The Internal Revenue Service, Department of Labor, and Department of Health and Human Services (the “Agencies”) have issued a revised, mandatory notice for fixed indemnity insurance coverage....
Law Alert
Employee Must Provide Adequate Notice of Need for FMLA Leave
The U.S. Court of Appeals for the Fifth Circuit has ruled, in Cerda v. Blue Cube Operations, that an employee was not protected by the Family and Medical Leave Act (“FMLA”) when she never gave the...
Agencies Revise Short-Term Health Insurance Regulations
HHS, DOL and IRS (the “Agencies”) have jointly issued revised final regulations reducing the maximum duration of short-term, limited-duration health insurance (“STLDHI”) coverage. Background. ...
Insurer May Be Liable Under ERISA for Unauthorized Premium Increases
The U.S. Court of Appeals for the First Circuit, in Parameter v. Prudential Insurance and Tufts University, has ruled that an insurer may have breached its fiduciary duty through unauthorized...
Pension Risk Transfers and the Continuing Concern About Buying a Pig in a Poke
By Michael Schloss Pension risk transfers (“PRTs”) continue to make the news. And well they should. Last year alone, over $100 billion in liabilities were transferred from defined benefit pension...
Employer May Be Liable for Misrepresenting Life Insurance Conversion Information
In Watson vs. EMC Corp., the U.S. Court of Appeals for the Tenth Circuit has ruled that an employer may be liable for the amount of life insurance proceeds if the participant failed to convert his...
IRS Warns Companies are Making False Statements About Health Plan Reimbursements
In IR-2024-65 (the “IR”), the IRS warns taxpayers that some companies are misrepresenting the circumstances under which food and wellness expenses can be paid or reimbursed under health flexible...
LTD Plan Must Consider Future Harm from Stress
In Aisenberg v. Reliance Standard Life Ins. Co., the United States District Court for the Eastern District of Virginia has ruled that a long term disability (“LTD”) plan must take into account...
Court Finds Health Plan Not Required to Furnish Administrative Service Agreements in Response to ERISA Document Request
In Zavislak v. Netflix, Inc., the U.S. District Court for the Northern District of California has largely rejected a plaintiff’s assertion that an employer/plan administrator for an ERISA...
Merger and Acquisition Considerations for Employee Benefit Plans
By Seth Gaudreau and Stephen Wilkes In the context of mergers and acquisitions, an acquisition target’s qualified retirement plans, health plans, executive compensation arrangements, and benefit...
IRS Announces Decreased 2025 Employer Shared Responsibility Penalties
In Revenue Procedure 2024-14, the IRS has announced the 2025 penalty rates for violations of the employer shared responsibility provisions of the Affordable Care Act (“ACA”). Background. Under the...
DOL Updates FMLA Fact Sheets
To assist in employer and employee compliance, the Department of Labor (“DOL”) has issued several revised Family and Medical Leave Act (“FMLA”) Fact Sheets, including Fact Sheet 28D: Employer...
Agencies Update Non-English Language Requirements
The Departments of Labor and Health and Human Services, and the IRS (“the Agencies”) have issued Frequently Asked Questions About Affordable Care Act (“ACA”) and Consolidated Appropriations Act,...
California Restricts Non-Compete Agreements
By David Gabor Over the years, California has taken steps to prevent employers from forcing employees to enter into non-compete agreements that limit an employee’s ability to obtain subsequent...
New Fire for Enforcing Forfeiture-for-Competition Provisions
By Mark Poerio and Jordan Mamorsky The enforceability of non-compete provisions continues to be in the national spotlight. In a very recent Delaware Supreme Court decision, Cantor Fitzgerald, L.P....
DOL Announces Indexed Penalties for Health and Welfare Plans
The Department of Labor released a final rule that provides new figures reflecting the adjusted civil penalty amounts for 2024, for certain health and welfare plan violations. The DOL is required...
SEC Matters to Consider in the New Year: 2024 Exam Priorities and Off-Channel Enforcement Actions
By Seth Gaureau and Stephen Wilkes Since taking office, Chair Gary Gensler has pursued a robust agenda and expectations are high for another year of regulatory scrutiny. Below we discuss recent...
Plan Insurer Held Liable for Failure to Follow Claims Procedures
The U.S. District Court for the District of Utah, in R.E. v. Blue Cross Blue Shield, has ruled that the failure to properly follow ERISA’s claims procedures may result in a reversal of a claims...
State Law Claims Preempted By ERISA
In Steigleman v. Symetra Life, the U.S. District Court for the District of Arizona has ruled that a small business owner could not sue an insurance company under state law for long term disability...
LTD Insurer May Subsequently Reverse Disability Determination
The U.S. District Court for the Southern District of Florida has ruled, in Delucca v. The Guardian Life Insurance Company of America, that a long term disability (“LTD”) plan was not bound by prior...
DOL Proposes Rescission of Association Health Plan Rules
The Department of Labor (“DOL”) has proposed that the Association Health Plan (“AHP”) regulations be revoked and replaced with stricter standards that provide additional employee protections....
Eleventh Circuit Adopts Strict Standard for FMLA Claims
The Eleventh Circuit Court of Appeals, in Lapham v. Walgreen Co., has ruled that the “but for” legal standard applies to Family and Medical Leave Act (“FMLA”) retaliation claims. Law. The FMLA...
Bugielski v. At&T Case Continues With Appellate Reversal
By Michael Schloss and Stephen Wilkes On August 4, 2023, a Ninth Circuit panel reversed a District Court decision in favor of AT&T - holding that AT&T breached its fiduciary duties by,...
Plan Must Consider All “Independent Grounds” for Claims Coverage
The U.S. Court of Appeals for the Tenth Circuit, in Ian C. v. UnitedHealthcare Ins. Co., has ruled that a group health plan violated ERISA’s claims procedures by failing to separately evaluate each...
Longstanding Internal Revenue Service Position Called into Question
By Barry Salkin, Michael Schloss and Mark Greenstein Recently, several class action lawsuits have been filed challenging the permissibility of plan language providing discretion as to how...
2025 ACA Out-of-Pocket Limits
The U.S. Department of Health and Human Services (“HHS”) has announced the proposed maximum out-of-pocket (“OOP”) limits that will apply to non-grandfathered plans for plan years beginning in...
Participant May Sue Plan for Facial Feminization Surgery Coverage
The United States District Court for the Eastern District of Pennsylvania, in Doe v. Independence Blue Cross, declined to dismiss a participant’s lawsuit claiming that a group health plan covered...
SEC Speaks to Importance of Naming Convention
By Seth Gaudreau and Stephen Wilkes SEC Commissioner Crenshaw reminded us last year that, despite the poetic beauty of Shakespeare’s observation that, “A rose by any other name would smell as...
Court Upholds PBGC Denial of Special Financial Assistance to a Terminated Multiemployer Plan
By Israel Goldowitz In March 2021, Congress enacted the American Rescue Plan Act (ARPA), which authorized the Pension Benefit Guaranty Corporation (PBGC) to provide taxpayer-funded special financial...
The SEC Fires All Guns Against a Crypto Platform Plan Fiduciaries Should Take Note
By Kim Shaw Elliott The SEC announced November 20 that it has charged Payward Inc. and Payward Ventures, Inc. (together “Kraken”, an online crypto platform) with a litany of securities registration...
Developments on the ESOP Front
By Jon Schultze, Andrew Oringer and Barry Salkin Employee stock ownership plans (“ESOPs”) are retirement plans that provide employees with the opportunity to own stock of their employer. Congress...
The Retirement Security (Nee Fiduciary) Rule Rides Again
By Michael Schloss, Andrew Oringer, Barry Salkin, John Sohn and Stephen Wilkes Earlier this week, on October 31, 2023, the Department of Labor (the “Department”) rolled out its long anticipated new...
IRS Announces 2024 Cost-of-Living Adjustments Affecting Retirement Plans
By Ari Sonneberg The Internal Revenue Service announced cost-of-living adjustments affecting certain dollar limitations for pension plans and other retirement-related limitations for 2024 in Notice...
Prepare for Upcoming Changes to Defined Contribution Plans Long-Term, Part-Time Employees
The SECURE Act of 2019 (the “2019 Act”) and the SECURE 2.0 Act of 2022 (the “2022 Act”) made many significant changes to retirement plans and how they operate. Several provisions became effective...
IRS Announces PCORI Fee
IRS has released Notice 2023-70, which provides the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“ PCORI” ) fee for plan years ending before October 1, 2024....
Massachusetts has Increased its Estate Tax Exemption to $2,000,000
By Regina Snow Mandl Massachusetts has raised the estate tax exemption from $1,000,000 to $2,000,000, retroactively to January 1, 2023. As a result, for decedents dying after 2022 who have a...
CMS Announces Medicare Part A Deductibles and Part B Premiums for 2024
The Centers for Medicare & Medicaid Services (“CMS”) has announced the 2024 premiums, deductibles and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part A covers...
IRS Issues Notice Providing Relief to Taxpayers Affected by Recent Terroristic Actions Against Israel
By Michael Schloss On October 13, 2023, responding to the terroristic action in the State of Israel that began on October 7, 2023, the Department of the Treasury and the Internal Revenue Service...
IRS Notice on Treatment of Leave-Based Donation Programs
In response to an extreme need for charitable relief by victims of the Hawaiian wildfires that began on August 8, 2023, the IRS has issued Notice 2023-69 (the “Notice”) to provide guidance under the...
Participant May Receive Monetary Damages for Plan’s Failure to Approve Procedure
In Rose v. PSA Airlines, Inc., the Fourth Circuit Court of Appeals ruled that a self-funded group health plan may be sued for monetary damages for failure to approve a medical procedure for a plan...
Court Rules ERISA Preempts Oklahoma Law Regulating PBMs
The U.S. Court of Appeals for the Tenth Circuit, in Pharmaceutical Care Management v. Mulready, has ruled that a state law regulating pharmacy benefit managers (“PBMs”) is preempted by the Employee...
Guidelines for Mental Health and Medical/Surgical Claims Need Not Be Identical
The U S District Court for the District of Utah has ruled, in L.D. v. United HealthCare, that a group health plan does not violate the Mental Health Parity and Addiction Equity Act (“MHPAEA”) if it...
COBRA Notice Need Not Be Single Notification
In deciding Bryant v. Walgreen Co., the U.S. District Court for the Northern District of Illinois addressed several important aspects of the COBRA notification requirements. Law. Employers must...
Highlights of 2023 PBGC Meeting With ABA’s Joint Committee on Employee Benefits
By Harold Ashner and Israel Goldowitz On September 11, 2023, the American Bar Association (“ABA”) posted a summary of the May 3, 2023, meeting between representatives of the Pension Benefit Guaranty...
Claims Denial Overturned for Failure to Follow Claims Procedures
The U.S. Court of Appeals for the Tenth Circuit, in David P. v. United Healthcare Ins. Co., has reversed a group health plan’s benefits claim denial because the plan’s claims administrator failed to...
IRS Delays Roth Catch-up Contribution Change to Defined Contribution Plans
By John Schultze and Barry Salkin One of the changes made by the SECURE 2.0 Act requires that catch-up contributions made by employees with FICA compensation from an employer sponsoring a 401(k),...
HHS Issues Warning About Online Tracking
The Office of Civil Rights (“OCR”) at the U.S. Department of Health and Human Services (“HHS”) and the Federal Trade Commission (“FTC”) have issued a letter, dated July 20, 2023 (the “Letter”),...
IRS Releases ACA Affordability Rates for 2024
The Internal Revenue Service has issued Revenue Procedure 2023-29 to implement the 2024 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
IRS Issues Guidance on Taxation of Restricted Stock Units to Employees Working in United States and Abroad
By Barry Salkin In a global economy, it will frequently be the case that employees of multinational organizations will be employed in both the United States and abroad. In Chief Counsel Advice...
DOL Revises Medicaid/CHIP Model Notice
The Department of Labor (“DOL”) has released a revised Model Notice for employers to use to inform employees about the potential for them to receive state-provided premium assistance subsidies to...