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Health & Welfare Plans Newsletter

August 12, 2021

8 New Job Opportunities


[Guidance Overview]

No More Balance Billing for Some Out-of-Network Services

"Effective beginning January 1, 2022, the CAA prohibits plans and providers from billing patients more than in-network cost-sharing amounts in certain circumstances. The prohibition applies to both emergency care and certain non-emergency situations where patients do not have the ability to choose an in-network provider."  MORE >>

Holland & Hart LLP

[Guidance Overview]

Pittsburgh Expands COVID-19 Paid Sick Leave

"[T]he new legislation ... amends the [Pittsburgh Paid Sick Days Act (PSDA)] by expressly permitting employees to take sick time under the PSDA before it is accrued if the reason for use arises directly from COVID-19.... The July 29 Ordinance also requires employers to provide paid COVID sick time in addition to other forms of paid leave, so long as the employee provides notice to the employer of the need for COVID-19 sick time as soon as practicable."  MORE >>

Jackson Lewis P.C.

United Behavioral Health, United Healthcare Insurance Co. Plans to Pay $15.6M, Take Corrective Actions After Federal, State Investigations

"An investigation by the department's Employee Benefits Security Administration found that -- going back to at least 2013 -- United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, resulting in many denials of payment for those services." [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)]   MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

UnitedHealthcare Inks Settlement Over Mental Health Coverage

"United Healthcare Insurance Co., United Behavioral Health, and Oxford Health Insurance Inc. will collectively pay more than $13 million to settle private litigation and investigations by the [DOL] and New York Attorney General, which accused the companies of violating federal mental health parity law[.]" [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)]  MORE >>

Bloomberg Law

Third Circuit Rules Reservists May Need to Be Paid for Military Leave

"The court specifically referenced that FedEx pays employees who miss work for other reasons -- such as jury duty, illness, and bereavement -- and remanded the case to the district court to determine if those forms of leave are comparable to military leave." [Travers v. Federal Express Corp., No. 20-2073 (3d Cir. Aug. 10, 2021)]  MORE >>

Ballard Spahr

Can an Employer Discipline an Employee for Excessive FMLA-Related Absences Before Requesting Recertification?

"What happens when you verbally request recertification? Almost 100% of the time, your employee denies that you ever requested it. Although the FMLA regulations technically allow you to request recertification verbally, why would you ever leave this to chance? Every time, all the time, make a written request for recertification so that you have a clear paper trail proving the request." [Calio v. Camden County Board of Chosen Freeholders, No. 19-8393 (D.N.J. Aug. 6, 2021)]  MORE >>

FMLA Insights

Discounted Premiums on Individual Disability Policies Do Not Create ERISA Plan

"While it was clear that the employer paid no portion of the policy premiums, the insurer argued that the premium discount was effectively a company contribution. But the court rejected this contention, explaining that discounted premiums are not considered employer contributions unless the employer negotiated or was otherwise involved with the discount[.]" [Shrago v. UNUM Life Ins. Co. of Am., No. 80-1097 (D. Md. Jul. 28, 2021)]  MORE >>

Thomson Reuters / EBIA

Court Applies Section 1557 Nondiscrimination Requirements to Insurer's Entire Operations

"The court explained that Section 1557 prohibits discrimination under any health program or activity, 'any part of which' receives federal financial assistance and therefore, the plain text of the statute unambiguously prohibits discrimination by an insurer under its 'entire portfolio.' Pointing out that the insurer offered a Medicare plan that was receiving federal financial assistance, the court denied the insurer's request to dismiss the case, ruling that the insurer's acceptance of federal assistance under its Medicare plan meant that its entire portfolio must comply with Section 1557." [Fain v. Crouch, No. 20, 740 (S.D. W.Va. May 19, 2021)]  MORE >>

Thomson Reuters / EBIA

Benefits in General


ERISA's Broken Promise

"This article explores the policy dimension of ERISA disclosure law and chronicles the decay of the equilibrium Congress envisioned.... The new balance serves the interests of federal courts (reduced caseload) and some employers (increased flexibility), but likely contributes to the increasing standardization of employee benefit plans, decreasing their utility as instruments of workforce management. Far worse, it abandons ERISA's goal of improved economic performance through better-informed career and financial planning."  MORE >>

Peter J. Wiedenbeck, Washington University in St. Louis - School of Law, via SSRN

Employee Benefits Jobs

View job as Implementation Manager, Northwest
for Human Interest Implementation Manager, Northwest

Human Interest

Remote / San Francisco CA

View job as Implementation Manager, Northwest
for Human Interest

View job as 401(k) Retirement Plan Administrator
for Red Bank Pension Services, Inc. 401(k) Retirement Plan Administrator

Red Bank Pension Services, Inc.

Remote / Shrewsbury NJ

View job as Retirement Plan Administrator
for The Finway Group Retirement Plan Administrator

The Finway Group

Remote / West Des Moines IA / IL / MN / MO

View job as Retirement Plan Consultant & Document Team Manager
for Alliance Benefit Group of Houston, Inc. Retirement Plan Consultant & Document Team Manager

Alliance Benefit Group of Houston, Inc.

Remote / Houston TX

View job as Senior Retirement Compliance Analyst
for Insperity Senior Retirement Compliance Analyst


Kingwood TX

View job as Retirement Plan Administrator II
for FranFund Retirement Plan Administrator II


Remote / Fort Worth TX

View job as Implementation Specialist
for Definiti Implementation Specialist


Remote / CA / FL / PA / TX / WA

View job as Management and Program Analyst (Recent Graduate)
for Employee Benefits Security Administration [EBSA] Management and Program Analyst (Recent Graduate)

Employee Benefits Security Administration [EBSA]

Remote / Washington DC

Press Releases

National Launch of EBenefitsHub Kicks-Off at the BenefitsPRO BROKER EXPO

Wealth Engineering Family of Companies

Webcasts and Conferences
(Health & Welfare Plans)

No Surprises Act (Part 1): Emergency Services Protections, and Plan and Provider Requirements

August 18, 2021 WEBCAST

Miller Johnson

Oregon Time Off and Leave

September 8, 2021 WEBCAST


No Surprises Act (Part 2): Nonemergency Services Provided at In-Network Facilities by Out-of-Network Providers

September 15, 2021 WEBCAST

Miller Johnson

Ready, Set, Go! The Evolution of PFML Preparedness

September 30, 2021 WEBCAST

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

Surprise Billing Regs: Out-of-Network Providers at In-Network Facilities

K&L Gates

The Collapsing Legal Basis for Cross-Plan Offsetting

BenefitsPro; free registration required

IRS Expands Employer Tax Credits for Paid COVID-19 Vaccination Leave

Husch Blackwell

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

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