logo logo

Health & Welfare Plans Newsletter

May 25, 2022

6 New Job Opportunities 6 New Job Opportunities


[Official Guidance]

Text of DOL Q&As: Mental Health and the FMLA

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 >>

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

[Guidance Overview]

Text of DOL Fact Sheet: Mental Health Conditions and the FMLA

"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 >>

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

[Guidance Overview]

What Employers Should Know About Washington State's Paid Family Medical Leave Program in 2022

"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 >>

Davis Wright Tremaine LLP

Leaving on a Jet Plane... Is Travel to Obtain Abortion a Covered Benefit?

"[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 >>

Holland & Hart LLP

Class Action Accuses Advocate Aurora Health of Suppressing Competition

"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 >>


Sixth Circuit: Plan Had Subrogation Right Even Though Pre-Approval of Surgery Was Not Consistent with Plan Terms

"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 >>

Roberts Disability Law

District Court Permits Litigation Over COVID-19 Testing to Proceed

"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 >>

Thomson Reuters Practical Law

Don't Let Your Disability Claim Be Denied by a 'Fibro Denier'

"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 >>

Kantor & Kantor

How Voluntary Benefits Can Boost Engagement and Retention

"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 >>

HUB International


IRS Needs to Amend Form 1095-C Instructions to Allow Employers to Tell an Accurate Narrative with Respect to Form W-2 Affordability Safe Harbor

"[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 >>


Employee Benefits Jobs

View job as Chief Pension Actuary
          for Loren D. Stark Company Chief Pension Actuary

Loren D. Stark Company


View job as Chief Pension Actuary
          for Loren D. Stark Company

View job as Pension Administrator
          for Actuaries Unlimited, Inc. Pension Administrator

Actuaries Unlimited, Inc.

Remote / Los Angeles CA

View job as Pension Administrator
          for Actuaries Unlimited, Inc.

View job as Regional Sales Consultant
          for Definiti LLC Regional Sales Consultant

Definiti LLC


View job as Regional Sales Consultant
          for Definiti LLC

View job as Actuarial Analyst
          for Definiti LLC Actuarial Analyst

Definiti LLC


View job as Actuarial Analyst
          for Definiti LLC

View job as Implementation Specialist
          for Definiti LLC Implementation Specialist

Definiti LLC


View job as Implementation Specialist
          for Definiti LLC

View job as Defined Contribution (DC) Counsel
          for LGIM America Defined Contribution (DC) Counsel

LGIM America

Chicago IL

View job as Defined Contribution (DC) Counsel
          for LGIM America

Press Releases

Milliman Adds Emergency Savings Program, SecureSave, to Financial Wellness Offering for Retirement Plan Clients


Stradley Ronon Welcomes Seasoned ERISA Lawyer to Washington, DC

Stradley Ronon

Health Professionals Alliance and Merit Wealth Management, LLC Launch The Doctor’s Retirement Plan

Health Professionals Alliance

Webcasts and Conferences
(Health & Welfare Plans)

Employee Benefit Impact of Restrictions on Abortion, Contraceptive and Prenatal Services


Seyfarth Shaw LLP


September 19, 2022 in CO


Last Issue's Most Popular Items

Businesses That Pay for Out-of-State Abortion Costs Could Be Next Target of Texas Lawmakers If Roe v. Wade Is Overturned

Herald Democrat

Mental Health Parity: Are You Ready for an Audit?

BenefitsPro; free registration required

More Than 2 Million Surprise Bills Avoided During January-February 2022 (PDF)

America's Health Insurance Plans [AHIP] and Blue Cross Blue Shield Association

Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2021, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.