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 ...

New Laws Impact ACA and Employer-Sponsored Health Plans

President Trump has signed into law a spending package which includes the Further Consolidated Appropriations Act, (the "Act"), and contains a number of provisions related to employer-sponsored group health plans and the Affordable Care Act ("ACA"). Below is a summary of the key provisions found in the Act:

IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules

The IRS has issued proposed regulations to clarify the application of the ACA's employer shared responsibility provisions under Section 4980H of the Internal Revenue Code (the "Code") and certain nondiscrimination rules for self-funded plans under Code Section 105(h) to Individual Coverage Health Reimbursement Arrangements ("ICHRAs"). Background. The ACA's employer shared responsibility ...

Genetic Testing May Include Medical Expenses

The IRS has ruled, in Private Letter Ruling 201933005, that portions of the cost of a genetic testing service may be considered medical expenses and may, therefore, be reimbursed by a health care Flexible Spending Account ("FSA"). An employee purchased a private company's DNA ancestry and health testing services and submitted his DNA sample. His DNA sample was then tested and the company provided ...

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 ...