8 Q&As, including: "[1] May I use FMLA leave when I am unable to work because of severe anxiety? I see a physician monthly for this condition to manage my symptoms.... [2] I am under the care of a psychologist and attend psychotherapy sessions regularly for anorexia nervosa. Is my leave for treatment related to this condition protected under the FMLA? ... [3] My daughter, who is 24 years old, was recently released from several days of inpatient treatment for a mental health condition. May I use FMLA leave for her care? She is unable to work or go to school and needs help with cooking, cleaning, shopping, and other daily activities.... [4] May I use FMLA leave to attend a family counseling session for my spouse who is in an inpatient treatment program for substance abuse?"  MORE >>

"The Family and Medical Leave Act (FMLA) provides job-protected leave to address mental health conditions. This fact sheet explains when eligible employees of covered employers may use FMLA leave for their own or a family member's mental health condition."  MORE >>

"While there are some similarities to other leave entitlements, such as the federal [FMLA], there are some distinct differences that create challenges for employers to administer leave programs.... Unlike federal FMLA where employees interact directly with their employers to determine eligibility, employees apply directly to the Washington Employment Security Department (ESD) to request leave, and the ESD administers the PFML program and determines employee eligibility."  MORE >>

"[Employer] considerations ... when designing an abortion care travel reimbursement benefit [include] : Do the travel expenses constitute medical care? ... Will the travel reimbursement benefit be offered under the company's group health plan? ... How will state laws impact an employer's ability to provide the travel reimbursement benefit? ... Will the reimbursement be taxable compensation to employees? ... Other considerations: Impact on eligibility for an employee's participation in a health savings account (HSA). HIPAA and privacy issues. Ability to permit mid-year election changes in connection with the addition of the benefit."  MORE >>

"Advocate Aurora Health has been hit with a class-action antitrust lawsuit alleging the system has used its market strength in Eastern Wisconsin to suppress competition and drive 'unreasonably high prices.' ... [T]he case was brought by Uriel Pharmacy, a Wisconsin-based pharmacy, and its self-funded health plan.... Among the anticompetitive strategies plaintiffs alleged the large nonprofit employed were 'all-or-nothing' clauses that require commercial health plans to include all Advocate Aurora facilities in their networks." [Uriel Pharmacy Health & Welfare Plan v. Advocate Aurora Health, Inc., No. 22-0610 (E.D. Wis. complaint filed May 24, 2022)]  MORE >>

"The court found that Zahuranec incurred a Covered Expense when she underwent bariatric surgery and Cigna determined that it was medically necessary when it approved the procedure. The payment for the surgery was a 'benefit' under the plan. Whether a procedure is medically necessary does not determine what a benefit is -- only when it's paid. And there's no dispute that [a third party, namely a physician against whom the participant-plaintiff had recovered money damages] is responsible for the cost [under the plan document's subrogation provision]." [Zahuranec v. Cigna Healthcare, Inc., No. 21-3695 (6th Cir. May 23, 2022)]  MORE >>

"In a dispute over reimbursements for COVID-19 testing, a district court concluded that the COVID-19 testing coverage mandate of the [FFCRA] and the [CARES Act] was an implied ERISA plan term. As a result, the court concluded that plan participants -- and health providers on behalf of the participants -- could sue under ERISA after a health insurer denied coverage for COVID-19 testing." [Open MRI and Imaging of RP Vestibular Diagnostics, P.A., v. Cigna Health & Life Ins. Co., No. 20-10345 (D.N.J. May 18, 2022)]  MORE >>

"When [fibromyalgia] first came to the forefront in disability litigation, insurers sought to deny these claims based on the rationale that the insured did not prove the claim with 'objective evidence.' However, more often than not, there was no 'objective evidence' requirement in the disability insurance policy.... Insurers have now been using a different tactic. They utilize 'Fibro Denier' physicians to review the claim. These physicians often opine that Fibromyalgia is a 'syndrome,' as opposed to a true illness and that it can never be impairing."  MORE >>

"Employers shying away from offering voluntary benefits should know that the vast majority of the most sought-after voluntary benefits are low or no-cost to the employer, putting small and medium-sized organizations on even footing with larger competitors."  MORE >>

"[T]he language in the instructions is not allowing employers to tell an accurate 12-chapter narrative to the IRS with respect to some employees. The problem is [exacerbated] by the fact the State exchanges are failing to accurately determine who is eligible for a premium tax credit and are also not sending out the required 1411 notices to employers. Collectively this is leading to a waste of IRS and employer resources through appealing the proposed IRS penalties.... A simple change to the language in the instruction from 'calendar year' to 'plan year' would solve this problem."  MORE >>