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February 5, 2020 logo logo
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[Guidance Overview]

When Are Employees Entitled to FMLA Leave Related to Coronavirus? Can an Employee with No Symptoms Be Forced Off Work?

"Clearly, employees with the coronavirus and employees with a child, spouse, or parent infected by the coronavirus are entitled to FMLA leave (if otherwise FMLA-eligible). But what if the employee demonstrates no symptoms? ... If the employee demonstrates no symptoms of coronavirus, however, the employer should not count any of this leave against the employee's FMLA allotment, as there is no evidence (yet) of a serious health condition rendering the employee unable to work."

FMLA Insights

[Guidance Overview]

Prescription Drug Creditable Coverage Disclosures Must Be Submitted to CMS by February 29, 2020

"Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to CMS whether that coverage is 'creditable' or 'non-creditable.' The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that offer prescription drug coverage only to active employees and not to retirees. Calendar year plans must submit this year's disclosure by February 29, 2020."


First Circuit Addresses Remedy for Providing Inadequate Notice of Reason for Claim Denial

"[The First Circuit held that] Sun Life provided adequate notice, but barring Sun Life from asserting the provision would not be the proper remedy anyway; the [district court] did not abuse its discretion in denying Martinez discovery because '[i]t is unclear how discovery would help elucidate the plain meaning of an unambiguous contract term.' " [Martinez v. Sun Life Assurance Co. of Canada, No. 18-2127 (1st Cir. Jan. 27, 2020)]

Lane Powell PC

Eleventh Circuit Affirms Judgment Against Reliance Standard in Favor of Dentist in Long-Term Disability Dispute

"Though this is an unpublished decision, it provides a good road map of arguments for disability claimants who suffer from progressive conditions causing pain and who have attempted to continue working despite the pain. The decision also arguably reflects a softened arbitrary and capricious standard in the Eleventh Circuit." [Kaviani v. Reliance Standard Life Ins. Co., No. 19-11798 (11th Cir. Jan. 31, 2020)]

Kantor & Kantor

HHS Releases Exchange Program Integrity Final Rule

"This rule implements a number of provisions from the ACA, including the requirement that each state have the opportunity to establish an Exchange, as well as the steps [HHS] may take to oversee Exchanges' compliance with HHS standards, including ensuring their financial integrity, including conducting investigations and annual audits, and the requirement that the Secretary establish procedures to verify the accuracy of information provided by applicants, including eligibility to purchase qualified health plans (QHPs) through the Exchange and for advance payments of premium tax credit (APTC) and cost-sharing reductions (CSRs)."

Sheppard Mullin

Press Releases

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Text of Agency ACA Implementation FAQs, Part 41: Summary of Benefits and Coverage (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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