Health & Welfare

AD&D Plan Not Subject to State Health Insurance Law

The U.S. Court of Appeals for the Eighth Circuit has ruled, in Williams v. Unum Life, that a state law regulating health insurance policies does not apply to an accidental death and dismemberment (“AD&D”) plan.

Mental Health Parity is Finally Being Enforced

On August 12, 2021, the U.S. Department of Labor (“DOL”) issued a press release regarding a groundbreaking settlement reached with United Healthcare Insurance Co., United Behavioral Health and Oxford Health Insurance, Inc. The settlement will require payment of more than $15.6 million, in both penalties and reparations to participants, and other corrective actions following investigations and ...

Employer’s Leave Policies Required It to Provide Paid Military Leave

The Third Circuit Court of Appeals has ruled, in Travers v. Federal Express, that the Uniformed Services Employment and Reemployment Rights Act (“USERRA”) requires employers to provide paid leave to employees who take military leave when the employer provides paid leave for various other forms of leave.

FSA Debit Card Substantiation Rules

The IRS has released Information Letter 2021-0013 to reconfirm the substantiation rules for debit card use in health care flexible spending account plans (“FSAs”).

IRS Sheds Some Clarity on COBRA Premium Assistance

By Dannae Delano, Barry Salkin and Roberta Watson

Court Settles Dispute When Employer Switches LTD Insurer

The Fifth Circuit Court of Appeals has determined, in Talamantes v Metropolitan Life Insurance Company, that a long-term disability (“LTD”) insurer was responsible for benefit payments even though a participant’s disability began before its insurance policy was effective. 

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 Says No Specific Wording Required in Plan Document to Give Plan Discretionary Claims Authority

The Second Circuit Court of Appeals, in Tyll vs. Black and Decker Life Insurance Program, has ruled that a plan document is not required to use any specific language in order to give the plan discretionary authority when reviewing claims against the plan.