"This bulletin extends the [CMS] policy under which CMS will not take enforcement action against certain non-grandfathered health insurance coverage ... that is out of compliance with certain specified market reforms. The extended non-enforcement policy in this bulletin applies for policy years beginning after October 1, 2022, and will remain in effect until CMS announces that all such coverage must come into compliance with the specified requirements."  MORE >>

"This paper describes Treasury's methodology for modeling health insurance coverage and PTC at the state level, for evaluating Section 1332 waiver applications and calculating pass-through payments for 2022, for states with reinsurance program waivers. This methodology was developed by Treasury's Office of Tax Analysis (OTA) in collaboration with the Office of the Actuary, [CMS] (OACT)." [Also see Key Components of ACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2022 (XLSX) and State Specific Premium Data for Section 1332 Waiver 2022 Pass-through Calculations (XLS)]  MORE >>

"[T]he Extended Telehealth Relief is optional. If a plan sponsor decides to implement the Extended Telehealth Relief, it should ... [1] [For fully-insured plans,] contact its HDHP carrier to ascertain whether the carrier's plans will adopt the Extended Telehealth Relief from April 2022 to December 2022.... [1] If the HDHP is self-insured, the plan sponsor should consult with its stop-loss carrier and third party administrator regarding the telehealth relief extension."  MORE >>

"Sometimes an ERISA-governed disability benefit claim is denied on a specific issue that precludes the need for a full development of the record on the merits of the claim. E.g., claimant was not eligible for benefits because he was not a full-time employee at the time of disability. But when should courts order remand, after determining the claimant may be eligible for benefits? This new decision provides some helpful guidance." [Newsom v. Reliance Standard Life Ins. Co., No. 20-1994 (5th Cir. February 18, 2022)]  MORE >>

"[N]either the insurance policy provided to the employer nor the benefits certificate provided to participants included an exhaustion requirement -- or any description of the plan's claims review process. The insurer argued that its procedure was detailed in the benefit denial letter, but the court concluded that this was insufficient[.]" [Yates v. Symetra Life Insurance Co., No. 19-154 (E.D. Mo. Jan. 3, 2022)]  MORE >>

"ERISA preemption plays a major role in considering the scope of a state benefit or insurance law and its applicability to employee benefit plans. However, determining whether ERISA preempts a particular state law isn't always straightforward and can present challenges for employers, so the courts sometimes must step in to determine if preemption applies. This GRIST provides a basic primer on ERISA's preemption of state laws, including various exceptions, exclusions and court rulings."  MORE >>

"The legislation ... would give eight weeks paid leave annually to county employees working 20 hours or more a week for the birth of a child, or for families that have taken in a child through adoption, fostering, guardianship or acting as a parent. It also offers three weeks paid leave following a miscarriage or stillbirth, and two additional weeks if there are complications with the pregnancy or birth that cause incapacity or other serious health conditions."  MORE >>

"[D]espite the potential benefits, there are definite downsides to unlimited PTO policies in workplaces with certain cultures.... A solution may be putting guidelines in place to help employees navigate the freedom and flexibility that unlimited PTO policies promise."  MORE >>

"The district court appropriately applied the Secretary's regulations ... and correctly considered United's shifting and inconsistent denial rationales in determining that United's claim denial was arbitrary and capricious.... '[F]ull and fair review' requires fiduciaries to 'take into account' expert opinions supporting the claim, which requires more than simply citing the evidence in a denial letter." [D.K. v. United Behavioral Health, No. 17-1328 (D. Utah Jun. 22, 2021; on appeal to 10th Cir. No. 21-4088)]  MORE >>

"Although the term 'civil action' is supposed to have identical meaning under the Federal Rules of Civil Procedure regardless of the type of claim being brought, ERISA claim litigation differs dramatically from ordinary civil procedure. Courts have invented rules that lack any statutory or other support.... For years, no court questioned the quasi-administrative law regime to which ERISA claims have been relegated. However, in a quartet of recent appellate rulings, courts have started to question the status quo."  MORE >>

"[T]he Trump rule condensed the analysis to weighing two key factors: [1] the nature and degree of the individual's control over the work; and [2] the individual's opportunity for profit or loss. Under the Trump rule, only when these two factors are insufficient to answer whether the individual is an employee or independent contractor should the remaining four factors be considered." [Coalition for Workforce Innovation v. Walsh, No. 21-0130 (E.D. Tex. Mar. 14, 2022)]  MORE >>

"Although the ruling purports to vacate the delay and withdrawal rules, there is a long-running legal debate as to whether such vacatur orders from lower courts do or ought to apply nationwide as opposed to only the court jurisdiction or to the plaintiffs involved. So it is possible that the DOL could file a motion for clarification with the court or offer a public statement that competes with what appears to be a nationwide vacatur of the rule." [Coalition for Workforce Innovation v. Walsh, No. 21-0130 (E.D. Tex. Mar. 14, 2022)]  MORE >>