Employee Benefits Compliance Resource Center

Our employee benefits compliance experts regularly examine state & federal insurance regulations to keep our clients from incurring costly fees or penalties. The Employee Benefits Compliance Resource Center is a repository of new laws/regulations, expert guidance and insightful news articles, where HR & Finance professionals gain actionable information for their benefit programs.

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10.07.2021 | Compliance Alert!

Agencies Issue Guidance on COVID-19 Vaccine-Related Premium Surcharges and Discounts
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10.07.2021 | Compliance Alert!

Agencies Issue Guidance on COVID-19 Vaccine-Related Premium Surcharges and Discounts
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Coronavirus Employer Insurance ResourcesCOVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics
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Below are our compliance resource postings over the last 6 months. For your convenience the sections are color-coded in chronological order. Orange Compliance Alerts discuss new guidance interpreted by our staff ERISA attorney and team. U.S. Policy postings represent new state and Federal laws and In the News articles convey current commentary from reputable news outlets.

Compliance Alerts
New York Paid Family Leave Premium Rates Set for 2022

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IRS Decreases ACA Employer Mandate Affordability Percentage for 2022

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Agencies Delay Healthcare Price Transparency Rules

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Deadline for Medicare Part D Notice of Creditable Coverage Nears

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IRS Proposes Substantial Changes to ACA Information Reporting Requirements

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IRS Issues COBRA Subsidy Guidance Less Than A Week Before Tax Credit Filing Deadline

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Agencies Issue Interim Final Rule Implementing the No Surprises Act

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Reminder: PCORI Fees Due July 31, 2021

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IRS Issues Guidance on COBRA Subsidies under ARPA​​​

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IRS Issues 2022 Limits for HSAs, High-Deductible Health Plans and Excepted Benefit HRAs​​​ ​​

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Update Regarding Blue Cross Blue Shield Class Action Settlement​ ​​

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DOL Issues FAQs and Model Notices on the new ARPA COBRA Subsidies​

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IRS Clarifies that COVID-19-Related PPE Qualifies as Medical Care Expenses​

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$1.9T COVID-19 Relief Package Includes Rules to Expand COBRA and ACA Exchange Subsidies​

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What to Do if Your Organization Receives a Notice about the $2.67 Billion Blue Cross Blue Shield Antitrust Settlement

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Agencies Issue Guidance on COVID-19 Testing and Vaccines

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DOL Issues Guidance on Duration of “Outbreak Period” Rules

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IRS Issues Guidance Clarifying COVID-19 Relief Rules for FSAs and Cafeteria Plans​​

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President Biden Signs Executive Orders Expanding Access to Health Coverage​​

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$900B COVID-19 Relief Package Signed into Law; Includes Rules to End Surprise Medical Billing​​

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Massachusetts Health Insurance Reporting Form Must be Filed by December 15​​

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Agencies Issue Healthcare Transparency Rules for 2022 and Beyond

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IRS Announces Health FSA and other 2021 Plan Limits ​​​​​

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IRS Releases Final Forms and Instructions for 2020 ACA Information Reporting ​​​​​

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IRS Extends Deadline for Distributing 2020 Forms 1095-C and 1095-B; Extends "Good Faith" Penalty Relief for One More Year​​​​

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New York Paid Family Leave Contributions and Benefits Set to Increase January 1, 2021​​​

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New York City Amends Paid Sick Leave Law to Align with State Law​​

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NY Sick Leave Law Goes Into Effect 9.30.20​

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DOL Revises COVID-19 Leave Regulation in Light of a Recent Court Decision​

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IRS Releases 2021 ACA Employer Mandate Penalty Amounts​

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Judge Blocks Key Provisions of New ACA Section 1557 Regulation

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Deadline for Medicare Part D Notice of Creditable Coverage Nears

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Court Eliminates Key Provisions of COVID-19 Leave Regulation​

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Supreme Court Upholds Religious and Moral Exemptions to ACA Contraceptive Mandate ​

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Agencies Issue Guidance on COVID-19 Testing and Treatment​

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Agencies Issue Plan Limits and other New ACA Rules for 2021 and Future Plan Years​

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HHS Removes ACA Rules Prohibiting Gender Identity Discrimination; Supreme Court Concludes That Title VII Prohibits Discrimination Against LGBTQ Employees​

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Insurers Issue Refunds Due to COVID-19

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The PCOR Fee Continues: IRS Issues Long-awaited PCOR Fee Update​

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Reminder: PCOR Fees for Non-calendar Year Plans are Due July 31, 2020 ​

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Internal Revenue Service Issues 2021 HSA Limits​

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IRS Guidance Gives Cafeteria Plans Flexibility During COVID-19 Pandemic​

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DOL Issues New COBRA Model Notices and FAQ Guidance​

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Agencies Issue COV​​ID-19-Rela​​ted Compliance Relief for Benefit Plans​​​

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President Signs Coronavirus Stimulus Package into Law​

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President Signs Coronavirus Stimulus Package into Law​

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Senate Approves Coronavirus Bill; Now Under Review by the House​

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DOL Guidance Clarifies Coronavirus Paid Leave Requirements​

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Important State & Federal Reporting and Enrollment Extensions

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Agencies Issue Guidance on Coronavirus Paid Leave Tax Credits

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Agencies Issue Guidance Relaxing Enforcement of Benefits Compliance Rules During Coronavirus Health Emergency

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Coronavirus Bill Requiring Paid Leave and Other Benefits Signed Into Law

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House Coronavirus Bill Awaits Senate Approval​

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COVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics for Employees

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State "Individual Mandate" Law Impose New Compliance Requirements on Employers and Employees

02.20.2020 revised from 11.18.2019
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For earlier Compliance Alerts, please contact your Corporate Synergies Account Manager.​

U.S. Policy

Texas Executive Order Creates Broad Exemptions to Vaccine Mandates
10.11.2021 — Texas Gov. Greg Abbott issued an executive order permitting broad exemptions to any vaccine mandate, including if someone objects to the vaccine for "any reason of personal conscience." The Texas Order applies to vaccine mandates by any “entity in Texas,” including private sector employers.
Executive Order »
Axios »

D.C. Enacts Expanded Paid Family Leave Rights
10.08.2021 — The expanded employer-funded D.C. paid family leave (DCPFL) includes an additional two weeks of leave for an individual’s serious medical condition, including prenatal care. Beginning October 1, 2021, the amendment applies to leaves of absence beginning on or after September 26, 2021.
DCPFL law »
Epstein Becker Green »

IRS Guidance Clarifies Application of COVID-19 Relief to COBRA Rules
10.06.2021 — The IRS has issued guidance clarifying the application of certain COBRA deadline extensions under prior relief that was issued as a result of the COVID-19 outbreak (the “Outbreak Period Rules”). The guidance also addresses the interaction of the Outbreak Period Rules with the COBRA subsidies that were made available for certain eligible individuals under the American Rescue Plan Act.
IRS Guidance »

Agencies Issue Guidance on COVID-19 Vaccine-Related Premium Surcharges and Discounts
10.04.2021 — The Departments of Labor, Treasury and Health and Human Services (“Agencies”) issued FAQ guidance regarding the application of the HIPAA wellness rules and ACA affordability rules to vaccine-related premium surcharges and discounts. The Agencies confirmed the permissibility of implementing COVID-19 vaccination discounts and surcharges under employer-provided group health plans to incentivize employees to become vaccinated assuming applicable HIPAA requirements are satisfied.
FAQ Guidance »

IRS Issues Draft 2021 ACA Information Reporting Forms and Instructions
09.30.2021 — With some exceptions, the draft forms are mostly unchanged from 2020. The draft instructions no longer mention an automatic extension to furnish the forms to individuals, and simply note the normal January 31, 2022 due date. The instructions remove references to “good faith” penalty relief which had been available for reporting incomplete or incorrect information. The threshold for mandatory electronic filing with the IRS remains at 250 returns, which differs from the recently proposed regulations reducing the filing thresholds and aggregating different return types (see our e-Alert here) and suggests that the IRS may not be able to finalize the proposal in time for the March 31, 2022 electronic filing deadline.
Draft Forms:
Draft Form 1094-C »
Draft Form 1095-C »
Draft Form 1094-B »
Draft Form 1095-B »
Draft Instructions:
Draft C Form Instructions »
Draft B Form Instructions »

HHS/OCR Issues COVID-19-Related HIPAA Guidance
09.30.2021 — HHS/OCR FAQ guidance helps consumers, businesses and health care entities understand when the HIPAA Privacy Rule applies to disclosures and requests for information about whether a person has received a COVID-19 vaccine. The guidance provides common workplace examples which clarify that the HIPAA Privacy Rule applies only to covered entities and business associates, and does not include employers in the context of employment related questions and disclosures.
HHS/OCR FAQ guidance »

Part II of the No Surprises Act Regulations Issued—Focus is on IDR Process
09.30.2021 The agencies implementing the No Surprises Act have issued Part II of their three-part interim final regulations (IFRs) under the new statute intended to prevent most forms of surprise billing (see our eAlert here on Part I). These Part II IFRs establish a federal independent dispute resolution (IDR) process that nonparticipating providers, group health plans and insurers can use to resolve disputes regarding the appropriate out-of-network rate for certain services.
Part II IFRs »

U.S. Government Issues Vaccine Mandate Guidance for Federal Contractors and Subcontractors
09.24.2021 — The Safer Federal Workforce Task Force issued guidance explaining the necessary COVID-19 safety protocols for covered federal government contractors and subcontractors, including their remote workers (“covered contractors”) to comply with Executive Order 14042, Ensuring Adequate Covid Safety Protocols for Federal Contractors. Among other requirements, covered contractors will have until December 8, 2021 to be fully vaccinated or qualify for a medical or religious accommodation.
Federal Guidance »
Executive Order 14042 »
Morgan Lewis Article »

Agencies Issue Proposed Rules under No Surprises Act
09.10.2021 — The proposed rule focuses on 1) the submission of information about air ambulance services; 2) the process that HHS will take to investigate and enforce violations of federal insurance law (including the NSA and CAA); and 3) implementation of a CAA provision that requires insurers to disclose direct and indirect compensation to agents and brokers for enrollment in individual market coverage and STLDI.
Proposed Regulation »
Health Affairs »

ACA Affordability Percentage Set to Decrease in 2022
08.27.2021 — The IRS has updated the required contribution percentage for purposes of determining whether an employer’s offer of coverage will be “affordable” under the Affordable Care Act’s (ACA) Employer Shared Responsibility rules (“Employer Mandate”). For plan years beginning in calendar year 2022, the new affordability percentage will be 9.61%, which is down from the 2021 percentage of 9.83%.
IRS Rev. Proc. 2021-36 »

CAA Healthcare Price Transparency Rules Delayed
08.20.2021 — FAQ guidance issued by the agencies implementing the Consolidated Appropriations Act, 2021 (CAA) delays enforcement of some of the CAA’s most challenging health plan transparency requirements. The FAQ guidance delays enforcement of the following rules: the requirement to disclose new “advanced explanations of benefits” providing good-faith estimates of the out-of-pocket costs for scheduled medical services; a “price comparison tool” to enable participants to compare cost-sharing amounts for specific network providers; extensive drug cost information that was required to be reported to federal regulators in December 2021; and health plan pricing disclosures (required to be disclosed to the public) related to in-network rates, out-of-network allowed costs, and prescription drug prices.
DOL/HHS/IRS FAQ Guidance »

IRS Information Letters Clarifies Health FSA Issues under COBRA and COVID-19 Relief
08.19.2021 — The IRS has issued guidance clarifying how employers can claim the tax credit for the 100% COBRA premium subsidies available under the American Rescue Plan Act of 2021. Employers and plan sponsors may need to make last-minute changes to (or amend) their Form 941 IRS filings for claiming these tax credits, due on August 2, 2021.
IRS Information Letter: 2021-0004 »
IRS Information Letter: 2021-0005 »

New Guidance Signals Change to ACA Contraceptive Coverage Mandate
08.16.2021 — The new FAQ guidance advises that the agencies are considering changes to the exemptions to the ACA’s contraceptive coverage requirements “in light of recent litigation” and intend to initiate rulemaking to amend the current regulations (issued in 2018) within the next six months.
DOL FAQ Guidance »

COBRA Guidance Changes ARPA Subsidy Rules Days Before Filing Deadline
07.26.2021 — The IRS has issued guidance clarifying how employers can claim the tax credit for the 100% COBRA premium subsidies available under the American Rescue Plan Act of 2021. Employers and plan sponsors may need to make last-minute changes to (or amend) their Form 941 IRS filings for claiming these tax credits, due on August 2, 2021.
IRS Notice 2021-46 »
Groom Law Group »

Agencies Delay ACA Requirement to Cover HIV PrEP as a Preventive Service until 9/17/21
07.19.2021 — The Affordable Care Act (ACA) will require all non-grandfathered employer-sponsored health plans to provide pre-exposure prophylaxis (“PrEP”) drugs as a preventive service. Tthe HIV drugs must be offered at no cost to all participants at risk for HIV exposure beginning in the 2021 plan year. However, recent guidance clarifies that enforcement action will not be taken against plans for failing to provide this through the period ending 60 days after publication of the FAQs (September 17, 2021).
DOL FAQ Guidance »

Biden Executive Order Seeks to Lower Rx and Healthcare Costs
07.09.2021 — Among the Executive Order’s 72 initiatives to “promote competition in the American economy,” there are several designed to reduce Rx and healthcare costs. For example, it directs the FTC to ban “price-gouging” agreements used by drug manufacturers, it encourages the agencies to issue rules to make it easier to import Rx from Canada, it takes aim at consolidation in the hospital and health insurance industries, and directs the agencies to allow over-the-counter sales of hearing aids.
Executive Order »
Fact Sheet »

HHS Proposes to Amend Various Benefits Rules for 2022 and Beyond
07.01.2021 — Although the proposed rules are largely aimed at insurers and Exchange regulators, these rules will likely have a big impact on private employers and other plan sponsors. Among other proposed changes, these rules would lengthen the Exchange annual open enrollment period (which also applies to non-grandfathered plans in the individual market) to November 1 through January 15 each year, and amend the ACA essential health benefit (EHB) requirements.
Proposed Regulation »

UPDATE: November 1 Deadline Approaching for New Washington Long-Term Care Law
07.01.2021 — To opt out of the “WA Cares Fund,” employees must secure their own private long-term care insurance by November 1, 2021. On April 21, 2021, WA Governor Jay Inslee signed into law the “WA Cares Fund” enacting a mandatory, public, state-run long-term care insurance program for workers. The program imposes a new employee-paid premium of $0.58 per $100 of worker earnings.
WA Cares Fund “Employer Toolkit” »
Littler Legal Analysis »

EEOC Issues Update to Guidance on COVID-19 Vaccine Incentives and other Vaccine-related Workplace Policies
05.28.2021 — The US Equal Employment Opportunity Commission (EEOC) guidance clarifies that employers may encourage employees and their family members to receive a vaccination without violating federal EEO laws by offering incentives to employees who voluntarily participate in an incentive program and prove that they and/or their family members received a vaccination so long as such incentives are not “so substantial as to be coercive.”
Updated EEOC Guidance »
Morgan Lewis »

IRS Guidance Explains DCAP Tax Rules
05.11.2021 — New IRS guidance now clarifies how dependent care FSA (DCAP) carryover amounts (for carryovers impacted by recent COVID-19 relief laws) will be taxable to DCAP participants. According to the new guidance, amounts that would have been nontaxable to the participant if used in the original year will remain nontaxable in subsequent years if carried over, even if the DCAP is not a calendar year plan.
IRS Notice 2021-26 »

HHS Clarifies ACA Section 1557 Rules will be Interpreted to Prohibit Discrimination on the Basis of Sexual Orientation and Gender Identity
05.10.2021 — The new interpretation is being made pursuant to last year’s Supreme Court decision in Bostock v. Clayton County. In that case, the Supreme Court—in a 6-3 decision written by Justice Gorsuch—held that Title VII’s ban on sex discrimination bars workplace discrimination (including with respect to employee benefits) because someone is gay or transgender.
HHS Announcement »

DOL Repeals Trump-era Independent Contractor Rules
05.5.2021 — This regulation was intended to unify the rules that employers use when determining if a worker is an independent contractor vs. an employee (and thus, in determining whether employee benefits must be offered to the worker). The DOL indicated that the regulation was “in tension” with the Fair Labor Standards Act.
DOL News Release »

IRS Issues Guidance Explaining ARPA Tax Credits for COVID-19 Vaccinations
04.21.2021 — The new IRS guidance clarifies which employers are eligible for the tax credits and explains how such employers may claim the credit. The American Rescue Plan Act of 2021 (ARPA) allows employers with fewer than 500 employees to claim refundable tax credits that reimburse them for the cost of providing paid sick and family leave to their employees due to COVID-19 and COVID-19 vaccinations.
IRS Guidance »

DOL Issues Guidance on Cybersecurity Best Practices for Benefit Plan Sponsors, Participants, and Fiduciaries
04.14.2021 — The DOL’s Employee Benefits Security Administration (EBSA) guidance identifies 12 best practices, including maintaining a written cybersecurity plan, annual risk assessments and third-party audits of security controls. Additionally, the guidance recommends clearly defined roles and responsibilities and strong access and technical controls—including encryption—combined with annual workforce training.
Cybersecurity “Best Practices” »
DOL/EBSA Press Release »

Agencies Issue FAQ Guidance on Mental Health Parity Comparative Analysis Requirements under the CAA
04.2.2021 — The DOL, HHS, and IRS have jointly issued FAQ guidance explaining the CAA requirement to perform and document a comparative analysis of nonquantitative treatment limitations (NQTL) on mental health or substance use disorder (MH/SUD) benefits. Each NQTL must demonstrate whether the factors used in developing and applying the NQTL are comparable and applied no more stringently to MH/SUD than to medical/surgical benefits.
FAQ Guidance »

IRS: Face Masks and PPE to Prevent the Spread of COVID-19 are Covered by HSAs, HRAs and Health FSAs
03.29.2021 — The IRS has clarified that amounts paid for personal protective equipment such as masks, hand sanitizer, and sanitizing wipes that are purchased “for the primary purpose of preventing the spread of COVID-19” are qualified medical expenses under Section 213(d) of the Code. Participants in health savings accounts (HSAs), health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs) can now use the funds in these accounts for purchases of these items.
IRS Announcement 2021-7 »

San Francisco Postpones HCSO Reporting Deadline
03.24.2021 — The San Francisco Office of Labor Standards Enforcement (OLSE) has postponed the normal April 30 deadline for reporting compliance with the San Francisco Health Care Security Ordinance (HCSO). The postponement will be for a minimum of 6 months, to at least October 31, 2021.
San Francisco OLSE »

NJ Issues Guidance on Employer-Mandated Vaccines
03.19.2021 — Closely echoing the U.S. EEOC guidance, the NJ Dept. of Health has clarified that employers can require employees receive the COVID-19 vaccine to return to the workplace, unless the employee cannot get the vaccine because of a disability, because their doctor has advised them not to get the vaccine while pregnant or breastfeeding, or because of a sincerely held religious belief.
NJ Dept. of Health »

CA Retroactively Expands Supplemental COVID-19 Paid Sick Leave
03.19.2021 — The bill would provide for 80 hours of COVID-19 supplemental paid sick leave for covered employees who are unable to work or telework due to COVID-19. This applies to public and private employers with more than 25 employees.
Senate Bill 95 »
EBG Law »

NY Signs Law Permitting Paid Leave for COVID-19 Vaccines
03.12.2021 — The New York State Department of Labor has issued guidance clarifying the rules regarding when and how employees can take paid leave for COVID-19 vaccine injections. Generally, employees in New York are allowed to take up to 4 hours of paid leave per vaccine injection.
Senate Bill S2588A »

CDC Publishes New Vaccination Guidance for the Workplace
02.02.2021 — The CDC recently updated its guidance to include information to educate employers and employees about COVID-19 vaccines, raise awareness of the benefits of vaccination, and address common questions. This guidance lists potential benefits of having a workplace COVID-19 vaccination program for both employers and employees and includes practical advice on putting such a program in place.
CDC Vaccine Communication Toolkit »
CDC FAQ Guidance »

DOL/OSHA Publishes New Guidance for Workplace Safety during the Pandemic
01.29.2021 — The Department of Labor’s (DOL) Occupational Safety and Health Agency (OSHA) issued what it described as “stronger worker safety guidance” to help employers fight the spread of COVID-19 in the workplace. While OSHA is using the new guidance to advocate for businesses to establish infection prevention programs, the guidance is not legally binding.
OSHA Guidance »

Biden Administration Freezes EEOC’s Proposed Wellness Incentive Rules
01.21.2021 — Newly proposed wellness plan regulations issued by the EEOC that were designed to clarify how plan incentives should work under the ADA and GINA were removed by the White House. Specifically, the Biden administration has instructed the EEOC to withdraw these regulations to allow for review and approval by the current administration.
White House Memorandum »

EEOC Issues Proposed Wellness Incentive Rules
01.07.2021 — Because the ADA and GINA do not define what constitutes a “voluntary” wellness plan, new regulations from the EEOC propose that, to comply with the ADA and GINA, employers may offer no more than a minimal incentive to encourage participation in wellness programs, except in certain wellness programs that would be permitted to offer the maximum allowed incentive under the 2013 HIPAA regulations.
New EEOC Proposed Regulations »
EEOC Press Release »

DOL Issues Final Rules Making it Easier to Provide Benefits to Independent Contractors
01.06.2021 — The new regulation, issued under the Fair Labor Standards Act, is designed to streamline and simplify the complex rules used to identify independent contractor status, making it easier to determine when such a worker should receive employee benefits. Scheduled to be implemented on March 8, 2021, the incoming Biden administration may freeze this rule and prevent it from going into effect.
DOL Final Regulation »
Morgan Lewis Labor & Employment Law »

IRS Releases Temporary COVID-19 Relief Rules for Employer-provided Automobile Benefit
01.04.2021 — Under the new rules, employers and employees will have increased flexibility about how they choose to calculate the value of an employee’s personal use of an employer-provided automobile for employment tax and tax reporting purposes.
IRS Notice 2021-7 »

California Updates Healthcare Information Reporting Guidance
01.01.2021 — The California Franchise Tax Board (FTB) recently clarified that employers sponsoring fully-insured health plans are required to report insurance information to the FTB by March 31, but only if their insurance providers do not report to FTB.
CA FTB Guidance »

In The News

Florida Dept. of Health Fines County $3.5M for Implementing Vaccine Mandate
10.12.2021 — The Florida Department of Health fined Leon County $3.5 million for requiring its employees to get vaccinated against the coronavirus, saying it violated the state's ban on "vaccine passports."
Axios »

Twenty-four States Threaten to Challenge OSHA Vaccine Mandate
09.16.2021 — Recently, 24 state attorneys general submitted a letter strongly opposing President Joe Biden’s proposed COVID-19 vaccine mandate among private sector employers. The President’s proposed mandate would require that all such employers with 100 or more employees require their employees to be vaccinated or submit to weekly testing. These states have threatened legal action should the mandate’s efforts move forward.
Attorneys General Letter »

DeSantis threatens $5K fine against Florida cities with vaccine mandates
09.13.2021 — Florida Gov. Ron DeSantis threatens to fine cities and counties thousands of dollars if they impose vaccine requirements on their employees. It’s not clear how quickly the state will put in new rules that would call for these fines. At least three Florida counties and cities have required their workers to be vaccinated or tested.
Politico »

Biden Lays Out Plan To Mandate Vaccines Or Testing For Millions Of Workers
09.09.2021 — President Biden announced new federal rules requiring all businesses with 100 or more employees to ensure that every worker is either fully vaccinated for COVID-19 or submits to weekly testing for the coronavirus. Biden said the new emergency rule for private sector employers, which will be issued by the Department of Labor's Occupational Safety and Health Administration, would apply to 80 million workers.
WhiteHouse.gov »

Delta Airlines Imposes Premium Surcharge on Unvaccinated Employees
08.25.2021 — On August 25, Delta Airlines announced that as of November 1, unvaccinated staff will pay up to $200 a month more for their company health insurance, depending on the coverage. It will also limit the number of sick days unvaccinated employees are allowed to take if they contract Covid-19.

FDA Grants Full Approval of Pfizer COVID-19 Vaccine
08.23.2021 — On August 23, the FDA granted the first full approval of a COVID-19 vaccine. This approval will likely mean that a significantly greater number of U.S. employers will adopt mandatory vaccination policies. The vaccine remains available under emergency use authorization (EUA), including for individuals 12-15 years of age and for a third dose in certain immunocompromised individuals.
FDA News Release »

Most Private Insurers No Longer Waiving Cost-Sharing for Covid-19 Treatment
08.19.2021 — New research by the Kaiser Family Foundation (KFF) shows that most private insurers are no longer waiving cost-sharing for COVID-19 treatment. There is no federal mandate requiring insurers to waive COVID-19 out-of-pocket treatment costs. KFF finds that 72% of the two largest insurers in each state and DC (102 health plans) are no longer waiving these costs, and another 10% of plans are phasing out waivers by the end of October.
KFF Research Brief »

Biden Admin Recommends Booster Shots Beginning in September
08.18.2021 — The Biden Administration has announced that it plans to begin offering Covid-19 booster shots to all American adults starting Sept. 20, 2021, amid growing evidence that a third dose of the vaccine will be needed to maintain immunity against the virus.
Politico »

DOL Settles Lawsuit Against United Healthcare under MHPAEA
08.11.2021 — Two settlement agreements filed on August 11 provide that United Healthcare Insurance Co., United Behavioral Health, and Oxford Health Insurance Inc., will together pay more than $15.6 million to settle allegations they violated the Mental Health Parity and Addiction Equity Act (MHPAE). The settlement marks the clearest signal yet of the Biden Administration’s increased enforcement of the MHPAE.
Bloomberg »

United Airlines To Require US Employees Get Vaccinated Against COVID-19
08.06.2021 — United Airlines has announced that employees will be required to get vaccinated against Covid-19 by October 25 – the first major U.S. airline to implement such a mandate. A United executive said it was not considering a similar rule for passengers, and that any such requirement would be a decision for the government.
AP News »

ACA Survives 3rd Major Supreme Court Challenge
06.17.2021 — In California v. Texas, the U.S. Supreme Court, by a vote of 7-2, denied a challenge to the Affordable Care Act (ACA), concluding that the plaintiffs did not have standing to challenge the constitutionality of the now penalty-less individual mandate. This decision is the Court’s third rejection of a broad, global challenge to the ACA in less than a decade.
SCOTUS decision »
K&L Gates article »

White House Releases Fact Sheet on The American Families Plan (AFP)
04.28.2021 — Among other proposed provisions, the AFP would create a national comprehensive paid family and medical leave program, funded through tax increases, and paying workers up to $4,000 a month. Under that cap, it would replace a minimum of two-thirds of average weekly wages, rising to 80 percent for the lowest-wage workers. The program would be phased in over a 10-year period.
White House Fact Sheet »

Biden Administration Encourages Employers to Provide Paid Leave and Financial Incentives for Employees’ COVID-19 Vaccinations
04.21.2021 — Tax credits are available for employers with fewer than 500 employees for providing workers with paid leave for COVID-19 vaccinations as part of the American Rescue Plan Act. The administration is also calling for employers to incentivize employees to get vaccinated, which they say could convince an additional 25% of Americans.
Biden Administration Fact Sheet »

Biden Administration Asks Supreme Court to Uphold the ACA
02.10.2021 — The Biden administration has withdrawn the federal government's support for a challenge to the Affordable Care Act’s (ACA) constitutionality before the U.S. Supreme Court, telling the Supreme Court that the law should remain on the books. While the move shows the policy shift between the two presidential administrations, it is not expected to have a major impact on the outcome of the case.
Solicitor General’s Request »
Politico »

Congress Passes Resolution to Clear the Way for $1.9 Trillion Stimulus Legislation
02.05.2021 — The House and Senate have approved a budget resolution that paves the way to pass President Joe Biden’s $1.9 trillion stimulus bill in the coming weeks with only Democratic votes.
Bloomberg »

Biden Selects Marty Walsh to Head U.S. Dept. of Labor
01.07.2021 — President-elect Joe Biden has named Boston Mayor Marty Walsh to be Secretary of the U.S. Department of Labor (DOL). If confirmed, Walsh will work with the Biden administration on significant issues, including an emergency standard to protect workers from on-the-job COVID-19 infection, and coordinating states’ payment of unemployment insurance benefits to millions of unemployed workers.
Bloomberg »

President-elect Biden will Halt Agency Rules Described as “Midnight Regulations”
12.30.2020 — President-elect Joe Biden will issue a memo on Inauguration Day seeking to halt or delay so-called “midnight regulations” issued by the Trump administration that have not taken effect by Inauguration Day.
The Hill »

Lawmakers strike deal to end 'surprise' medical bills
12.11.2020 — The “No Surprises Act” calls for parties to negotiate an agreed-upon rate or bring their dispute to a mediator. However, providers would still be allowed to bill patients to make up the difference if they inform patients the services won’t be covered and they provide an estimate of charges 72 hours before care.
No Surprises Act »
Politico »

FDA Panel Votes to Approve Pfizer COVID-19 Vaccine for Emergency Use
12.10.2020 — A U.S. Food and Drug Administration advisory committee voted Thursday to approve an emergency use authorization request from Pfizer and BioNTech for their COVID-19 vaccine, clearing the way for some groups to start getting vaccinated as early as next week. Under the CARES Act, the vaccine will be covered under all employer-sponsored group health plans without cost sharing.
U.S. Food and Drug Administration»

FDA Authorizes Monoclonal Antibody for Treatment of COVID-19
11.9.2020 — The U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients. Under the CARES Act, treatments with EUA are covered under all group health plans without cost sharing.
U.S. Food and Drug Administration»

CDC Says Airborne Transmission Plays a Role in Coronavirus Spread
10.5.2020 — The Centers for Disease Control and Prevention acknowledged that people can sometimes become infected with the novel coronavirus through airborne transmission, especially in enclosed spaces with inadequate ventilation.
The Washington Post »

Pelosi, Mnuchin Talk Coronavirus Aid as Presidential Illness Complicates Picture
10.5.2020 — The renewed effort in the U.S. Congress to reach a fresh deal to pump coronavirus relief funds into the pandemic-hit economy has been further complicated by the news that President Donald Trump and three Senate Republicans have tested positive.
Reuters »

Former Vice President Joe Biden Urges Americans to Vote to Protect the ACA
09.26.2020 — In response to President Trump's nomination of Judge Amy Coney Barrett to the U.S. Supreme Court, Democratic nominee Joe Biden urged Democrats to vote in the presidential election to protect the Affordable Care Act.

Dr. Fauci Advises Americans to Hunker Down During Flu Season
09.10.2020 — As the country heads into flu season, Americans can't let up in the fight against the coronavirus pandemic, said Dr. Anthony Fauci. Although the number of new daily cases of coronavirus has slowly declined over the last two weeks, the country is still closing in on 200,000 deaths from COVID-19 and more than 6 million confirmed infections.
NBC News »

U.S. Senate Fails to Advance GOP Coronavirus Relief Bill
09.10.2020 — The Senate failed to advance a Republican proposal to address the health and economic crises caused by the pandemic, four months after House Democrats passed their $3 trillion plan. But the narrower Senate bill could help Republican senators in tough reelection races by giving them a rebuttal to Democratic challengers attacking their delayed response.

AstraZeneca Halts Vaccine Trial After Patient Becomes Sick
09.9.2020 — AstraZeneca Plc halted phase 3 testing of its experimental coronavirus vaccine after a person participating in one of the company’s studies became ill. The study participant’s adverse reaction could delay or derail efforts to speed an immunization against COVID-19.
Bloomberg »

N.J. Health Insurance Tax: What It Means for Employers
09.8.2020 — New Jersey Governor Phil Murphy recently signed a new law levying a 2.5% health insurance tax on insurance carriers based on net premiums they collect for individual and large business plans across the state. Premiums for small businesses, non-profit dental plans, Medicaid, Medicare and certain self-funded coverages are not included.
Corporate Synergies “Our Take” »
nj.com »

Bad Flu Season Colliding with COVID-19 Could Be Overwhelming
09.5.2020 — Doctors and health officials are urging Americans to get vaccinated against influenza in record numbers this fall to avoid a dreaded scenario: flu colliding with a raging coronavirus pandemic. They worry that tens of millions of ¬flu-related illnesses could overwhelm hospitals, doctor offices and laboratories that test for both respiratory illnesses.
Washington Post »

FDA Issues Emergency Use Authorization for Blood Plasma Treatment Despite Scientists' Objections
08.23.2020 — The Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for blood plasma as a coronavirus treatment, one day after President Trump attacked the drug regulator for moving too slowly to back the treatment. The agency held off on the decision last week over concerns from government scientists that evidence for the treatment's effectiveness is thin, prompting Trump to accuse the FDA of slow-walking the therapy to harm his reelection chances without offering any evidence to support his claim. On 8/25/2020, FDA Commissioner Stephen Hahn issued an apology for overstating the effectiveness of the blood plasma treatment at the press conference to announce the EUA.
Politico »

$400 COVID-19 Unemployment Checks May Take Weeks to Reach Individuals
08.14.2020 — The extra $400 in weekly COVID-19 unemployment insurance benefits, authorized by President’s Trump’s recent executive order, is designed to be retroactive to August 1. But the checks may take several more weeks to reach individuals.
CBS News »

U.S. Chamber Raises Concerns about Implementing Payroll Tax Deferral
08.14.2020 — The U.S. Chamber of Commerce, the largest lobbying group for U.S. businesses, asked the Treasury Department to clear up uncertainty about how Trump's executive order initiating a payroll tax deferral could be implemented by firms, their employees and payroll processors. The payroll tax deferral is scheduled to go into effect on September 1, 2020.

HHS Posts State COVID-19 Testing Plans
08.10.2020 — The U.S. Dept. of Health & Human Services (HHS) has publicly posted the July through December COVID-19 Testing Plans from all states, territories, and localities on its website, HHS.gov. The State Testing Plans serve as a roadmap, developed in partnership with the federal government, for each jurisdiction's monthly 2020 COVID-19 testing strategy. The plans include details on responding to surges in specific cases and reaching vulnerable populations, including minorities, immunocompromised individuals and older adults.
HHS News Release on COVID-19 Testing Plans »
State-by-State COVID-19 Testing Plans »

President Signs Measures to Provide Additional Benefits during Pandemic
08.9.2020 — President Trump signed an executive order and three memoranda designed to provide economic aid to those struggling during the coronavirus pandemic, with additional benefits for the unemployed and tax cuts for workers. The executive actions are intended to bypass Congress — which has been deadlocked in negotiations to extend relief — and could face legal challenges. These executive actions, if implemented, would provide $400 in added unemployment benefits for those out of work because of the pandemic, and defer payroll taxes for those earning less than $100,000 a year. Unemployed workers had been receiving a weekly unemployment insurance supplement of $600, a benefit that expired on July 31, 2020.
CBS News »

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