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<< Older News  |  March 7, 2021

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All News > Health Plan Administration

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Group Health Plans Must Perform Comparative Analyses of Non-Quantitative Treatment Limitations Under Mental Health Parity
Cheiron Link to more items from this source
[Guidance Overview]
Mar. 4, 2021

"While the Act did not add any additional penalties for noncompliance, the agencies can apply existing penalties to plans within their jurisdictions. For example, the DOL can assess a penalty of up to $161 per day for failure to provide requested mental health parity documents to participants."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration  •  Health Plan Design

DOL Extends COBRA and Claims Tolling in the Worst Way
Davis Wright Tremaine LLP Link to more items from this source
[Guidance Overview]
Mar. 4, 2021

"This change makes the tolling period much more difficult to administer because it will now be individualized for each affected participant and situation, rather than ending at a uniform date.... [P]lan administrators should ... be prepared to send out new notices restating the end of the COBRA election period, prioritizing election periods that started last March or before."

Tags: COBRA  •  Coronavirus (COVID-19)  •  Health Plan Administration

New Guidance on Health Plans' COVID-19 Coverage Obligations
Sheppard Mullin Link to more items from this source
[Guidance Overview]
Mar. 3, 2021

"Plans cannot require the presence of symptoms or a recent known or suspected exposure to COVID-19, or otherwise impose medical screening criteria on coverage for tests."

Tags: Health Plan Administration  •  Health Plan Design

Government Clarifies End of Benefit Plan 'Outbreak Period'
Warner Norcross & Judd LLP Link to more items from this source
[Guidance Overview]
Mar. 3, 2021

"[T]he Notice emphasizes that plan fiduciaries ... should take steps to minimize the possibility of individuals losing benefits because of a failure to comply with pre-established time frames."

Tags: COBRA  •  Health Plan Administration

Outbreak Extension Period: When Does It End?
Trucker Huss Link to more items from this source
[Guidance Overview]
Mar. 2, 2021

"[T]he Plan Administrator could choose to voluntarily extend the tolling period until the end of the Outbreak Period for all impacted deadlines.... [F]or fully-insured coverage, the carrier would need to agree (which may be unlikely); and for self-funded plans with stop loss coverage, it would need to be permitted under the stop loss policy."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Retirement Plan Administration

Every COBRA, Special Enrollment, or Claims Event Gets Its Own COVID-Extended Deadline
HUB International Link to more items from this source
[Guidance Overview]
Mar. 2, 2021

"This new interpretation only makes the administrative concerns more pronounced since employers and their administrators will now have to track dates on an event-by-event basis.... Self-insured plans in particular need to ensure their stop loss policies don't have any potential gaps that may be exposed by claims paid later than customary or allowed by the policy due to these extended deadlines."

Tags: COBRA  •  Health Plan Administration

Mental Health Parity: New Comparative Analysis Required
EPIC Link to more items from this source
[Guidance Overview]
Mar. 2, 2021

"Group health plans that provide coverage for mental health or substance use disorder benefits and are therefore subject to mental health parity rules will soon be required to prepare a comparative analysis and have it available upon request."

Tags: Health Plan Administration  •  Health Plan Design

District Court: Benefit Denial Letter Omission Renders Limitations Period Unenforceable
Faegre Drinker Link to more items from this source
Mar. 2, 2021

"An Illinois federal court recently held that the failure to identify a contractual limitations period in a benefits denial letter renders the limitations period unenforceable, even before applicable regulations were changed to expressly require that the limitations period be included." [Hewitt v. Lincoln Financial Corp., No. 18-8235 (N.D. Ill. Feb. 2, 2021)]

Tags: Health Plan Administration  •  Retirement Plan Administration

Second Circuit Finds Arbitration Agreement Is Enforceable with Scope of Claims Provision Severed
Roberts Disability Law Link to more items from this source
Mar. 2, 2021

"The court explained that where provisions of an arbitration agreement operate as a prospective waiver of a party’s right to pursue statutory remedies, the agreement would be unenforceable as against public policy. But here, Aflac represented to the court that it would waive Paragraph 10.7.1 and it is judicially estopped from revoking the waiver." [American Family Life Assurance Company of New York v. Baker, No. 20-1435 (2d Cir. Mar. 1, 2021; unpub.)]

Tags: Health Plan Administration  •  Health Plan Design

IRS Gymnastics with Code Section 125 for FSAs: Notice 2021-15
Morgan Lewis Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"While the Notice clarifies the permissible opportunities available under the Act, the IRS twists long established rules under Section 125 of the Code ... The Notice offers up a cornucopia of additional opportunities that create administrative burdens and may be too costly for a third-party administrator to implement given the emphasis in the Notice that these permissible opportunities are all temporary in duration."

Tags: Cafeteria Plans  •  Dependent Care  •  Health Plan Administration  •  Health Plan Design

Visiting a Family Member and Need a COVID-19 Test? Your Health Plan Must Pay for That
Miller Johnson Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"Group health plans must cover the required COVID-19 testing even for an asymptomatic individual with no known or suspected exposure to COVID-19.... This requirement does not, however, require group health plans to cover without participant cost-sharing, prior authorization, or other medical management requirements COVID-19 tests that are required for public health surveillance or employment purposes."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Health Plan Design

Agencies Clarify Outbreak Period Relief Due to COVID-19
Winston & Strawn LLP Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"[T]he DOL notes that prior disclosures made to plan participants during the pandemic regarding the mechanics of the Outbreak Period may need to be revised and reissued if they failed to provide accurate information regarding the time in which participants and beneficiaries were required to act."

Tags: COBRA  •  Coronavirus (COVID-19)  •  Health Plan Administration  •  Retirement Plan Administration

Suspended Deadlines Under ERISA, Part Two: Sound the Alarm!
Morgan Lewis Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"The Notice encourages plan fiduciaries to be proactive about communicating these changes so participants and beneficiaries are aware that deadlines may expire soon. Plan fiduciaries will also need to revisit this once the National Emergency ends to decide whether to provide additional communications at that time. In fact, the Agencies suggest that supplemental notices may be necessary to fulfill ERISA fiduciary duties."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Retirement Plan Administration

New Guidance from DOL Regarding the Suspension of Certain Employee Benefit Plan Deadlines Due to COVID-19
Akerman Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"[I]ndividuals and plans with deadlines that are suspended pursuant to the previously-issued rule will have the applicable periods under the Notices disregarded until the earlier of: [1] one year from the date they were 'first eligible for relief' ... or [2] 60 days after the announced end of the National Emergency."

Tags: COBRA  •  Coronavirus (COVID-19)  •  HIPAA  •  Health Plan Administration  •  Retirement Plan Administration

DOL Issues Guidance on Outbreak Period Extensions
Groom Law Group Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"It is unclear how plans, TPAs, and insurers will be able to build their systems to create custom COBRA, special enrollment, and claims deadlines individual-by-individual ... Many may have to extend the deadlines for all while they determine how to proceed. This complexity will be even greater if COBRA subsidies are enacted ... DOL seems to be saying that plans may need to notify each individual when his or her one-year extension is about to be up[.]"

Tags: COBRA  •  Coronavirus (COVID-19)  •  HIPAA  •  Health Plan Administration

COVID-19 Relief for Employees Who Participate in Flexible Spending Accounts
Stradley Ronon Link to more items from this source
[Guidance Overview]
Mar. 1, 2021

"The centerpiece ... is to combine the grace period and carryover rules. Conceptually there is no distinction between the grace period and carryover for PYs 2020 and 2021 PYs. In order to avoid confusion, the IRS refers to the period as the 'temporary extension period.' An employer has the discretion to adopt all, some or none of the opportunities presented by TCDRA and Notice 2021-15."

Tags: Cafeteria Plans  •  Dependent Care  •  Health Plan Administration  •  Health Plan Design

Text of Agency FAQs About FFCRA and CARES Act Implementation, Part 44: Coverage of COVID-19 Diagnostic Testing Without Cost Sharing (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S.Treasury Department Link to more items from this source
[Official Guidance]
Feb. 27, 2021

11 pages; 14 Q&As. "This document addresses the requirement under section 6001 of the [FFCRA], as amended by section 3201 of the [CARES Act], for group health plans and health insurance issuers offering group or individual health insurance coverage, including grandfathered health plans, to provide benefits for certain items and services related to diagnostic testing for COVID-19, without imposing any cost-sharing requirements, prior authorization, or other medical management requirements. In addition, this document addresses the requirement under section 3203 of the CARES Act for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover, without cost sharing, qualifying coronavirus preventive services, including recommended COVID-19 vaccines. This document also addresses other health coverage issues related to COVID-19 and includes information about how providers may seek federal reimbursement when delivering COVID-19 related services to the uninsured."

Tags: CARES Act  •  Coronavirus (COVID-19)  •  FFCRA  •  Health Plan Administration  •  Health Plan Design

Administration Strengthens Requirements That Plans and Issuers Cover COVID-19 Diagnostic Testing Without Cost Sharing and Ensures Providers Are Reimbursed for Administering COVID-19 Vaccines to Uninsured
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
Feb. 27, 2021

"This guidance makes clear that private group health plans and issuers generally cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19. Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer.... In addition, the guidance confirms that plans and issuers must cover point-of-care COVID-19 diagnostic tests, and COVID-19 diagnostic tests administered at state or locally administered testing sites. "

Tags: CARES Act  •  Coronavirus (COVID-19)  •  FFCRA  •  Health Plan Administration  •  Health Plan Design

Text of EBSA Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Feb. 26, 2021

"Subject to the statutory duration limitation in ERISA section 518 and Code section 7508A, all group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA or the Code must disregard the period from March 1, 2020 until sixty [60] days after the announced end of the National Emergency or such other date announced by the Agencies in a future notification (the 'Outbreak Period") for all plan participants, beneficiaries, qualified beneficiaries, or claimants wherever located in determining the following periods and date:

  1. The 30-day period (or 60-day period, if applicable) to request special enrollment under ERISA section 701(f) and Code section 9801(f),
  2. The 60-day election period for COBRA continuation coverage under ERISA section 605 and Code section 4980B(f)(5),
  3. The date for making COBRA premium payments pursuant to ERISA section 602(2)(C) and (3) and Code section 4980B(f)(2)(B)(iii) and (C),
  4. The date for individuals to notify the plan of a qualifying event or determination of disability under ERISA section 606(a)(3) and Code section 4980B(f)(6)(C),
  5. The date within which individuals may file a benefit claim under the plan's claims procedure pursuant to 29 CFR 2560.503-1,
  6. The date within which claimants may file an appeal of an adverse benefit determination under the plan's claims procedure pursuant to 29 CFR 2560.503-1(h),
  7. The date within which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination pursuant to 29 CFR 2590.715-2719(d)(2)(i) and 26 CFR 54.9815-2719(d)(2)(i), and
  8. The date within which a claimant may file information to perfect a request for external review upon a finding that the request was not complete pursuant to 29 CFR 2590.715-2719(d)(2)(ii) and 26 CFR 54.9815-2719(d)(2)(ii)....

"With respect to group health plans, and their sponsors and administrators, the Outbreak Period shall be disregarded when determining the date for providing a COBRA election notice under ERISA section 606(c) and Code section 4980B(f)(6)(D)."

Tags: COBRA  •  Coronavirus (COVID-19)  •  Health Plan Administration  •  Retirement Plan Administration

EBSA Disaster Relief Notice 2021-01: Guidance on Continuation of Relief for Employee Benefit Plans and Plan Participants and Beneficiaries Due to the COVID-19 (Novel Coronavirus) Outbreak
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Feb. 26, 2021

"Individuals and plans with timeframes that are subject to the relief under the Notices will have the applicable periods under the Notices disregarded until the earlier of (a) 1 year from the date they were first eligible for relief, or (b) 60 days after the announced end of the National Emergency (the end of the Outbreak Period). On the applicable date, the timeframes for individuals and plans with periods that were previously disregarded under the Notices will resume. In no case will a disregarded period exceed 1 year."

Tags: COBRA  •  Health Plan Administration  •  Retirement Plan Administration

Doctor Lacks Standing to Bring ERISA Claims Due to Health Plans' Anti-Assignment Provisions
Roberts Disability Law Link to more items from this source
Feb. 26, 2021

"The court noted that the 'appeals raise an unsettled issue about whether an ERISA plan administrator or its claims agent may waive its right to rely on an anti-assignment provision in an ERISA-covered plan,' but it declined to decide that issue because even if waiver is available, Defendants did not waive their ability to assert the anti-assignment defense." [Griffin v. Coca-Cola Refreshments USA, Inc., No. 18-10417 (11th Cir. Feb. 24, 2021)]

Tags: Health Plan Administration

IRS Guidance Makes FSAs More Flexible
Groom Law Group Link to more items from this source
[Guidance Overview]
Feb. 26, 2021

"For plan years ending in 2021, an employer can permit an employee to change his/her FSA election mid-plan year, regardless of reason.... [T]he employer can allow the employee to receive reimbursements for expenses incurred starting on January 1, 2021. This is a significant departure from the general FSA rules[.]"

Tags: Cafeteria Plans  •  Health Plan Administration

IRS Clarifies FSA Relief in CAA, Provides More Flexibility for Cafeteria Plan Elections
Mercer Link to more items from this source
[Guidance Overview]
Feb. 26, 2021

"In this most recent notice, the IRS broadened the relief ... so that an employer may allow election changes for all pre-tax health benefits in the 2021 plan year without a qualifying reason. The rules retain the written attestation requirement of other coverage for revoking medical coverage."

Tags: Cafeteria Plans  •  Coronavirus (COVID-19)  •  Dependent Care  •  Health Plan Administration  •  Health Plan Design

District Court Finds Fiduciary Breach in Misuse of Health Plan Assets and Failure to Provide Notice of Coverage Lapse
Thomson Reuters / EBIA Link to more items from this source
Feb. 26, 2021

"Amounts withheld from employees' paychecks for their portion of medical insurance premiums typically had not been separated from other funds in the employer's general operating account, and it appeared that the employer used the funds to pay operating expenses." [Hammer v. Johnson Senior Ctr., No. 19-027 (W.D. Va. Jan. 21, 2021)

Tags: Fiduciary Duties  •  Health Plan Administration

Suspended Deadlines Under ERISA: Is It Time to Restart the Clock?
Morgan Lewis Link to more items from this source
[Guidance Overview]
Feb. 25, 2021

"In anticipation of any guidance, plan sponsors should be prepared to fire up any suspended timeframes effective March 1, 2021, and should talk with their third-party administrators to implement an administrative process to begin the clock on any suspended timeframes. Plan sponsors could also consider being more generous with the freeze[.]"

Tags: COBRA  •  Health Plan Administration


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