Health & Welfare

Wagner Law Group

DOL Confirms Limited Partnership's Health Plan is Not an ERISA-Covered Single Employer Plan

The United States Department of Labor ("DOL") has issued guidance (i.e., Advisory Opinion 2020-01A) to confirm that a limited partnership's health-benefit programs were not ERISA-covered group health plans.

Agencies Release FAQs on Updated 2021 Summary of Benefits and Coverage Template

HHS, DOL and IRS (collectively, the "Agencies") have released FAQs discussing the recently updated version of the Summary of Benefits and Coverage ("SBC") template and related materials (i.e., instructions, coverage examples guides and narratives, and the optional SBC Coverage Examples Calculator) to be used by group health plans and health insurers beginning in 2021.

Cafeteria Plan Need Not Provide Mid-Year Election Changes

The IRS has reiterated, in IRS Information Letter 2019-0028, that while a Section 125 cafeteria plan may allow participants to make a mid-year pre-tax contribution election change because of the occurrence of certain events (informally called change in status or qualifying events), the plan is not required to make this option available.

De Novo Standard Does Not Save Participant's Claim

Although the Fifth Circuit Court of Appeals, in Ariana v. Humana Health Plan of Texas, held that the "de novo" standard of review applies to a denial of benefits, this was not sufficient to save a group health plan participant's claim for denial of benefits.

Evidence of Employer's Mailing Procedures Does Not Prove COBRA Compliance

The United States District Court for the Middle District of Louisiana, in Randolph v. Baton Rouge Parish Sch. Bd., has ruled that an employer's declaration about its general business practices was insufficient to demonstrate it had met its obligations to timely notify a terminated employee about her continuation rights under COBRA. In particular, the court held that an employer must provide ...

Employees Need Not Expressly Request FMLA Leave

The United States District Court for the District of Maine, in Waterman v. Paul G. White Interior Solutions, has ruled that a terminated employee may continue his Family and Medical Leave Act ("FMLA") retaliation claim even though he did not expressly request leave under the statute.

Retiree Medical Benefits Vest for Life and Survived CBA Termination

The Seventh Circuit Court of Appeals, in Stone v. Signode Industrial Group, LLC, has upheld a district court's decision that an employer was obligated to continue providing lifetime health care benefits to its retirees, even after the employer terminated the operative collective bargaining agreement ("CBA") that provided the benefits.

New Laws Impact ACA and Employer-Sponsored Health Plans

President Trump has signed into law a spending package which includes the Further Consolidated Appropriations Act, (the "Act"), and contains a number of provisions related to employer-sponsored group health plans and the Affordable Care Act ("ACA"). Below is a summary of the key provisions found in the Act:

Federal Circuit Court Determines ACA's Individual Mandate is Unconstitutional

The Fifth Circuit Court of Appeals, in Texas v. United States, has upheld a district court ruling that the individual mandate provision of the Affordable Care Act ("ACA") is unconstitutional. However, the Fifth Circuit has sent the case back to the district court for it to reconsider how much of the remainder of the ACA should also be invalidated.

IRS Issues Qs&As on the ACA's Individual Shared Responsibility Provisions

The IRS has issued a set of Qs&As explaining the Individual Shared Responsibility provisions of the ACA after the elimination of the individual shared responsibility penalty.