Health & Welfare

HHS Guidance on When One Health Plan May Share PHI of Individuals with Another Health Plan

HHS has issued FAQs that provide guidance on the circumstances under which HIPAA's Privacy Rule allows for one health plan to share protected health information ("PHI") about individuals who "have a relationship" with a second health plan. Background. HIPAA's Privacy Rule allows a covered entity ("CE"), including a health plan, to disclose PHI to another CE for either: (i) the health plan's own ...

Beneficiary May Sue Trustees of One ERISA Plan for Fiduciary Breaches Causing Loss of Benefits under Another ERISA Plan

The U.S. District Court for the Southern District of New York, in DeRogatis v. Bd. of Trustees of the Cent. Pension Fund of the Int'l Union of Operating Engineers, has held that ERISA allows a plaintiff to sue the trustees of an ERISA welfare benefit plan for a fiduciary breach that caused her to lose benefits under another, related ERISA pension plan.

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 ...

Guidance on When Employers Can Prorate Bonuses of Employees on FMLA Leave

The Second Circuit Court of Appeals, in Clemens v. Moody's Analytics, Inc., has held that an employer did not unlawfully interfere with an employee's rights under the Family and Medical Leave Act ("FMLA") when it prorated his bonus based on his FMLA leave-related absences. Law. FMLA regulations entitle employees to "unconditional pay increases" that occur during FMLA leave, including cost of ...

HHS Reduces Maximum Penalty Amounts for Certain HIPAA Violations

The Department of Health and Human Services ("HHS") has lowered the maximum civil monetary penalty amounts for most violations of the Health Insurance Portability and Accountability Act ("HIPAA") Privacy and Security Rules. Background. In 2009, Congress enacted the Health Information Technology for Economic and Clinical Health ("HITECH") Act that, among other things, enhanced HIPAA enforcement by ...

Current Association Health Plan Contracts Safe

The Department of Labor ("DOL") has announced that it will not take action against association health plans ("AHPs") that comply with its final regulations, even though these regulations were partially overturned by a federal court in State of New York v. United States Department of Labor. In that case, a federal district court in Washington, D.C. ruled that the regulations are an unreasonable ...

Relative of 2-Percent Shareholder May Deduct Cost of Health Insurance

Certain individuals who receive health care coverage from an S corporation must include the cost of the coverage in their income because of their relationship to the owner of the S corporation. However, they are then permitted to deduct the cost on their personal tax returns, according to IRS Chief Counsel Memorandum 201912001. Facts: The owner of an S corporation employs a family member through ...

Plan May Deny Coverage for Bariatric Surgery

The U.S. Court of Appeals for the Fifth Circuit, in Rittinger v. Healthy Alliance Life Insurance Company, has ruled that a plan administrator that has been granted discretionary authority with regards to claim decisions, may deny a claim for bariatric surgery when there are conflicting medical opinions as to whether the surgery falls within an exception that would have given the participant ...