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Health & Welfare Plans Newsletter
August 12, 2021
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► 8 New Job Opportunities
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[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
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[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.
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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]
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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
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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
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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
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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
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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
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Benefits in General |
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[Opinion]
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
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Employee Benefits Jobs |
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Press Releases |
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National Launch of EBenefitsHub Kicks-Off at the BenefitsPRO BROKER EXPO
Wealth Engineering Family of Companies
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Webcasts and Conferences
(Health & Welfare Plans) |
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No Surprises Act (Part 1): Emergency Services Protections, and Plan and Provider Requirements
August 18, 2021 WEBCAST
Miller Johnson
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Oregon Time Off and Leave
September 8, 2021 WEBCAST
Littler
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No Surprises Act (Part 2): Nonemergency Services Provided at In-Network Facilities by Out-of-Network Providers
September 15, 2021 WEBCAST
Miller Johnson
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Ready, Set, Go! The Evolution of PFML Preparedness
September 30, 2021 WEBCAST
Disability Management Employer Coalition [DMEC]
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Last Issue's Most Popular Items |
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Surprise Billing Regs: Out-of-Network Providers at In-Network Facilities
K&L Gates
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The Collapsing Legal Basis for Cross-Plan Offsetting
BenefitsPro; free registration required
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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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