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Health & Welfare Plans Newsletter

August 18, 2022


[Guidance Overview]

Employers May Have to Pay More in 2023 as Affordability Threshold Hits New Low

"For plan years beginning in 2023, a plan will meet the ACA affordability requirement under the FPL safe harbor if an employee's required contribution for self-only coverage does not exceed $103.28 per month."  MORE >>


Text of Fifth Circuit Opinion Upholding Vacatur of DOL's Rejection of ERISA Coverage for Health Plan of Data-Mining Limited Partnership (PDF)

17 pages. "The key factors the Department ignored were its prior advisory opinions discussing the term 'working owner' and its regulation adopting a definition of the term in a related context.... [T]he Department spills much ink in its response brief either explaining away the prior advisory opinions and the regulation or arguing that the definitions they adopted are consistent with the ones adopted elsewhere. But all those arguments were not made in the final agency action itself and thus aren't 'contemporaneous explanations.' ... They are instead 'impermissible post hoc rationalizations.' ... And these post hoc rationalizations confirm that the action here is arbitrary and capricious."   [Data Marketing Partnership, LP v. DOL, No. 20-11179 (5th Cir. Aug. 17, 2022)]  MORE >>

U.S. Court of Appeals for the Fifth Circuit

Two Recent Cases Provide Important ERISA Reminders

"The reminders [in one recent case] are: [1] the DOL does audit many plans of many sizes, and [2] blatantly ignoring the requirements of ERISA when administering or amending an ERISA plan or the advice of your counsel and other advisors on the hope that you will not be audited is not prudent or smart. [Walsh v. Board of Trustees of Local 272 Welfare Fund, No. 22-5292 (S.D.N.Y August 2, 2022)] ... [W]hile a de novo review standard continues to be fairly rare in ERISA benefit cases, there is a range of reasons why this may be the appropriate standard, including poor drafting, significant claims regulation violations, or the situs of the case.... [T]he law of the land on this issue varies significantly depending on where the litigation is located[.]" [Harris v. The Lincoln National Life Ins. Co., No. 21-13186 (11th Cir. Jul. 29, 2022)]  MORE >>

Foley & Lardner LLP

Fourth Circuit Affirms Denial of Long-Term Disability Benefits Based on Insufficient Information

"Shaw asserts that the information United requested was irrelevant and that it had sufficient information to pay his benefits. The court found that the scope of United's request is irrelevant since Shaw did not object to the requests nor did he assert any basis for his failure to respond.... [T]he court found that United's determination that it had insufficient records to determine disability was reasonable." [Shaw v. United Mutual of Omaha Life Ins. Co. of America, No. 21-1818 (4th Cir. Aug. 16, 2022; unpub.)]  MORE >>

Roberts Disability Law

U.S. Employer Health Care Costs Projected to Increase 6.5 Percent Next Year

"Average costs for U.S. employers that pay for their employees' health care will increase 6.5 percent to more than $13,800 per employee in 2023 ... This projection is more than double the 3 percent increase to health care budgets which employers experienced from 2021 to 2022; but is significantly below the 9.1 inflation figure reported through the Consumer Price Index. "  MORE >>


2023 Open Enrollment Compliance Checklist

"To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2023. Employers should review their plan documents to confirm that they include these required changes.... Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable[.]"  MORE >>


Benefits in General

[Official Guidance]

Text of EBSA Request for Nominations: Advisory Council on Employee Welfare and Pension Benefit Plans

"The terms of five Council members expire at the end of this year. The groups or fields they represent are as follows: [1] Employee organizations; [2] employers; [3] the general public; [4] insurance; and [5] accounting.... Nominations must be received on or before [45 days after publication in the Federal Register, currently scheduled for August 19, 2022]."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Press Releases

Nine Attorneys from the Wagner Law Group to Be Recognized in 2023 Edition of the Best Lawyers in America©

The Wagner Law Group P.C.

Aflac Enhances Individual Short-Term Disability Insurance to Include Mental Health Coverage


Arlington Chamber Launches 401(k) Program for Members

Arlington Chamber of Commerce

Last Issue's Most Popular Items

Decoding the New Rules for Prescription Drug and Other Healthcare Spending Transparency


Technical Assistance for Certified Independent Dispute Resolution (IDR) Entities (PDF)

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

When Being Wrong Isn't Enough: Eleventh Circuit Upholds Benefit Decision with Which It Disagrees

Kantor & Kantor LLC

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

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