An employer learned the full cost of ambiguity when a Connecticut federal district court agreed with an employee’s widow that the word “maximum” was ambiguous in the company’s life insurance plan, thus making the widow entitled to an additional $4 million in benefits. This decision serves as a warning for employers sponsoring insured benefits.
A Texas federal court certified a class in case brought by participants in one plan, and allowed those participants to represent participants in unaffiliated plans. The claims alleged that the defendants, who marketed and provided services to all of the plans, breached fiduciary duties by imposing excessive fees. See Chavez, et al. v. Plan Benefits Services, Inc., et al., No. AU-17-CA-00659-SS, United States District Court for Western District of Texas (Aug. 30, 2019).
A growing number of medical organizations, courts and administrative bodies have stated that transition-related medical care is medically necessary and should be covered by employer-sponsored medical plans. Access to employer-sponsored healthcare coverage for transgender workers has become an issue of focus for civil rights advocacy groups such as Lambda Legal and the American Civil Liberties Union, and there has been an uptick in discrimination lawsuits filed against health plans and insurers denying such care.
These trends highlight the importance of weighing the legal and business considerations that come with providing (or not providing) comprehensive health benefits for transgender workers. Health plan sponsors and insurers should consider how the decision to provide or exclude transition-related medical coverage will affect their legal compliance, overall costs and workplace culture—all of which are discussed in this article.
Originally published in Benefits Magazine, August 2019.
A Third Circuit appeals panel upheld the lower court ruling in Commonwealth of Pennsylvania v. President United States of America et al. No. 17-3752. This ruling grants a nationwide preliminary injunction against the religious and moral exemptions for employers to the ACA’s birth control mandate, so employers may want to take a cautious approach toward limiting contraceptive coverage.
Teal Trujillo, a summer associate in our Chicago office, also contributed to this article.
The IRS issued a private letter ruling (PLR) this week indicating that an FSA (and presumably an HSA and HRA) may reimburse a portion of the purchase of genetic testing and reports regarding ancestry and health. The IRS noted that the health services portion of such a cost is a reimbursable medical expense under Code Section 213(d) because the tests fall under “diagnosis of a disease.” With respect to the genetic services incurred by the individual seeking the PLR, the IRS noted that the reports contained genotyping (a qualified medical expense), as well as general information and ancestry information (not a qualified medical expense). It is incumbent upon the taxpayer to allocate the cost for the reimbursement to the portion which was attributable to a qualified medical expense. IRS private letter rulings are only applicable for the taxpayer that requests it; however, this is helpful insight to IRS approach to genetic testing kits as Code Section 213 medical expenses.
With the uncertainty of the general election just one year away—and change on the horizon—now is the time to take stock of the legal and regulatory environment to prepare your organization for the future.
On September 10 in Boston, the ERISA Industry Committee (ERIC), Fidelity and McDermott invite you to join your peers and colleagues for breakfast and an interactive discussion at 8 am EDT around hot topics in benefits and compensation. Areas of focus will include:
The Departments of Labor, Treasury, and Health and Human Services have released final rules removing the prohibition on pairing HRAs with individual health policies. The final rules also allow certain HRAs and other account-based group health plans to qualify as limited excepted benefits. These rules are generally effective for plan years beginning on or after January 1, 2020.
A new IRS notice will allow many with chronic health conditions who participate in high-deductible health plans (HDHPs) with health savings accounts (HSAs) to receive necessary care that may otherwise be out of financial reach. The notice expands the list of preventive care benefits that can be covered by an HDHP prior to a participant meeting the minimum deductible without disqualifying them from making or receiving HSA contributions.
The US Supreme Court declined to review a recent Ninth Circuit decision, blocking the interim rules that exempted employers with religious or moral objections from providing birth control coverage required by the Affordable Care Act (ACA). Until such time as this issue is clarified, it is prudent for employers with employees in certain states to comply with the ACA mandate and to cover contraceptives under their health plans.
Teal Trujillo, a summer associate in our Chicago office, also contributed to this article.
Over the past several years, the IRS and DOL have significantly increased the number of benefit plans audits conducted each year.
As a result, it is important for plan sponsors to understand the types of issues that often arise in connection with such audits. At the recent PSCA 2019 National Conference, Brian Tiemann explained what plan sponsors should expect if their benefit plan is selected for audited. More specifically, Brian discussed the ways audits are typically triggered and how to respond when a plan is audited. In addition, Brian outlined some of the most common retirement and health and welfare compliance issues identified in plan audits. He also discussed how plan sponsors can prepare for audits and even address potential compliance issues before they occur.
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