"[T]he proposed regulations would provide that an eligible employer-sponsored plan is affordable for related individuals if the portion of the annual premium the employee must pay for family coverage does not exceed 9.5% of household income.... They would similarly define the employee's required contribution for family coverage as the portion of the annual premium charged for coverage of the employee and all other individuals in the employee's family who are offered coverage. The proposed regulations would also address situations where an individual has offers of coverage from more than one employer, either as an employee or a related individual."  MORE >>

"The proposed rule should not affect liability under the employer mandate. Why? The employer mandate requires certain large employers to offer coverage to employees and dependents. But penalties for violating the mandate are triggered only when an employee receives premium tax credits through the marketplace. As discussed below, the proposed rule would extend marketplace tax credits to only the family members of workers who are not offered affordable job-based family coverage. It would do nothing to affect the eligibility of employees and thus should not implicate the employer mandate."  MORE >>

"After a two-year hiatus, ... May 2, 2022, is the deadline for employers subject to San Francisco's Health Care Security Ordinance (HCSO) and those covered by San Francisco's Fair Chance Ordinance to file an annual report ... to substantiate compliance with these ordinances for 2021.... Covered employers who fail to submit the 2021 Employer Annual Reporting Form can be subject to a penalty of $500 for each quarter that the violation occurs."  MORE >>

"The law requires public school districts, public charter schools, and public universities to reimburse all sick leave taken by fully vaccinated teachers and employees during the 2021-2022 school year if the leave was taken due to a confirmed or probable diagnosis of COVID-19, being identified as a 'close contact' of an individual with COVID-19, or due to a required exclusion from school due to COVID-19, either experienced by the employee or a child of the employee."  MORE >>

"The appellate court held that Reliance Standard [in its denial of the LTD claim] had not made any merits determination regarding benefits; it had made only a determination that Newsom was not a full-time employee at the time of his disability, and therefore had not met the eligibility requirements ... Once Reliance Standard determined that Newsom was ineligible for coverage, it ended the inquiry and did not develop any record regarding the merits of Newson's claim. The court held that remand was necessary for Reliance Standard to develop [such a record]." [Newsom v. Reliance Standard Life Ins. Co., No. 20-1994 (5th Cir. Feb. 18, 2022)]  MORE >>

"The Ninth Circuit decision means that UBH no longer has to reprocess the tens of thousands of claims ... UBH was still adjusting its criteria and guidelines at the time of the Ninth Circuit's decision. It is not clear whether UBS will now 'walk back' its revised criteria ... This decision signifies great latitude for plan administrators and seems to mark a deviation from an otherwise broad national movement toward enforcement of mental health parity laws[.]" [Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]  MORE >>

"[The district court] held that a health plan's 180-day deadline for filing suit was unenforceable because the plan's final benefits denial letter did not disclose the deadline to a claimant. Applying Utah's six-year limitations period for breach of contract claims, the district court concluded that the claim was timely." [A. v. United Healthcare Ins. Co., (D. Utah Mar. 30, 2022)]  MORE >>

"Starting in 2023, if coverage for the family as a whole costs more than about 10 percent of household income under the lowest-cost employer-sponsored option, then the nonemployee family members will be eligible for financial assistance in the ACA marketplace, if the proposal take effect."  MORE >>

"Employees and their families are sicker than they were pre-pandemic.... Reductions in preventive care spend during the pandemic are projected to rebound in 2022 but fail to reach pre-pandemic levels.... Telehealth utilization accelerated and shifted to virtual primary care and condition management.... Gaps in primary care utilization are even more pronounced in low-income communities.... Significant growth in employee demand for behavioral health services is projected to continue.... Demand for musculoskeletal services was exacerbated by the pandemic and is expected to grow in 2022.... Investments in health and wellbeing programs have grown."  MORE >>

"Voluntary workplace life insurance premium ... jumped 60% in the fourth quarter to $614 million.... Voluntary disability premium jumped 10% ... For the year, voluntary long-term disability premium rose 20%, and short-term disability premium increased 5%, compared with prior year.... For the year, supplemental health new premium rose 6% to nearly $2.6 billion, compared with sales from the same period in 2020."  MORE >>

"Employers are ... increasing flexibility and placing a greater emphasis on voluntary benefit options across a variety of categories. 77 percent of employers now offer an average of five health plan options between HDHP and PPOs, and nearly two thirds now offer both an HSA and FSA.... [E]mployers limited out-of-pocket cost increases to two percent or less on average. Employers also picked up the five percent premium increase for individual PPOs.... HDHP elections experienced a significant decline in 2022 for the first time in three years when employees had a choice between a PPO and HDHP."  MORE >>

20 pages. "This memorandum addresses a 2012 private letter ruling, PLR 201246039 ... [which] was issued ... prior to a significant court case on the issue and does not reflect the current position of our office. In the PLR, dated August 21, 2012, the IRS issued a favorable ruling to an IRC 501(c)(6) Business League that provided pension and health benefits to its eligible members.... [T]he 2012 PLR has been called into question because of the reasons cited in this memorandum[.]" [Program Manager Technical Advice dated Oct. 26, 2021; published Apr. 5, 2022.]  MORE >>

"The Federal Civil Penalties Inflation Adjustment Act of 2015 directs the US [DOL] to make annual inflation adjustments to specified [ERISA] violations.... [A table] compares penalty amounts assessed for violations after January 15, 2021, through January 15, 2022, to penalty amounts assessed after January 15, 2022."  MORE >>