Health and Welfare Plans

On June 17, 2021, the Supreme Court rejected another attempt to dismantle the Patient Protection and Affordable Care Act (“ACA”) in its highly-anticipated decision in Texas v. California.  However, instead of ruling on the central issue in the case—whether the ACA was rendered unconstitutional when Congress eliminated the individual tax penalty for failing to

On June 14, 2021, the Department Labor (“DOL”) issued Information Letter 06-14-2021 to address whether ERISA requires plan fiduciaries to produce audio recordings and transcripts of telephone conversations between plan insurers and claimants.

The issue arose from a plan insurer’s denial of a claimant’s request for an audio recording.  When it denied the request, the

On July 1, 2021, the U.S. Department of Health and Human Services (“HHS”), Department of Labor, Internal Revenue Service, and Office of Personnel Management issued their first installment of interim final surprise billing regulations.  As explained in a prior post, the regulations implement new requirements for group health plans, health insurance issuers, and healthcare providers and facilities that were imposed by the bipartisan No Surprises Act, which was enacted as part of a 2020 appropriations act.  The rules, “Requirements Related to Surprise Billing; Part I,” prohibit surprise or balance billing for certain healthcare services.

One important aspect of the new surprise billing regulations for sponsors of group health plans and health insurance companies is its effect on billing for emergency services, out-of-network air ambulance services, and certain out-of-network services provided at an in-network facility.  If a plan or policy provides or covers any emergency services, they must
Continue Reading Federal Agencies Release Interim Final Surprise Billing Regulations

On June 8, the U.S. Department of Health and Human Services sent proposed regulations limiting surprise billing to the White House Office of Management and Budget (“OMB”).  The proposed regulations would implement the bipartisan No Surprises Act, which was enacted as part of a 2020 appropriations act.  OMB must review the proposed regulations before

The Department of Health and Human Services has stated that it will restore transgender and LGBTQ+ health care protections. Under the Trump Administration, HHS had defined the term “sex” narrowly to mean gender assigned at birth. This had the consequence of excluding transgender and other LGBTQ+ individuals from protection against discrimination in health care. The

On Tuesday, May 18, 2021 the IRS issued Notice 2021-31 providing 86 FAQs related to premium assistance for COBRA benefits under the American Rescue Plan Act, 2021. The full text version of the FAQs is available below. These provide additional guidance on, among other things:

  • Whether an individual has had an “involuntary” termination, including employee-initiated

On April 8, 2021, Washington Governor Jay Inslee issued Proclamation 20-46.3, which modifies proclamations issued in 2020 that provide employment and benefit protections during the COVID-19 pandemic emergency for “high-risk employees.” (For purposes of the Proclamation, a “high-risk employee” is any employee that the Centers for Disease Control defines as being more likely to

In 2019, Washington passed the first law in the nation requiring employees to fund a state-operated long-term care insurance program. The program, codified at RCW 50B.04 and set to begin on January 1, 2025, will be funded by an uncapped payroll tax starting at 0.58% on all employee compensation beginning January 1, 2022.

Although changes

The American Rescue Plan Act of 2021 includes a 100% federal subsidy of COBRA premiums (including the up-to-2% administrative fees) during the period of April 1, 2021, through September 30, 2021. Earlier this week, the Employee Benefits Security Administration published clarifying FAQs and model notices related to the COBRA subsidy. This update discusses the guidance