Health & Welfare

HDHPs May Pay for COVID-19 Testing and Treatment

The IRS has issued Notice 2020-15 permitting High Deductible Health Plans ("HDHPs") to cover testing and treatment for COVID-19, without affecting the status of a person as an "eligible individual" for tax exempt Health Saving Account ("HSA") contribution purposes.

Agencies Issue Proposed Rules Regarding Health Care Transparency

Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments on how providers, insurers, and group health plans could be required to disclose information about expected out-of-pocket costs before a patient receives care.  In response, the Agencies issued proposed regulations, with respect to which the comment period ...

No Statute of Limitations Protection Gained from Filing Forms for Employer Shared Responsibility Penalties

The IRS Office of Chief Counsel has released a memorandum stating that employers are not protected by a statute of limitations from the ACA's employer shared responsibility penalties ("ESRP"), even if they file the required forms relating to the penalties. (IRS Chief Counsel Memorandum 20200801F; Dec. 26, 2019). The ACA's employer shared responsibility provisions apply to an employer that is an ...

CMS Proposes Reporting Penalty Rule

The Centers for Medicare & Medicaid Services ("CMS") has proposed methods to calculate and impose civil penalties when a group health plan ("GHP") or a non-group health plan fails to comply with the Medicare as Secondary Payer ("MSP") reporting requirements.

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.

Cafeteria Plan Need Not Provide Mid-Year Election Changes

The IRS has reiterated, in IRS Information Letter 2019-0028, that while a Section 125 cafeteria plan may allow participants to make a mid-year pre-tax contribution election change because of the occurrence of certain events (informally called change in status or qualifying events), the plan is not required to make this option available.

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 ...

Employees Need Not Expressly Request FMLA Leave

The United States District Court for the District of Maine, in Waterman v. Paul G. White Interior Solutions, has ruled that a terminated employee may continue his Family and Medical Leave Act ("FMLA") retaliation claim even though he did not expressly request leave under the statute.