Internal Revenue Service has released Revenue Procedure 2016-24 to implement index adjustments in 2017 for certain Affordable Care Act ("ACA") contribution percentages. Background. Under ACA,...
DOL Releases New FMLA Guide and General Notice for Employers to Use
DOL has released a new FMLA Guide along with a new General FMLA Notice to help employers administer the FMLA requirements. FMLA Guide. DOL says that its new FMLA Guide, "The Employer's Guide to the...
First Circuit: Benefit Denial Letters must Explain Plan’s Deadline for filing a Lawsuit
The U.S. Court of Appeals for the First Circuit, in Santana-Diaz v. Metro. Life Ins. Co, has ruled that an ERISA-covered employee benefit plan's three year limitation period for filing a lawsuit to...
Correcting Mistakes on ACA Reporting Forms
To enforce the Affordable Care Act's ("ACA's") employer and individual mandates, the IRS requires information about the group health coverage provided by applicable large employers ("ALEs"). IRS...
Federal Court Rules HR Director May Be Individually Liable Under FMLA
The Second Circuit Court of Appeals has ruled, in Graziadio v. Culinary Institute of America, that human resources personnel and supervisors who handle the administration of leave requests under the...
Agencies Propose Revised SBC Template
DOL, HHS and IRS have jointly proposed a revised Summary of Benefits and Coverage ("SBC") template and related materials. The revised SBC will likely become effective for plan years beginning with...
IRS Issues Guidance on Reallocation of VEBA Assets
IRS has released guidance to address when assets held in a voluntary employee beneficiary association ("VEBA") to fund one type of welfare benefit are reallocated to fund other benefits under the...
Guidance on Individuals’ HIPPA Right to Access PHI
The Department of Health and Human Services ("HHS") has issued guidance clarifying individuals' right under the HIPAA Privacy Rule to access their protected health information ("PHI") maintained by...
Guidance on Health Reimbursement Arrangements
The IRS has issued Notice 2015-87, which provides guidance on a myriad of Affordable Care Act ("ACA") market reforms, including ACA compliance issues raised by health reimbursement arrangements...
DOL Says Certain Stop-Loss Insurance Policies Are Not Plan Assets
The DOL, in Advisory Opinion 2015-02A, has determined that a stop-loss insurance policy purchased by an employer for its self-insured health plan is not a plan asset, even though part of the plan's...
DOL Issues Proposed Regulations Implementing ACA Protections for Disability Claims
The DOL has issued proposed regulations for adjudicating disability benefit claims. This proposal would apply many of the procedural protections and safeguards provided under the Affordable Care...
ACA Reporting Requirements for Multiemployer Plans
IRS has released the final forms and instructions for satisfying the reporting requirements of the Affordable Care Act ("ACA"). In particular, the final instructions offer guidance on how applicable...
HHS’s Office of Civil Rights to Launch New Round of HIPAA Audits
The Department of Health and Human Services' Office of Civil Rights ("OCR") will begin audits early next year to gauge covered entities' compliance with HIPPA's security and privacy requirements for...
IRS Grants Relief for many Integrated HRAs in Final Instructions for ACA Reporting Forms
The IRS has issued final instructions for Forms 1094 and 1095 (collectively, the "Forms"). Notably, the final instructions eliminate the requirement that employers report the coverage provided to...
Federal Court Provides Test for Whether Severance Pay Policy is an ERISA Plan
In Okun v. Montefiore Medical Center, the Second Circuit Court of Appeals created a three-part test to determine whether a severance pay policy is an "employee welfare benefit plan" as defined in...
Final Revised SBC Regulations Issued
IRS and the Departments of Labor and Health and Human Services have issued final revised regulations that identify the standards for the Summary of Benefits and Coverage ("SBC") requirement under...
DOL Releases New FMLA Forms
The U.S. Department of Labor ("DOL") has released updated Family and Medical Leave Act ("FMLA") forms. The new FMLA forms, which expire May 31, 2018, contain "safe harbor" language that tell persons...
Court Rules that ERISA’s Hold-in-Trust Requirement Does Not Require Express Words
The Ninth Circuit U.S. Court of Appeals has ruled that ERISA's hold-in-trust requirement does not necessitate the creation of a document including express words of trust. In Barboza v. California...
IRS Issues Updated Guidance on ACA Reporting Requirements for Large Employers
The IRS has released updated guidance on the reporting requirements for applicable large employers ("ALEs") under Internal Revenue Code Sections 6055 and 6056. Beginning in 2016, ALEs must file...
ACA FAQs Address Coverage of Preventive Services
DOL, HHS and IRS (the "Departments") have released FAQs About Affordable Care Act (ACA) Implementation Part XXVI ("FAQ XXVI"). FAQ XXVI provides clarification of the no-cost preventive services...
Federal Court Finds Employer Failed to Deliver SPD Because It Failed to Follow ERISA’s Electronic Disclosure Rules
A federal court has found that merely posting a summary plan description ("SPD") on a company intranet did not satisfy the electronic disclosure rules under ERISA. In Thomas v. CIGNA Group Ins., the...
SPD Alone Cannot Grant Plan Administrator Discretionary Authority to Determine Eligibility for Benefits
The United States Court of Appeals for the Ninth Circuit has ruled, in Prichard v. Metropolitan Life Insurance Company, that a summary plan description ("SPD") cannot give a plan administrator...
Employer Breached Fiduciary Duty by Issuing Inaccurate SPD
The United States Court of Appeals for the Sixth Circuit has ruled that an employer breached its fiduciary duty by furnishing a participant with a misleading summary plan description ("SPD")...
Federal Judge Stops DOL’s Enforcement of New FMLA Same-sex Spouse Rule
A federal judge in Texas has granted a temporary injunction preventing the DOL from enforcing its new rule under the Family and Medical Leave Act ("FMLA") that would extend FMLA protections to...