Health & Welfare

A Sigh of Relief For Employers Subject to Potential ACA Disparate Impact Discrimination Claims

In the aftermath of Title VI of the Civil Rights Act of 1964, litigants have pressed courts on what conduct meets the criteria for a disparate impact discrimination claim. Typically, a disparate impact discrimination claim contends that a facially neutral employment practice has a discriminatory effect on a protected class of people such as race, gender, or age. In contrast to traditional ...

Was The Court of Claims Correct for the Wrong Reason?

In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA") definition of a "covered entity" under Section 9010 of the ACA, subject to the annual fee on health insurance providers. Section 9010 of the ACA is not codified, but is interpreted by the IRS regulation at 26 ...

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 ...

Massachusetts Delays the Start of Paid Family and Medical Leave Program by Three Months

Delayed Contribution Date: On Friday, June 14, 2019. the Commonwealth of Massachusetts has delayed Paid Family and Medical Leave (PFML) contributions from employers and employees.  The new start date for required PFML contributions is October 1, 2019.  On October 1, 2019 employers are required to begin withholding PFML contributions from employee qualifying earnings.  Extended Notice Requirement: ...

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 ...