Newsletters | The Wagner Law Group

The U.S. Court of Appeals for the Eleventh Circuit has ruled, in Ramji vs. Hospital Housekeeping Systems, that complying with the state’s workers’ compensation laws does not absolve an employer from its separate...

The U.S. Court of Appeals for the Fifth Circuit has ruled in Atkins vs. CB&I, LLC, that a Project Completion Incentive (“PCI”) plan which offered a bonus to employees upon termination of employment is not an...

The IRS has issued Announcement 2021-7, which confirms that personal protective equipment (“PPE”) such as masks, hand sanitizer, and sanitizing wipes purchased “for the primary purpose of preventing the spread of...

The District Court for the Northern District of California has ruled, in Doe v. United Behavioral Health, that the exclusion of certain specified procedures related to the treatment of autism violates the Mental...

On March 11, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (“ARPA”). Among other provisions aimed at economic recovery, ARPA extends employer tax credit opportunities for certain forms...

By Dannae Delano, Israel Goldowitz, Barry Salkin and Roberta Casper Watson Although not the primary focus of the American Rescue Plan Act of 2021 (“ARPA”) and, at least with respect to the multiemployer relief...

A federal district court in the Western District of Virginia has held, in Hammer v. Johnson Senior Ctr., that the fiduciary for a welfare plan violated its duties of loyalty, care and prudence by misusing a health...

By Dannae Delano and Barry Salkin Even with widespread bipartisan support, it can be difficult to draft legislation to address all possible contingencies. In the wake of the events of September 11, 2001, Congress...

The IRS has issued Notice 2021-15 (“Notice”) to provide clarification on the flexible spending account (“FSA”) relief contained in the Consolidated Appropriations Act, 2021 (“CAA”). The Notice also extends...

The Ninth Circuit Court of Appeals, in Estate of Foster v. American Marine Servs. Group Benefits Plan, has held that an employer failed to provide a former employee with adequate notice of the limited time period...

The Centers for Medicare & Medicaid Services (“CMS”) has determined that the COVID-19 emergency presents exceptional circumstances for consumers in accessing health insurance, and will be providing a new...

On January 7, 2021 the Equal Employment Opportunity Commission (“EEOC”) issued an opinion letter explaining the application of the Age Discrimination in Employment Act (“ADEA”) to individual coverage health...

The Department of Labor has issued additional FAQs regarding the expiration of the requirement that employers provide paid sick and family leave under the Families First Coronavirus Response Act (“FFCRA”). Law. The...

The Equal Employment Opportunity Commission (“EEOC”) has issued two sets of proposed regulations that would change certain rules on how employer-sponsored wellness programs that require employees to answer...

The Department of Labor (“DOL”) has issued Field Assistance Bulletin (“FAB”) 2020-8 to provide guidance regarding the use of telemedicine in establishing a “serious health condition” under the Family and Medical...

By Dannae Delano, Barry Salkin and Roberta Casper Watson In a year-end piece of legislation intended to fund the federal government, especially one that is 5,593 pages in length, there is always the possibility...

The Department of Labor (“DOL”) has issued Field Assistance Bulletin (“FAB”) 2020-7 to provide guidance on when, as a matter of enforcement policy, it will consider the electronic posting of the General FMLA Notice...

In Pharmaceutical Care Management Association v. Rutledge, the U.S. Supreme Court has held that ERISA does not preempt an Arkansas statute that imposes rules on pharmacy benefits managers (“PBMs”). Facts. In 2015,...

The Department of Labor, Department of Health and Human Services, and the IRS (collectively, the “Agencies”) have issued final regulations providing greater flexibility to plan sponsors that wish to retain their...

The IRS has issued FAQs to help employers determine the amount of “qualified health plan expenses” for purposes of determining their tax credit under the Families First Coronavirus Response Act (“FFCRA”). Law. The...

Facts. The IRS released Information Letter 2020-0024 in response to an inquiry it received from a qualified transportation plan participant with unused transit benefits due to COIVD-19. In particular, the...

The Centers for Medicare & Medicaid Services (“CMS”) has announced the deductibles, premiums and coinsurance amounts for Medicare Part A and Part B for 2021. Medicare Part A covers inpatient hospital and...

By Barry L. Salkin, Roberta Casper Watson, and Dannae Delano Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments on how...

Section 6001 of the Families First Coronavirus Response Act (FFCRA) required group health plans and health insurance issuers to provide coverage for certain items and services including in vitro diagnostic testing...

The IRS has released Revenue Procedures 2020-45 and 2020-32, which set forth the 2021 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination...

The U.S. District Court for the Southern District of New York, in Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family out-of-pocket...

The U.S. Court of Appeals for the Eighth Circuit has ruled, in McIntyre v. Reliance Standard Life, that a claims decision will be judged under the arbitrary and capricious standard despite the fact that the claims...

The IRS has issued Notice 2020-76, which provides an automatic deadline extension for Applicable Large Employers’ (“ALE”) reporting obligations to employees under the Affordable Care Act’s (“ACA”) Employer Mandate...

The Tenth Circuit Court of Appeals has ruled, in Lyn M. v. Premera Blue Cross, that the “arbitrary and capricious” standard cannot be applied to a plan administrator’s denial of a participant’s claim unless the...

The Second Circuit Court of Appeals, in Sullivan-Mestecky v. Verizon Communications, Inc., has held that a plaintiff properly pled her breach of fiduciary duty claim for equitable relief against an employer in...

By  Dannae Delano, Barry Salkin and Roberta Casper Watson On August 3, 2020, the District Court for the Southern District of New York ruled that four parts of the temporary rules adopted by the DOL to implement the...

The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave under the Families First Coronavirus Response Act (“FFCRA”) and issues...

The Massachusetts Department of Family and Medical Leave has announced that the “annual” payroll tax exemptions received by employers for insured plans under the Paid Family and Medical Leave Law (the “Law”) have...

The Ninth Circuit Court of Appeals has held, in Castillo v. Metropolitan Life Ins. Co.,  that ERISA does not authorize an award of attorney’s fees incurred during the administrative phase of the ERISA claims...

The U.S. Department of Labor (“DOL”) has released updated Family and Medical Leave Act (“FMLA”) forms. Background. Certain posters and forms are required under the FMLA to inform employees of their rights and to...

By Dannae Delano, Barry Salkin and Roberta Casper Watson The federal District Court for the Southern District of New York invalidated parts of  the DOL’s final rules implementing the paid leave provisions of the...

In Private Letter Ruling 202023001, the IRS has ruled that collectively bargained employees can allocate employer contributions between a profit sharing plan and a health reimbursement arrangement (“HRA”) without...

The Internal Revenue Service has issued Revenue Procedure 2020-36 to implement the 2021 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine affordability under the...

The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave (“EPSL”) and Emergency Family and Medical Leave (“EFMLA”) under the...

The Department of Labor, Department of Health and Human Services (“HHS”), and the IRS (collectively, the “Agencies”) have issued proposed regulations that would provide greater flexibility for plan sponsors that...

The Department of Labor (“DOL”) has issued Field Assistance Bulletin No. 2020-4 ("FAB 2020-4") to provide guidance on when an employee may take paid leave under the Families First Coronavirus Response Act (“FFCRA”)...

The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions #43 (“FAQs”) regarding implementation of the Families First Coronavirus Response...

The Department of Health and Human Services (“HHS”) announced on June 12, 2020, as part of a new final regulation (the “Final Rule”), that it had eliminated Obama-era nondiscrimination rules under Section 1557 of...

Although the penalties under the Affordable Care Act’s individual mandate were eliminated in 2017, Massachusetts has continued its own individual health insurance mandate as well as associated penalties for failure...

The IRS has issued Notice 2020-46 to explain the tax consequences of employer-based COVID-19 leave donation programs. Background. The IRS recognized that, in response to the need to provide relief to victims of the...

HHS and IRS have announced inflation-adjusted out-of-pocket (“OOP”) limits that will apply to non-grandfathered health plans for plan years beginning in 2021, and the indexed PCORI fee. The OOP limit includes the...

The DOL and IRS have issued COVID-19 related guidance that temporarily extends certain deadlines applicable to welfare plans and their participants and beneficiaries. COVID-19 Related Guidance. In April 2020, the...

The IRS has announced the 2021 calendar year dollar limits for health savings account (“HSA”) contributions, and the minimum deductible amounts and maximum out-of-pocket expenses for high deductible health plans...

The IRS, in Notice 2020-29, has relaxed the mid-year election change rules for cafeteria plans due to the nature of the public health emergency imposed by COVID-19, extended grace and carryover periods for certain...

The Department of Labor (“DOL”) has issued updated versions of its model general notice and model election notice to ensure that qualified beneficiaries better understand the interactions between...

In coordination, the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (collectively, the “Agencies”) have extended deadlines for multiple events important to health...

The IRS has issued Notice 2020-23 to provide employers, employees and retirement plan service providers with relief from business disruptions from the COVID-19 pandemic. Notice 2020-23 automatically extends, to...

The Department of Labor (“DOL”) has issued additional FAQs that provide further guidance for employers and employees on the administration of the Emergency Paid Sick Leave (“EPSL”) Act and the Emergency Family and...

HHS, DOL and IRS (the "Agencies") have jointly issued FAQ 42 to provide guidance on the implementation of the COVID-19 coverage requirements of the Families First Coronavirus Response Act ("FFCRA") and the...

The IRS has issued guidance for employers with under 500 employees explaining how to claim a tax credit for emergency paid sick leave ("EPSL") and expanded FMLA ("EFMLA") under the Families First Coronavirus...

The DOL has issued a series of FAQs that provide guidance for employers administering the Emergency Paid Sick Leave ("ESPL") and the Emergency Family and Medical Leave Act ("EFMLA") under the Families First...

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...

By Roberta Casper Watson and Barry Salkin Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments on how providers, insurers, and...

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...

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...

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....

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,...

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...

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...

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...

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...

The Seventh Circuit Court of Appeals, in Stone v. Signode Industrial Group, LLC, has upheld a district court's decision that an employer was obligated to continue providing lifetime health care benefits to its...

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...

The Fifth Circuit Court of Appeals, in Texas v. United States, has upheld a district court ruling that the individual mandate provision of the Affordable Care Act ("ACA") is unconstitutional. However, the Fifth...

The IRS has issued a set of Qs&As explaining the Individual Shared Responsibility provisions of the ACA after the elimination of the individual shared responsibility penalty. Background. Initially the ACA's...

HHS has issued final regulations containing inflation adjustments to the civil penalties for violations of HIPAA's "administrative simplification" rules. Background. The inflation adjustments are required under the...

The IRS has issued Notice 2019-63, which provides an automatic deadline extension for Applicable Large Employers' ("ALEs") reporting obligations under the Affordable Care Act's ("ACA"s) Employer Mandate for the...

The Centers for Medicare & Medicaid Services ("CMS") has announced the Medicare Part A deductibles and Part B premiums for 2020. Medicare Part A covers inpatient hospital and hospice care, while Part B covers...

The IRS has released the 2020 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests. Health FSAs. The limit for employee salary reduction...

The U.S. Department of Labor ("DOL") has issued Opinion Letter FMLA2019-3-A, which confirms that the terms of a leave policy provided under a collective bargaining agreement ("CBA") cannot supersede the...

A new California law (AB 1554) imposes a new notice mandate on employers with employees in California.  The law requires employers, beginning in 2020, to notify their flexible spending account (FSA) enrollees – via...

The Department of Health and Human Services ("HHS") has rescinded earlier regulations governing the health plan identifiers ("HPIDs") that group health plans were required to obtain and use in standard electronic...

The Seventh Circuit Court of Appeals, in Fessenden v. Reliance Standard Life Ins. Co., has held that a plan administrator's decision to deny a participant's claim for long-term disability ("LTD") benefits was...

The U.S. District Court for the District of Arizona has ruled, in Greiff vs. Life Insurance Company of North America, that a long-term disability plan participant need not exhaust an insurer's administrative...

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...

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...

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.,...

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...

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....

DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing limits under the...

The United States District Court for the District of Nevada, in Speca v. Aetna Life Ins. Co., has ruled that a ERISA plan administrator did not provide a full and fair review when it denied a short term disability...

The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2019-2-A confirming that an employee may take leave under the Family Medical Leave Act of 1993 ("FMLA") to attend special education meetings...

The United States District Court for the Southern District of Alabama, in Moore v. GPS Hospitality Partners IV, LLC, etc., has ruled that an employer's notice and procedural rules for requesting FMLA leave violated...

The Fourth Circuit Court of Appeals, in Dawson-Murdock v. Nat'l Counseling Group, Inc., has allowed a life insurance beneficiary to sue her husband's employer for breach of fiduciary duties concluding that she had...

The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the...

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt...

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...