Health & Welfare

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 discretionary authority when reviewing claims against 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 health plans (“HDHPs”) and the HRA excepted benefit limit. By law, these limits are indexed annually to adjust for inflation. 

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 claim for denial of benefits because she failed to exhaust the administrative remedies available to her under the plan in a timely manner.

Court Reviews Requirements for Providing Adequate Notice of COBRA Rights

The U.S. District Court for the Eastern District of Michigan, in Green vs. FCA US, LLC, has ruled that a terminated employee could proceed with his claim against his former employer based on its failure to provide adequate notice of his right to health care continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”).  

IRS Finally Releases Guidance Implementing COBRA Subsidies but Leaves Important Questions Unanswered

By Dannae Delano, Barry Salkin and Roberta Casper Watson

IRS Explains Tax Treatment of Dependent Care Benefits Under New Rules

The IRS has issued Notice 2021-26 to explain the tax treatment of dependent care flexible spending account plan (“DCAP”) benefits under the Consolidated Appropriations Act (“CAA”) and the American Rescue Plan Act (“ARP”).

OOP Limits and Marketplace Special Enrollment Period

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 2022.  The OOP limit includes the plan’s deductible and cost sharing for essential health benefits (EHBs) under the Affordable Care Act (ACA). HHS has also clarified the duration of the special open ...

Ninth Circuit Confirms ERISA Preempts State-Law Claims Against Health Plan’s Insurer

The Ninth Circuit Court of Appeals has ruled, in Meyer vs. United Healthcare, that a health plan participant’s lawsuit alleging that the plan’s insurer violated state law by improperly handling his claim for medical benefits is preempted by ERISA.   

Will Federal Rules on Mental Health Parity Work This Time?

Agencies Issue Guidance Regarding Consolidated Appropriations Act, 2021 (“CAA”) Amendments to Mental Health Parity and Addiction Equity Act (“MHPAEA”)

Court Finds Cost of Heart Transplant Could Be Appropriate Equitable Remedy

A federal district court has ruled, in Rose vs. PSA Airlines, Inc. Group Insurance Plan, that a decedent’s estate may be entitled to recover the cost of a heart transplant as equitable relief under ERISA.