Health & Welfare

Court Says Administrator's Denial of Disability Benefit Claim Was Arbitrary and Capricious

The Tenth Circuit Court of Appeals, in McMillan v. AT&T Umbrella Benefit Plan No. 1, has affirmed a district court's decision to reverse a plan administrator's denial of short-term disability benefits on the basis that that it acted arbitrarily and capriciously in denying an employee's claim.

Agencies Issue Final Rule that Expands Duration of Short-Term, Limited-Duration Health Insurance

HHS, DOL and IRS (the "Agencies") have jointly issued a final rule on August 3, 2018 (Fed. Reg., V. 83,8/3/18 p. 38212) that expands the availability of short-term, limited-duration health insurance. The final rule updates and finalizes a proposed rule that was issued on February 21, 2018. The final rule allows consumers to buy individual health insurance plans that provide coverage for any ...

Medicare and ERISA Preempt Arkansas Pharmacy Benefits Manager Law

The Eighth Circuit Court of Appeals, in Pharmaceutical Care Management Association v. Rutledge, has held that Medicare Part D and ERISA preempt an Arkansas statute that imposed regulations on pharmacy benefits managers ("PBMs").

Anti-Assignment Provision Does Not Prevent the Grant of Power of Attorney

Although the Third Circuit Court of Appeals ruled in American Orthopedic & Sports Medicine vs. Independence Blue Cross Blue Shield, that a group health plan's anti-assignment provision was valid, this does not prevent a health care service provider from representing a plan participant under a power of attorney agreement.

Employee Must Renew Request for Intermittent FMLA Leave Annually

The U.S. District Court for the Middle District of Pennsylvania has ruled, in Feistl v. Luzerne Intermediate Unit, that an employee on intermittent leave is not protected by the Family and Medical Leave Act ("FMLA") unless the leave is requested and approved annually.

Health Plan Must Cover Room and Board During Residential Treatment for Mental Illness

The Ninth Circuit, in Danny P. v. Catholic Health Initiatives, has ruled that a group health plan violated the Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA") when it denied coverage for room and board at a residential mental health treatment facility, because room and board was covered for medical conditions.

IRS Releases ACA Affordability Rates for 2019

The Internal Revenue Service has issued Revenue Procedure 2018-34 to implement index adjustments for 2019 for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the employer shared responsibility mandate.

Massachusetts Paid Medical Leave Law

Massachusetts has enacted a mandatory statewide paid family and medical leave program which will be administered by a newly created Department of Family and Medical Leave (the "Department") within the Executive Office of Labor and Workforce Development.

Association Health Plan Final Regulations

The US Department of Labor ("DOL"), after consultation with the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Department of the Treasury and the IRS, has issued final regulations on association health plans ("AHPs").  Among other things, these  regulations change the rules that determine when a multiple employer group health plan may be treated as a ...

Employer Created ERISA Covered Plan by Endorsing LTD Policy

A federal district court, in Stolebarger v. Prudential Insurance Company of America, ruled that long-term disability ("LTD") benefits were covered by ERISA because the employer had "endorsed" the coverage.