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. 

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.

IRS Announces 2022 HSA and HRA Limits

The IRS has announced the 2022 calendar year dollar limits for health savings account (“HSA”) contributions, the minimum deductible amounts and maximum out-of-pocket expenses for high deductible health plans (“HDHPs”) and the HRA excepted benefit limit. By law, these limits are indexed annually to adjust for inflation. 

Court Confirms Participant Must Exhaust Administrative Remedies Before Filing a Suit

The U.S. District Court for the Southern District of New York, in Benson vs. Tiffany and Company SPD, has ruled that a participant in an ERISA-governed group health plan may not proceed with her claim for denial of benefits because she failed to exhaust the administrative remedies available to her under the plan in a timely manner.

Court Reviews Requirements for Providing Adequate Notice of COBRA Rights

The U.S. District Court for the Eastern District of Michigan, in Green vs. FCA US, LLC, has ruled that a terminated employee could proceed with his claim against his former employer based on its failure to provide adequate notice of his right to health care continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”).