Health & Welfare

Wagner Law Group

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 Disabilities Act, the Rehabilitation Act, Title VII of the Civil Rights Act, the Age Discrimination in Employment Act and the Genetic Information Nondiscrimination Act. 

Group Health Plans May Provide Rewards for COVID Vaccinations

The Departments of Labor, Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions Part 50 (“FAQs”), which provides that a group health plan may offer premium discounts to participants and beneficiaries who receive COVID-19 vaccinations.

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 an individual has received a COVID-19 vaccine.

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. 

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 ...

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 provider by one health plan it administers by reducing the amount paid to that provider by a different health plan.

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 for benefits.

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.