Health & Welfare

Wagner Law Group

Agencies Expand HRA Availability to Provide Coverage

In response to an Executive Order from President Trump, the DOL, HHS, and the IRS proposed new regulations to expand the use of HRAs to pay for certain medical expenses.  They now have released final regulations that will be published in the Federal Register on June 20, 2019.  The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs. Excepted Benefit ...

Massachusetts Delays the Start of Paid Family and Medical Leave Program by Three Months

Delayed Contribution Date: On Friday, June 14, 2019. the Commonwealth of Massachusetts has delayed Paid Family and Medical Leave (PFML) contributions from employers and employees.  The new start date for required PFML contributions is October 1, 2019.  On October 1, 2019 employers are required to begin withholding PFML contributions from employee qualifying earnings.  Extended Notice Requirement: ...

HHS Proposes Revised ACA Section 1557 Regulations

HHS has issued proposed regulations that, if finalized, would significantly revise existing regulations issued under Section 1557 of the Affordable Care Act ("ACA"). The proposed regulations would continue to prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities, while revising certain provisions of the current ...

IRS and HHS Release Certain Limits for Welfare Benefit Plans in 2020

The IRS and HHS have released some of the 2020 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests. Health Savings Accounts ("HSAs"). The IRS released the inflation-adjusted contribution limits and related amounts for HSAs and HSA-compatible high deductible health plans ("HDHPs") for 2020. The 2020 limit on ...

Plan May Deny Coverage for Bariatric Surgery

The U.S. Court of Appeals for the Fifth Circuit, in Rittinger v. Healthy Alliance Life Insurance Company, has ruled that a plan administrator that has been granted discretionary authority with regards to claim decisions, may deny a claim for bariatric surgery when there are conflicting medical opinions as to whether the surgery falls within an exception that would have given the participant ...

Court Upholds LTD Insurer's Claim Denial Based on Failed Validity Tests

The Eighth Circuit Court of Appeals, in Johnston v. Prudential Ins. Co., has affirmed a lower court's ruling that the defendant insurer acted appropriately in terminating the plaintiff's long term-disability ("LTD") insurance benefits based on evidence that the plaintiff was "deliberately exaggerating" his symptoms.

Federal Judge Strikes Administration's Regulations Expanding Access to Association Health Plans as Illegal

A federal judge in Washington, D.C., ruled last Thursday that the current administration's attempt to broaden the types of health plans that can avoid the coverage rules under Title I of ERISA generally, and specifically for purposes of the Affordable Care Act ("ACA") was "clearly an end-run" around the statutes. The court struck down and remanded the implementing regulations to the Department of ...

Claims Denial Appeal Period Begins on Date of Denial, Not Date Benefits Cease

The First Circuit Court of Appeals has ruled, in Fortier v. Hartford Life and Accident Insurance Company, that a long term disability ("LTD") plan's 180 day period for claims denial appeals begins when a claim is denied and not when benefits cease to be paid.

DOL Says Employees Cannot Decline FMLA Leave When Absence is Covered by FMLA

The U.S. Department of Labor ("DOL") has issued Opinion Letter FMLA2019-1-A clarifying that neither an employer nor an employee may delay designating paid leave as Family and Medical Leave Act ("FMLA") leave.

LTD Benefit Denial Overturned

The Ninth Circuit Court of Appeals, in Kott v. Agilent Technologies Inc. Disability Plan, has determined that a plan administrator abused its discretion in denying long-term disability ("LTD") benefits because it: (i) failed to provide the plaintiff with a sufficient explanation for the basis of its denial; (ii) did not properly consider her physical limitations; and (iii) made erroneous factual ...