Health & Welfare

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.

Attending Children's Special Education Meetings Covered by FMLA

The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2019-2-A confirming that an employee may take leave under the Family Medical Leave Act of 1993 ("FMLA") to attend special education meetings called "Individualized Education Programs" ("IEPs") for children with serious health conditions.

Was The Court of Claims Correct for the Wrong Reason?

In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA") definition of a "covered entity" under Section 9010 of the ACA, subject to the annual fee on health insurance providers. Section 9010 of the ACA is not codified, but is interpreted by the IRS regulation at 26 ...

Apprenticeship Training Programs Must File Electronic Notice to be Exempt from ERISA's Reporting and Disclosure Requirements

The U.S. Department of Labor ("DOL") has issued new regulations requiring apprenticeship training programs to file electronically in order to take advantage of an exemption from ERISA's reporting and disclosure requirements. (See DOL Reg. § 2520.104-22) An apprenticeship training program ("ATP") is an employee welfare benefit plan that exclusively provides apprenticeship training and other ...

Current Association Health Plan Contracts Safe

The Department of Labor ("DOL") has announced that it will not take action against association health plans ("AHPs") that comply with its final regulations, even though these regulations were partially overturned by a federal court in State of New York v. United States Department of Labor. In that case, a federal district court in Washington, D.C. ruled that the regulations are an unreasonable ...

DOL Guidance on ERISA Preemption

The United States Department of Labor ("DOL") has issued an Information Letter confirming that state laws requiring employers to obtain written consent before withholding amounts from employees' wages for benefit plan contributions are preempted by ERISA. Background. The DOL has previously issued guidance (i.e., Advisory Opinion 2008-02A) that ERISA preempted state laws that attempt to govern ...