Health & Welfare

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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”)....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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”)...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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”)...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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")...

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...

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...

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"...

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,...

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...

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...

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...

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.,...

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...

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...

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...

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...

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...

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...

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....

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....

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...

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...

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...

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...

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...

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)...

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...

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")...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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...

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")...

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...

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 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...

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...

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...

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 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...

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...

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:...

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...

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")...

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...

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...

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...

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....

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...

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...

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...

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...

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...

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")...

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...

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...

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'...

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...

The Massachusetts Department of Family and Medical Leave (the "Department") has released proposed regulations explaining the rights and responsibilities of employers and employees under...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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...

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 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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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")....

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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-...

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...

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...

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...

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...

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...

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...

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...

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....

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...

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 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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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 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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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....

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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...

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...

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...

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 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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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")...

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...