Health & Welfare

DOL Issues Revised COBRA Notices

The Department of Labor (“DOL”) has issued updated versions of its model general notice and model election notice to ensure that qualified beneficiaries better understand the interactions between Medicare and COBRA.

Federal Agencies Extend Deadlines for COBRA and Health Plan Claims, Appeals, and Special Enrollments

In coordination, the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (collectively, the “Agencies”) have extended deadlines for multiple events important to health plan administration that will apply to ERISA-governed plans and governmental plans.  Third-party administrators and COBRA administrators will need to program for these extensions, and ...

Further Guidance from DOL on the Families First Coronavirus Response Act

The Department of Labor (“DOL”) has issued additional FAQs that provide further guidance for employers and employees on the administration of the Emergency Paid Sick Leave (“EPSL”) Act and the Emergency Family and Medical Leave Act (“EFMLA”) under the Families First Coronavirus Response Act (“FFCRA”).

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.

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, ...

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 ...

Agencies Issue Guidance on Impact of Drug Manufacturer Coupons on ACA's Out-Of-Pocket Limits

DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing limits under the Affordable Care Act ("ACA"), including situations where there is no medically appropriate generic drug available.

ERISA Plan Administrator Denies STD Claim Too Quickly

The United States District Court for the District of Nevada, in Speca v. Aetna Life Ins. Co., has ruled that a ERISA plan administrator did not provide a full and fair review when it denied a short term disability ("STD") claim in just 14 days and before receiving medical records from the plaintiff's treating physicians.