Health & Welfare

Wagner Law Group

Agencies Issue Guidance on Impact of Drug Manufacturer Coupons on ACA's Out-Of-Pocket Limits

DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing limits under the Affordable Care Act ("ACA"), including situations where there is no medically appropriate generic drug available.

ERISA Plan Administrator Denies STD Claim Too Quickly

The United States District Court for the District of Nevada, in Speca v. Aetna Life Ins. Co., has ruled that a ERISA plan administrator did not provide a full and fair review when it denied a short term disability ("STD") claim in just 14 days and before receiving medical records from the plaintiff's treating physicians.

Attending Children's Special Education Meetings Covered by FMLA

The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2019-2-A confirming that an employee may take leave under the Family Medical Leave Act of 1993 ("FMLA") to attend special education meetings called "Individualized Education Programs" ("IEPs") for children with serious health conditions.

Requirements for Requesting FMLA Leave Cannot Be More Onerous than for Requesting Non-FMLA Leave

The United States District Court for the Southern District of Alabama, in Moore v. GPS Hospitality Partners IV, LLC, etc., has ruled that an employer's notice and procedural rules for requesting FMLA leave violated the law because it placed additional burdens on employees seeking FMLA leave. Law. Employees who take FMLA leave may be required to comply with the employer's usual and customary ...

Plan Administrator Deemed an ERISA Fiduciary

The Fourth Circuit Court of Appeals, in Dawson-Murdock v. Nat'l Counseling Group, Inc., has allowed a life insurance beneficiary to sue her husband's employer for breach of fiduciary duties concluding that she had sufficiently alleged that the employer was an ERISA fiduciary.

IRS Releases ACA Affordability Rates for 2020

The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the employer shared responsibility mandate. Background. Under the ACA, contribution percentages are used to determine: (i) whether an Applicable Large Employer ("ALE") is subject to the ...

IRS Expands List of Preventive Care Benefits

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt contributions to a health savings account ("HSA"). In general, an individual is eligible to contribute (or have his or her employer contribute) to an HSA if he or she participates in ...

Court Finds an Employee's Vacation While On FMLA Leave is Acceptable

The Massachusetts Supreme Judicial Court ("SJC"), in DaPrato v. Mass. Water Resources Authority, has affirmed a jury's finding that an employee was wrongfully terminated for taking a vacation to Mexico during a period of Family and Medical Leave Act ("FMLA") leave. In doing so, the SJC also upheld the trial court's decision to award the employee liquidated damages under the FMLA.

Apprenticeship Training Programs Must File Electronic Notice to be Exempt from ERISA's Reporting and Disclosure Requirements

The U.S. Department of Labor ("DOL") has issued new regulations requiring apprenticeship training programs to file electronically in order to take advantage of an exemption from ERISA's reporting and disclosure requirements. (See DOL Reg. § 2520.104-22) An apprenticeship training program ("ATP") is an employee welfare benefit plan that exclusively provides apprenticeship training and other ...

HHS Guidance on When One Health Plan May Share PHI of Individuals with Another Health Plan

HHS has issued FAQs that provide guidance on the circumstances under which HIPAA's Privacy Rule allows for one health plan to share protected health information ("PHI") about individuals who "have a relationship" with a second health plan. Background. HIPAA's Privacy Rule allows a covered entity ("CE"), including a health plan, to disclose PHI to another CE for either: (i) the health plan's own ...