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Health & Welfare Plans Newsletter

May 12, 2022

5 New Job Opportunities 5 New Job Opportunities

 

[Guidance Overview]

Exceptional Usefulness and Quality icon Transparency Rules: New FAQs and Practical Tips

"As we fast approach the July 1, 2022 deadline to post these files it is important for plan sponsors to understand what their insurance carrier or TPA will be requiring them to do and the timeline that the carriers and TPAs will be making the files available for posting. Employers who do not host a public site may be required to work with their insurance carrier or TPA to determine if the insurance carrier or TPA will host a site in their name, or if the employer will be required to create a public site for the purpose of posting the files."  MORE >>

HUB International

[Guidance Overview]

Delaware Paid Family and Medical Leave Law Signed

"The related Family and Medical Leave Insurance Program will be funded by employer and employee contributions. Contributions will begin on January 1, 2025. Employees will be able to utilize the job-protected paid leave beginning on January 1, 2026.... The maximum amount of leave benefits a covered individual may take is 12 weeks per year for parental leave and an aggregate of six weeks in any 24-month period for other qualifying reasons, for a cumulative total of up to 12 weeks of benefits per year."  MORE >>

Jackson Lewis P.C.

Alert (High Risk Issue) icon Class Action Lawsuits Challenge Employers' Military Leave Practices

"As noted in both opinions, at least two federal appellate courts have determined that pay during leave is a 'right and benefit' protected by USERRA. Employers providing paid leave for non-military reasons should consult with counsel before denying pay during short-term military leave.... [E]mployees on military leave generally have a right under USERRA to elect to continue employment-based group health plan coverage for themselves and their covered dependents. This is in addition to any continuation rights under COBRA." [Baker v. United Parcel Service Inc., No. 21-0114 (E.D. Wash. Mar. 31, 2022); Haley v. Delta Airlines, Inc., No. 21-1076 (N.D. Ga. Mar. 29, 2022)]  MORE >>

Thomson Reuters / EBIA

Alert (High Risk Issue) icon Court Declines to Enforce Plan-Imposed Limitations Periods Not Disclosed in Benefit Denial Notices

"In two nearly identical rulings, a federal trial court has concluded that plan-imposed deadlines for filing lawsuits did not apply because they were not set forth in final denial letters to the participants. While the cases involved separate ERISA plans (one fully insured and one self-insured) sponsored by different employers, both plans involved denials by the same entity (as insurer for the insured plan and claims administrator for the self-insured plan)." [E.F. v. United HealthCare Ins. Co., No. 21-190 (D. Utah Mar. 30, 2022); Anne A. v. United HealthCare Ins. Co., No. 20-814 (D. Utah Mar. 30, 2022)]  MORE >>

Thomson Reuters / EBIA

Fourth Circuit ERISA Ruling Shows Plan Discretion Is Not Limitless

"A doctor's opinion relied on by the plan that was not based on a full review of the relevant evidence was viewed by the court as neither principled nor reasoned.... [T]he plan's imposition of an absolute requirement that all conservative treatments must be exhausted before approving surgery was also considered an abuse of discretion.... Finally, ... [an] abuse of discretion may exist when the benefit determination is inconsistent with the purpose of the plan." [Garner v. Cent. States, SE & SW Areas Health & Welfare Fund Active Plan, No. 21-1602 (4th Cir. Apr. 20, 2022)]  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Seventh Circuit Affirms AT&T's Denial of Short-Term Disability Benefits and Denies Defense's Pro Hac Vice Fees as Non-Taxable Cost

"The Court was satisfied that Sedgwick's determination was grounded in sufficient evidence and was adequately explained to Canter.... The Court rejected Canter's argument that the district court was wrong to reject evidence outside the administrative record concerning the reviewers' efforts to contact his doctors and the leave-of-absence accommodation that AT&T granted him." [Canter v. AT&T Umbrella Benefit Plan No. 3, No. 21-1514 (7th Cir. May 11, 2022)]  MORE >>

Roberts Disability Law

Alert (High Risk Issue) icon Eighth Circuit Rules That Reliance Standard's 'Haphazard System of Ships Passing in the Night' Led to a Breach of Fiduciary Duty

"ERISA-governed life insurance benefit plans are typically administered jointly by the employer and an insurance company.... It is common for one party to be uncertain as to what the other is supposed to be doing, and frequently neither party possesses full information as to which employees have signed up for what, and whether those employees have met all the requirements for eligibility or enrollment.... [T]his confusion, unfortunately, appears to be a feature of the system, not a bug. It gives both the employer and the insurer plausible deniability and leaves employees ... holding the bag. [This] case hopefully accelerates a trend toward ending such arrangements." [Skelton v. Radisson Hotel Bloomington, No. 21-2641 (8th Cir. May 6, 2022)]  MORE >>

Kantor & Kantor

How Employer-Provided Coverage Improves Access to Mental Health Support (PDF)

"41 million Americans -- nearly 1 in 4 enrolled in employer-provided coverage -- received mental health support in 2020. 6 million children received mental health services and treatment through a parent or guardian's employer-provided coverage in 2020. There was a 100-fold increase in telehealth appointments for mental health in 2020. Patients spend less than $15 in out-of-pocket costs for most drugs prescribed to treat mental health conditions."  MORE >>

America's Health Insurance Plans [AHIP]

Businesses Seek to Provide Abortion Travel Benefits in Light of Potential Supreme Court Decision

"In light of recent state-level trends, businesses have begun exploring avenues to assist employees in states with restrictive abortion laws with travel to nearby states to receive abortion services. In implementing these programs, employers should consider the various ERISA and tax code-related provisions that may impact design."  MORE >>

Seyfarth

Employee Benefits Jobs

View job as Compliance Specialist
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Wespath Benefits and Investments

Remote / Glenview IL

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Latitude Service Company

Remote / Plymouth IN / Powell OH / Cincinnati OH / Mount Pleasant SC / Woodland Hills CA / Glendale AZ

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          for Latitude Service Company

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          for July Business Services Client Service Manager

July Business Services

Remote

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          for July Business Services

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Employee Benefits Security Administration [EBSA]

Remote

View job as Senior Technical Advisor
          for Employee Benefits Security Administration [EBSA]

View job as Auditor (Healthcare)
          for Employee Benefits Security Administration [EBSA] Auditor (Healthcare)

Employee Benefits Security Administration [EBSA]

Remote / Covington KY

View job as Auditor (Healthcare)
          for Employee Benefits Security Administration [EBSA]

Press Releases

Nicole Jimenez Strengthens Newfront's Growing Benefits Team

Newfront

Webcasts and Conferences
(Health & Welfare Plans)

Employee Benefit Plans of Tax-Exempt and Governmental Employers 2022

October 13, 2022 in DC

ALI CLE [American Law Institute Continuing Legal Education]

Last Issue's Most Popular Items

What Exactly Is Driving the Great Resignation?

planadviser

Details in Regs Unlock Federal Poverty Line Affordability Safe Harbor Solution for Non-Calendar Year Plans

Accord

Steps to Take Before and During a Data Breach (PDF)

benefits magazine, a publication of the International Foundation of Employee Benefit Plans [IFEBP]

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

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