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...
Health & Welfare
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...