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Health & Welfare Plans Newsletter

July 8, 2021

3 New Job Opportunities


[Guidance Overview]

Alert (High Risk Issue) icon Which Federal and State Leave Laws Apply to Your Remote Employee?

"[R]emote work programs of the past likely neglected to address the fundamental differences between mandatory telework (at the employer's direction) and voluntary telework (at the employee's request).... [It's] also critical that you require employees to notify you whenever they will be working from a different jurisdiction, as you will need to track whether they are entitled to a statutory leave of absence under the laws of the state/city in which they are performing work."  MORE >>

FMLA Insights

[Guidance Overview]

OSHA's First Mandatory COVID-19 Workplace Safety Rule Requires PTO for Vaccination and COVID-19 Absences for Healthcare Employees

"[T]he standard requires that employers give unvaccinated employees reasonable time and paid leave to be vaccinated and to recover from vaccine side effects, although it does not define what 'reasonable' time is. Employers must also provide medical removal protection benefits, which include specified amounts of paid leave for certain employees removed from work due to COVID-19 exposure or contraction."  MORE >>

Miles & Stockbridge

[Guidance Overview]

Agencies Begin Providing Rules for 'No Surprises Act' Implementation

"[P]lans and insurers are required to apply a prudent layperson's standard, based on the patient's symptoms, to determine whether a visit to a hospital or free-standing emergency facility qualifies as an emergency protected by the Act, and cannot base such assessment on type of service or diagnosis-related group (DRG) code."  MORE >>

Winston & Strawn LLP

[Guidance Overview]

Surprise Medical Billing Guidance (Part 1) and Model Notice Released; Expectations for Future Guidance Addressed

"These regulations represent an opening salvo in the process of implementing the extensive surprise billing requirements in the NSA. The agencies intend to issue guidance later this year on the IDR process and some of the surprise billing disclosure requirements (including rules for price comparison tools); however, they caution that regulations on many of the NSA transparency requirements might not be provided in 2021[.]"  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

City of Los Angeles Requires Vaccine Leave for Employees Working in the City

"Under the [mayor's] order, employees who work within the City of Los Angeles and have been employed by their employer for 60 days are entitled to paid time off to get vaccinated for COVID-19, including traveling to and from the appointment, as well as recovering from the side effects of vaccination[.]"  MORE >>

Jackson Lewis

Fifth Circuit: ERISA Completely Preempted Health Providers' Tortious Interference Claim Against NFL

"[T]he court concluded that interpreting the plan terms ... was essential to the provider's tortious interference claim. This was because the claim ... hinged on the participants' coverage under the plan and ability to assign plan benefits. Accordingly, ERISA completely preempted the providers' claim." [Advanced Physicians, S.C. v. National Football League, No. 20-10998 (5th Cir. Jul. 1, 2021; unpub.)]  MORE >>

Thomson Reuters Practical Law

Using 'Dummy Code' to Pass Administrative Fees Through to Health Plan May Be Fiduciary Breach

"The court also observed that it would be reasonable to conclude that the claims administrator's actions -- such as referring to the subcontractor as a health care provider, and using codes that did not represent actual medical services -- violated the terms of the plan and constituted a fiduciary breach.... In addition, it appeared that the subcontractor was aware of the 'questionable nature' of the billing arrangement." [Peters v. Aetna, No. 19-2085 (4th Cir. Jun. 22, 2021)]  MORE >>

Thomson Reuters / EBIA

Amazon Care Has Approached Big Health Insurers to Expand Coverage

"The healthcare venture reportedly talked to Aetna, Premera Blue Cross and Blue Cross Blue Shield of Massachusetts ... Securing health insurance coverage or joining an insurer's network would be a big step for Amazon Care, as it would allow the company to expand services to more companies and patients. It would allow insured people to use Amazon Care as they would any other in-network provider."  MORE >>

Becker's Hospital Review

Benefits in General

Harmonizing 'Tax Home' Concepts with Evolving Remote Work Arrangements (PDF)

"An important issue that arises is whether an employer should reimburse employees for the associated travel costs to the [employer's physical location] to ease the transition -- or provide incentives for returning to traditional work locations. [The authors] highlight the historic federal tax rules regarding commuting and travel expenses; identify issues raised as more employers and employees transition to modified work arrangements; and offer recommendations for sensible interim policies in this area."  MORE >>

Groom Law Group, via Tax Notes State

Employee Benefits Jobs

View job as Legal Counsel - RPS Operations Oversight
for T.Rowe Price Legal Counsel - RPS Operations Oversight

T.Rowe Price

Owings Mills MD

View job as 5500 & Trust Specialist I
for Ascensus 5500 & Trust Specialist I



View job as Enrolled Actuary
for Ascensus Enrolled Actuary



Press Releases

Groom Expands Its Deep Team with Addition of Principal Elizabeth Drake

Groom Law Group

TIAA Named One of '70 Innovative Companies Leading on Leave in 2021'


Last Issue's Most Popular Items

HHS Issues Interim Final Rule Implementing Certain Provisions of the No Surprises Act

Holland & Knight

A Closer Look at the New Surprise Billing Regs: The Impact on Balance Billing

Healthcare Financial Management Association [HFMA]; free registration required

Federal Plan to End Surprise Medical Bills Draws Mixed Reactions

Medscape; free registration required

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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.

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