Health & Welfare

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.

Agencies Release FAQs on Updated 2021 Summary of Benefits and Coverage Template

HHS, DOL and IRS (collectively, the "Agencies") have released FAQs discussing the recently updated version of the Summary of Benefits and Coverage ("SBC") template and related materials (i.e., instructions, coverage examples guides and narratives, and the optional SBC Coverage Examples Calculator) to be used by group health plans and health insurers beginning in 2021.

De Novo Standard Does Not Save Participant's Claim

Although the Fifth Circuit Court of Appeals, in Ariana v. Humana Health Plan of Texas, held that the "de novo" standard of review applies to a denial of benefits, this was not sufficient to save a group health plan participant's claim for denial of benefits.

Evidence of Employer's Mailing Procedures Does Not Prove COBRA Compliance

The United States District Court for the Middle District of Louisiana, in Randolph v. Baton Rouge Parish Sch. Bd., has ruled that an employer's declaration about its general business practices was insufficient to demonstrate it had met its obligations to timely notify a terminated employee about her continuation rights under COBRA. In particular, the court held that an employer must provide ...

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.

IRS Releases ACA Affordability Rates for 2020

The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the employer shared responsibility mandate. Background. Under the ACA, contribution percentages are used to determine: (i) whether an Applicable Large Employer ("ALE") is subject to the ...

IRS Expands List of Preventive Care Benefits

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt contributions to a health savings account ("HSA"). In general, an individual is eligible to contribute (or have his or her employer contribute) to an HSA if he or she participates in ...