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...
Health & Welfare
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...