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DOL Proposes New Claims Procedures for Disability Benefits

On November 18, 2015, the U.S. Department of Labor (?Ç£DOL?Ç¥) published proposed amendments to the claims procedure regulations under ERISA with respect to claims for disability benefits. Generally, these amendments have the effect of extending to disability benefit claims several of the procedural protections that were added by the Affordable Care Act for health benefit claims, particularly regarding internal claims and appeals under group health plans (e.g., providing expanded benefit denial notices written in a culturally and linguistically appropriate manner). If the proposed regulations are adopted as final, administrators of plans providing disability benefits would be required to implement these enhanced claims and appeals procedures. The proposed regulations are available here.

ACA Final Regulations on Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, and Other Matters

The U.S. Departments of Health and Human Services, Labor, and the Treasury jointly issued final regulations on November 18, 2015, addressing a variety of topics under the Affordable Care Act (?Ç£ACA?Ç¥), including, (1) the preservation of grandfathered plan status, (2) the prohibition on preexisting condition exclusions, (3) the prohibition on lifetime and annual dollar limits for essential health benefits, (4) the prohibition on rescissions of coverage, (5) the extension of certain dependent child coverage to age 26, (6) internal claims and appeals and external review rules, and (7) certain patient protection rules (including rules regarding the designation of a primary care physician and coverage for emergency services). These final regulations primarily combine previously issued proposed and interim final regulations, posted ACA FAQs, technical notices and other informal guidance for each of these topics with relatively few noteworthy changes for employer-provided group health plans. The final regulations will generally be effective… Continue Reading

Bipartisan Budget Act of 2015 Impacts Funding and PBGC Premiums for Defined Benefit Plans

President Obama recently signed into law the Bipartisan Budget Act of 2015, legislation which includes several provisions that impact defined benefit pension plans. First, the act increases PBGC premiums for single-employer pension plan sponsors and accelerates the premium due date for plan year 2025 by one month. Second, the act permits pension plan sponsors to apply to the U.S. Treasury Department for plan years after 2015 to use custom mortality tables based on plan experience and projected trends on mortality, which could improve funding levels if alternative tables more accurately represent their experiences. Lastly, the act extends for three years defined benefit pension plan funding stabilization provisions originally included in the Moving Ahead for Progress in the 21st Century Act (“MAP-21”) in 2012 and extended in the Highway and Transportation Funding Act of 2014 (“HATFA”). The act can be found?áhere.

Affordable Care Act Auto-Enrollment Requirement Repealed

The recently enacted Bipartisan Budget Act of 2015 repeals Section 18A of the Fair Labor Standards Act of 1938 (the ?Ç£FLSA?Ç¥). The repealed provision, which was added by Section 1511 of the Patient Protection and Affordable Care Act, would have required employers with more than 200 full-time employees to automatically enroll new employees (and continue enrollment of existing employees) in a health benefits plan offered through the employer. Prior to its repeal, enforcement of Section 18A of the FLSA had been delayed pending issuance of implementing regulations by the U.S. Department of Labor. The Bipartisan Budget Act of 2015 is available here.

EEOC Issues Proposed Regulations on Wellness Programs and GINA

On October 30, 2015, the U.S. Equal Employment Opportunity Commission (the ?Ç£EEOC?Ç¥) issued proposed regulations amending previously issued proposed regulations under Title II of the Genetic Information Nondiscrimination Act of 2008 (?Ç£GINA?Ç¥) regarding employer wellness programs. Among other items, the proposed regulations explain that wellness programs that request or require employees (or their covered spouses) to provide genetic information as part of health or genetic services (e.g., through a health risk assessment (?Ç£HRA?Ç¥) involving a medical questionnaire or medical examination) must be reasonably likely to promote health or prevent disease. Furthermore, the proposed regulations clarify that GINA does not prohibit employers from offering limited inducements to employees whose spouses (who are covered under the employer?ÇÖs group health plan) complete an HRA under which genetic information is provided, subject to the requirements that the provision of such information by the spouse is voluntary and that prior written authorization is obtained from… Continue Reading

DOL, HHS, and Treasury Issue Joint FAQs on ACA and MHPAEA

On October 23, 2015, the U.S. Departments of Labor (?Ç£DOL?Ç¥), Health and Human Services (?Ç£HHS?Ç¥), and Treasury issued a set of Frequently Asked Questions (?Ç£FAQs?Ç¥) addressing certain provisions under the Affordable Care Act (?Ç£ACA?Ç¥) and Mental Health Parity and Addiction Equity Act of 2008 (?Ç£MHPAEA?Ç¥). The FAQs provide guidance on several topics, including coverage of preventive services, wellness programs, and required disclosures under the MHPAEA. The FAQs can be found here.

November 2015