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...
Health & Welfare
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...