News

The U.S. District Court for the Southern District of New York, in Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family out-of-pocket cost-sharing limit rather than the individual limit.  In reaching this outcome, the court concluded that HHS regulations interpreting the ACA’s cost-sharing […]

The U.S. Court of Appeals for the Eighth Circuit has ruled, in McIntyre v. Reliance Standard Life, that a claims decision will be judged under the arbitrary and capricious standard despite the fact that the claims administrator had a conflict of interest and that there were irregularities in the claims procedure. Law.  Generally, the default […]

The IRS has issued Notice 2020-76, which provides an automatic deadline extension for Applicable Large Employers’ (“ALE”) reporting obligations to employees under the Affordable Care Act’s (“ACA”) Employer Mandate for the 2020 tax year. Background.  The ACA’s Employer Mandate requires ALEs (i.e., employers with 50 or more full-time equivalent employees) to report information to the […]

The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave under the Families First Coronavirus Response Act (“FFCRA”) and issues related to school reopenings. The first new FAQ asks if employees may take paid leave if their child’s school is operating on an alternate day […]

The Ninth Circuit Court of Appeals has held, in Castillo v. Metropolitan Life Ins. Co.,  that ERISA does not authorize an award of attorney’s fees incurred during the administrative phase of the ERISA claims process. Background.  The plaintiff was a participant in a long term disability (“LTD”) plan.  After becoming disabled, he retired in 2013, […]

The U.S. Department of Labor (“DOL”) has released updated Family and Medical Leave Act (“FMLA”) forms. Background.  Certain posters and forms are required under the FMLA to inform employees of their rights and to request or verify the need for FMLA leave.  FMLA allows employers to create and use their own FMLA forms as long […]

When the Federal Affordable Care Act tax penalty for not maintaining health coverage was reduced to $0, many states implemented their own mandates for residents to carry appropriate insurance. California was one of those states. Starting this year, most California residents (and their dependents) must have individual, Marketplace or employer-provided health coverage or pay a […]

The Internal Revenue Service has issued Revenue Procedure 2020-36 to implement the 2021 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine affordability under the employer shared responsibility mandate. Background.  Under the ACA, contribution percentages are used to determine: (i) whether an Applicable Large Employer (“ALE”) is subject to the ACA’s […]

The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave (“EPSL”) and Emergency Family and Medical Leave (“EFMLA”) under the Families First Coronavirus Response Act (“FFCRA”). Background.  Generally, an employer must reinstate an employee to the same position after EPSL or EFMLA.  However, if an […]

The Department of Labor, Department of Health and Human Services (“HHS”), and the IRS (collectively, the “Agencies”) have issued proposed regulations that would provide greater flexibility for plan sponsors that wish to retain their group health plans’ “grandfathered” status under the Affordable Care Act (“ACA”). Law.  The ACA contains many provisions affecting group health plan […]