[Guidance Overview]

Are Employers Allowed to Use Health Plan Claims Records to Determine Whether Employees Have Received COVID-19 Vaccinations?

"An employer's group health plan is a HIPAA covered entity and, under HIPAA, is a separate legal entity from the employer.... Because the plan generally is required to cover COVID-19 vaccinations as preventive services, it is likely to have information about employees' receipt of COVID-19 vaccinations, and this information is considered PHI.... Employees (or other plan participants) cannot be required to sign authorizations allowing the employer to receive PHI from the group health plan as a condition of receiving group health plan benefits."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

IRS PLR Addresses Fertility Treatments and Gestational Surrogacy Expenses Under Section 213 as Applied to Same-Sex Spouses

"In a private letter ruling, the IRS maintains its position that the majority of the medical costs and fees incurred by a same-sex couple seeking to have a child through gestational surrogacy are not deductible 'medical expenses' under Section 213 of the Internal Revenue Code." [PLR 202114001, Jan. 12, 2021]  MORE >>

Epstein Becker Green

Fourth Circuit Revives ERISA Claims Alleging 'Buried' Service Fees Charged to Self-Funded Health Plans

"[T]he Fourth Circuit revived ERISA breach of fiduciary duty and prohibited transaction claims against Aetna Life Insurance Company and Optumhealth Care Solutions, Inc. as it relates to their subcontractor fee agreement for providing in-network services for Aetna insureds. The Fourth Circuit also determined that the district court 'too rigidly' analyzed Rule 23's class certification requirements when it denied class certification for lack of ascertainability and commonality." [Peters v. Aetna, No. 19-2085 (4th Cir. Jun. 22, 2021)]  MORE >>

Roberts Disability Law

Appellate Court Affirms Reinstatement of Retiree Medical Benefits for Rehired Employees

"The appellate court [concluded] that the state's retiree medical plan did not illegally discriminate against the officers on the basis of Medicare eligibility because they were not covered under that plan by virtue of their current employment status.... Finding the [Medicare secondary payer] rules inapplicable, the court concluded that the state violated its obligation under state law not to reduce or impair the officers' retirement benefits." [River City Fraternal Order of Police Lodge 614, Inc. v. Kentucky Retirement Systems, Nos. 20-5773, 20-5778 (6th Cir. Jun. 8, 2021)]  MORE >>

Thomson Reuters / EBIA

Bipartisan Proposal Seeks to Permanently Expand Telehealth Reimbursement

"[T]he Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021 [S 1512] ... aims to codify the expanded access to telehealth services provided by the current Section 1135 waivers due to the COVID-19 public health emergency, in addition to other measures that support the provision of telehealth care."  MORE >>

K&L Gates

Biden and Democrats Propose National Paid Leave, Probably Government-Paid

"The key elements of Biden's proposal, as well as a similar plan introduced in the House Ways and Means Committee, are discussed [in this article]. But some legislative history provides critical context amid the numerous COVID-19 relief bills since March 2020 and the Biden administration's sweeping, complex, and potentially nation-changing new proposals."  MORE >>

Health Affairs Blog

[Opinion]

How a Public Option Could Hold Down Costs

"Proponents of Medicare for All believe that, once all health spending is under government control, costs could be lowered by reducing what's paid to health care providers. But it's not that simple because of the influence that the health care and pharmaceutical industries have on Congress.... Rather than relying on an often-disproved notion that we can simply reduce health care prices by fiat, ... we must put providers at financial risk to reduce overall health care spending."  MORE >>

Ken Terry, in Health Affairs Blog

[Guidance Overview]

DOL Says Claimant May Request Phone Call Recordings Relevant to Benefits Claim

"DOL concluded that a recording of a conversation with a participant would not be excluded from disclosure merely because the plan or claims administrator does not include the recording in its administrative record; does not treat the recording or transcript as part of the claim activity history through which the insurer develops, tracks and administers the claim; or because the recording or transcript was generated for quality assurance purposes."  MORE >>

The Wagner Law Group

Courts Split on Class Action Waivers, Arbitration Provisions in ERISA Litigation (PDF)

"Courts have taken various approaches in determining whether class action waivers and arbitration provisions are enforceable in ERISA-based litigation.... [1] Lack of consideration ... [2] Lack of agreement between the ESOP and the company ... [3] Plan consent ... [4] Consistent with ERISA."  MORE >>

Holland & Knight, via Practical Guidance

What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Support?

"70 percent of adults who survive to age 65 develop severe [long-term services and support (LTSS)] needs before they die and 48 percent receive some paid care over their lifetime. Only 24 percent of older adults receive more than two years of paid LTSS care, and only 15 percent spend more than two years in a nursing home. Lengthy spells of severe LTSS needs and paid care are more common among older adults with few financial resources."  MORE >>

Urban Institute

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Collateral Split Dollar Life Insurance Plan -- What to Do When Company Goes Out of Business?

"A client has a C corporation. He has a split dollar life insurance collateral assignment. He assigned the whole-life insurance to the corporation, which pays the premiums. He personally pays the PS 58 costs. On the corporation's books is the cost (premiums paid). If he decides to cash in the policy, he'll have a taxable gain, because he stills owns the policy. Now he's going out of business. I want to close out the corporation. What happens to the cost of the insurance on the books? Does he need to repay the cost of the premiums? He's the only employee and shareholder."

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Using Mandatory Arbitration to Avoid ERISA Class Actions, Part 2: Recent Legal Decisions on Whether Plan Sponsors Can Compel Arbitration (PDF)

Cohen & Buckmann P.C., via Bloomberg Law

Study Stokes Fresh Scrutiny of Wellness Program Value

Society for Human Resource Management [SHRM]; membership may be required to view article

Government-Paid Healthcare Is Overtaking Private Coverage

Motley Fool