[Official Guidance]

Text of Draft IRS Instructions for 2021 Form 1095-A: Health Insurance Marketplace Statement (PDF)

Sep. 22, 2021. "Form 1095-A is used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Health Insurance Marketplace. Form 1095-A is also furnished to individuals to allow them to take the premium tax credit, to reconcile the credit on their returns with advance payments of the premium tax credit (advance credit payments), and to file an accurate tax return."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

MHPAEA Action Steps for Self-Insured Group Health Plan Sponsors

"[1] Review and familiarize yourself with the DOL's Self Compliance Tool ... [2] Contact your [TPA] and [PBM] to determine the steps they have taken to develop and document the NQTL analysis.... [3] Request a copy of the comparative analysis and supporting documentation from the TPA and PBM and review it ... [4] Consider developing internal controls to monitor compliance with the MHPAEA."  MORE >>

Verrill Dana LLP

[Guidance Overview]

Missouri Now Requires Leave for Victims of Domestic Violence

"Missouri employers with at least 20 employees must now provide unpaid leave and certain safety accommodations to victims of domestic or sexual violence under a new law, the Victims Economic Safety and Security Act [VESSA], which took effect on August 28.... [E]mployers must provide notice of the law's provisions to employees by October 27.... The length of the required leave period provided by the employer depends on the number of the employer's employees[.]"  MORE >>

Constangy, Brooks, Smith & Prophete LLP

Promises, Promises: Statements in a PowerPoint About Lifetime Health Benefits May Bind Employer

"The Court ... affirmed the district court's denial of [the participant's] claim for benefits. But the Court concluded that it was a different story with respect to [his] claim for equitable relief.... [T]he Court concluded that 'there was a genuine issue of material fact as to whether NetApp incorrectly represented to the Plan participants that the Plan provided lifetime health insurance benefits.' " [Warmenhoven v. NetApp, Inc., No. 19-16960 (9th Cir. Sep. 13, 2021)]  MORE >>

Kantor & Kantor

Texas District Court Upholds Denial of LTD Benefits Because Claimant Did Not Prove Functional Limitations Within Benefit Waiting Period

"The case ... highlights the need to focus on whether a claimant has a disabling condition and not merely a diagnosis within the benefit waiting period under the Policy.... Further, the reasoning of this case provides a strong basis for a Plan to argue to the reviewing court that it can only look to a claimant's condition during the benefit waiting period, and not the claimant's condition beyond, even though it may have worsened into a disabling condition during the administrative review, but after the elimination period." [Calkin v. United States Life Ins. Co., No. 20-0035 (S.D. TX., Apr. 29, 2021)]  MORE >>

Hinshaw & Culbertson LLP

First Circuit Upholds Unum's Application of Long-Term Disability Policy's Self-Reported Symptoms Limitation

"The First Circuit found that Unum did not abuse its discretion in requiring objective evidence of functional limitations. In so doing, the First Circuit declined to follow the Seventh Circuit's [self-reported symptoms (SRS)] limitation test set forth in Weitzenkamp v. Unum Life Ins. Co. of America, which applies the SRS limitation to illnesses or injuries that are diagnosed primarily based on self-reported symptoms rather than to all illnesses or injuries for which the disabling symptoms are self-reported." [Ovist v. Unum Life Ins. Co. of Am., No. 20-1464 (1st Cir. Sep. 22, 2021)]  MORE >>

Roberts Disability Law

The Checkup Is in the Mail? Soliciting Letter Carriers to Help Deliver Health Care

"Mail could be delivered just a few times a week, say, every other day. And on the off days, presto -- we get a new on-the-ground home health workforce. They could do home visits, to redress an epidemic of loneliness among older homebound Americans and check on whether a customer has an adequate supply of food and medicines. With a bit of retraining, they could check and record blood pressure, test blood sugar levels in people with diabetes and even administer pills."  MORE >>

Kaiser Health News

Paid Sick Leave Was Available to 77 Percent of Private Industry Workers in March 2021

"[A]ccess to paid sick leave ranged from 59 percent of workers in service occupations to 93 percent in management, professional, and related occupations. Twenty-three percent of private industry workers had access to paid family leave. ... Forty-five percent of private industry workers had access to plans that provide a single amount of time off for workers to use for multiple purposes, such as vacation, illness, or personal leave, referred to as consolidated leave plans."  MORE >>

U.S. Bureau of Labor Statistics [BLS]

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Competition Opens for Innovative Public Pension Funding Strategies Award

National Institute on Retirement Security [NIRS]

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Recent ERISA Litigation Trends & Outcomes

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Ropes & Gray

What, Who, and When? Avoiding Legal Compliance Surprises in Your Health and Welfare Benefit Plans

October 21, 2021 WEBCAST

Hall Benefits Law

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Prepare Your Business to Comply With the OSHA Vaccine Mandate

Foley & Lardner LLP

Employers: Check Your Severance Arrangements Now!

Faegre Drinker

Text of Agency Final Regs: Updating Payment Parameters, Section 1332 Waiver Implementing Regs, and Improving Health Insurance Markets for 2022 and Beyond

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; and Monetary Offices, Department of the Treasury