Health & Welfare Plans Newsletter

December 4, 2020

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[Guidance Overview]

Questions Remain After New York DOL Releases Proposed Regs Interpreting the New York Paid Sick Leave Law

"The New York State [DOL] has released proposed ... regulations interpreting New York Paid Sick Leave. They defined terms and clarify questions around documentation requests, accruals, and other issues. The proposed regulations still leave many questions unanswered, giving employers a small window in which to contact the state for further clarification." Icon to read more

Goldberg Segalla

[Guidance Overview]

Proposed New York State Paid Sick Leave Regs Leave Many Questions Unanswered

"Employers may not require medical or other verification in connection with sick leave that lasts less than three consecutive scheduled workdays or shifts.... Employers may not require an employee to provide information as to the nature of the illness or details related to domestic violence, sexual offense, family offense, human trafficking, or stalking that necessitates the use of safe leave.... The number of employees employed by an employer during a calendar year shall be determined by counting the highest total number of employees concurrently employed at any point during the calendar year to date." Icon to read more

Hodgson Russ LLP

[Guidance Overview]

CMS Issues Most Favored Nation Model Interim Final Rule -- What to Expect Next

"When fully implemented, the new payment model could result in a 65 percent reduction in Part B drug reimbursement. CMS estimates a reduction of $87.8 billion in spending on MFN drugs by the government and $28 billion in beneficiary savings. CMS estimates that, absent price concessions from manufacturers, providers will be underwater on these claims, with some providers, like 340B covered entities, increasing their market share given their favorable purchasing options and ability to purchase drugs with some margin early in the implementation." Icon to read more

K&L Gates

[Guidance Overview]

COVID-19 Relief for Health Plans: How Long Does It Last?

"Some relief measures apply only during the COVID-19 Public Health Emergency -- not to be confused with the COVID-19 National Emergency. Some apply only in 2020 and some are permanent. Keeping track of what you need to do and how long the relief lasts can be a compliance challenge. Here's a summary to help you keep it all straight." Icon to read more

Mercer

2021 Health Plan Compliance Calendar (PDF)

"Employers must comply with certain filing and disclosure requirements each year in connection with their group health plans. This chart summarizes some of the key requirements and is designed to be used as a tool to help facilitate annual compliance." Icon to read more

VCG Consultants

Health Plan Fiduciaries Breached ERISA's Fiduciary Duties by Failing to Remit Participant Contributions

"A Virginia district court has held that an employer and its owner violated their ERISA fiduciary duties by: [1] Failing to remit participant contributions that were withheld under an ERISA health plan to the plan's insurer. [2] Using the participant contributions, which were plan assets, to pay the employer's other operating expenses. [3] Not informing the plaintiff-participant that her health plan coverage had lapsed due to their failure to remit the withheld contributions." [Hammer v. Johnson Senior Ctr., No. 19-0027 (W.D. Va. Nov. 30, 2020)] Icon to read more

Thomson Reuters Practical Law

Ninth Circuit Finds Anti-Assignment Clause Inapplicable, Requires Plan to Pay Assignee

"[T]he court closely examined both the anti-assignment clause and the plan's incorporation-by-reference language. A dissenting judge disagreed with both elements of the ruling, concluding that the anti-assignment clause was part of the plan ... [T]he bottom line is that the plan must pay the hospital for benefits already paid to participants -- and either absorb the cost or seek reimbursement from those participants, if plan language so allows." [Martin Luther King, Jr., Community Hospital v. Community. Ins. Co., No. 19-55053 (9th Cir. Oct. 2, 2020; unpub.)] Icon to read more

Thomson Reuters / EBIA

Actors Sue SAG-AFTRA Health Plan; 12,000 to Lose Coverage

"The plaintiffs say that nearly 12,000 people will lose their health care next month -- about a third of those participating in the union's plan. Moreover, they say, many of those losing coverage are senior citizens who in many cases have paid into the plan for decades. Members will have to prove earnings of at least $25,950 to get health coverage through the union. Under the new rules, however, that income cannot include pensions or residuals[.]" Icon to read more

National Public Radio [NPR]

Access to Employer-Sponsored Health Coverage for Same-Sex Spouses: 2020 Update

"[As] of mid-2020, while employer offer of same-sex spousal coverage has increased over time, it remains less common than opposite sex spousal coverage. These increases follow two other Supreme Court rulings (United States v. Windsor and Obergerfell v. Hodges) which guaranteed the right to marriage nationwide and paved the way for wider access to health insurance through the workplace[.]" Icon to read more

Henry J. Kaiser Family Foundation

The Perils of PTO for Multi-Jurisdictional Employers (PDF)

"Categories of Paid Time Off ... Vacation/PTO: A question of contract, or a vested right? ... Use-it-or-lose-it policies and caps on accrual ... Payout of accrued vacation/PTO upon termination ... Interplay with paid sick leave laws ... Unlimited PTO policies." Icon to read more

Brownstein Hyatt Farber Schreck LLP

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