Health & Welfare

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.

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 ...

Agencies Expand HRA Availability to Provide Coverage

In response to an Executive Order from President Trump, the DOL, HHS, and the IRS proposed new regulations to expand the use of HRAs to pay for certain medical expenses.  They now have released final regulations that will be published in the Federal Register on June 20, 2019.  The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs. Excepted Benefit ...