Health & Welfare

Wagner Law Group

DOL Says FMLA Leave Runs Concurrently with Paid Leave

The U.S. Department of Labor ("DOL") has issued Opinion Letter FMLA2019-3-A, which confirms that the terms of a leave policy provided under a collective bargaining agreement ("CBA") cannot supersede the requirements of the Family and Medical Leave Act ("FMLA"), even if the CBA is more generous. FMLA2019-3-A reinforces guidance the DOL provided in a previous opinion letter (i.e., DOL FMLA2019-1-A, ...

Employers with California Employees who sponsor Flexible Spending Accounts May Have New Notice Requirements

A new California law (AB 1554) imposes a new notice mandate on employers with employees in California.  The law requires employers, beginning in 2020, to notify their flexible spending account (FSA) enrollees – via two different modes of communication – about any deadline to withdraw funds from the FSA where that deadline is prior to the end of the plan year.

Final Regulations Rescind HIPAA Health Plan Identifier Rules

The Department of Health and Human Services ("HHS") has rescinded earlier regulations governing the health plan identifiers ("HPIDs") that group health plans were required to obtain and use in standard electronic transmissions as specified in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Background. The HPID is a unique 10-digit number that identifies a group health ...

LTD Claim Denial Subject to Stricter Standard of Review Due to Untimely Decision

The Seventh Circuit Court of Appeals, in Fessenden v. Reliance Standard Life Ins. Co., has held that a plan administrator's decision to deny a participant's claim for long-term disability ("LTD") benefits was subject to the de novo standard of review because the administrator failed to comply with ERISA's deadline for issuing a claims decision.

Participant May Sue Insurer Before Exhausting Administrative Remedies

The U.S. District Court for the District of Arizona has ruled, in Greiff vs. Life Insurance Company of North America, that a long-term disability plan participant need not exhaust an insurer's administrative remedies before suing in federal court, unless the insurance contract and other relevant communications specifically require such exhaustion.

IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules

The IRS has issued proposed regulations to clarify the application of the ACA's employer shared responsibility provisions under Section 4980H of the Internal Revenue Code (the "Code") and certain nondiscrimination rules for self-funded plans under Code Section 105(h) to Individual Coverage Health Reimbursement Arrangements ("ICHRAs"). Background. The ACA's employer shared responsibility ...

Genetic Testing May Include Medical Expenses

The IRS has ruled, in Private Letter Ruling 201933005, that portions of the cost of a genetic testing service may be considered medical expenses and may, therefore, be reimbursed by a health care Flexible Spending Account ("FSA"). An employee purchased a private company's DNA ancestry and health testing services and submitted his DNA sample. His DNA sample was then tested and the company provided ...

Agencies Issue Final FAQs on Mental Health Parity Implementation

HHS, DOL and IRS have issued final FAQs on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act ("MHPAEA"). The MHPAEA requires that the financial requirements (e.g., coinsurance and copays) and treatment limitations (e.g., visit limits) imposed on mental health or substance use disorder ("MH/SUD") benefits cannot be more restrictive than the predominant ...

CHIP Notice Revised

The Department of Labor ("DOL") has released a revised and updated model notice that employers can use to inform employees of the potential for state premium assistance subsidies for the purchase of group health coverage. The Children's Health Insurance Program ("CHIP") Reauthorization Act of 2009 requires employers who maintain group health plans to provide an annual notification of the ...

Single Document Can Serve as ERISA Plan Document and SPD

The Eighth Circuit Court of Appeals, in MBI Energy Services v. Hoch, has held that a self-insured medical plan is entitled to reimbursement because its summary plan description ("SPD") was also the plan document. With this ruling, the Eighth Circuit has joined the Fifth, Sixth, Ninth, and Tenth Circuit Courts in concluding that the Supreme Court's ruling in Cigna v. Amara does not prevent an SPD ...