Health & Welfare

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 suffered any “prejudice” from the former employer’s alleged FMLA violations.

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 to a participant’s written request for “a copy of all documents under which the plan is operated.” In particular, the court concluded that the plan administrator failed to comply with ERISA’s “Other ...

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 affordability under the law’s employer shared responsibility mandate. 

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 (“AD&D”) plan.

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 Oxford Health Insurance, Inc. The settlement will require payment of more than $15.6 million, in both penalties and reparations to participants, and other corrective actions following investigations 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 employees who take military leave when the employer provides paid leave for various other forms of leave.

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”).

IRS Sheds Some Clarity on COBRA Premium Assistance

By Dannae Delano, Barry Salkin and Roberta Watson

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 participant’s disability began before its insurance policy was effective. 

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 costs from “surprise billing” and balance billing. Beginning in 2022, the interim final rule bans surprise out-of-network and balance billing for individuals enrolled in employer-sponsored or marketplace ...