On January 1, 2015, employers with 100 or more “full-time equivalents” will be subject to the “Pay or Play” regulations under the Affordable Care Act (“ACA”). Over the past few years, many consultants have sought to identify loopholes in the law and lower-cost strategies for complying. Unfortunately for employers who were banking on these “workarounds,” the Internal Revenue Service and the U.S. Department of Labor both issued guidance this week dismissing several of the more aggressive strategies that have garnered attention in the press.
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Earlier today, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled in Halbig v. Burwell that the Affordable Care Act (ACA) authorizes the issuance of tax credits to assist individuals to purchase health coverage only on state-run exchanges. On the same day, a panel of the U.S. Court of Appeals for the Fourth Circuit reached the opposite conclusion in King v. Burwell, holding that ACA tax credits were also available to participants in federally-run exchanges.
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On June 30, 2014, the U.S. Supreme Court held in Burwell v. Hobby Lobby Stores, Inc. et al., that the Affordable Care Act’s “contraceptive mandate”, as applied to “closely held corporations”, violates the Religious Freedom Restoration Act (RFRA). Much has been written about the decision authored by Justice Alito and its impact on the rights of corporations. However, most employers are still seeking clarity in terms of how the decision impacts their group health plans.
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The U.S. Supreme Court issued a rare unanimous decision earlier this week finding that employee benefit plans can set reasonable time limitations on when a plan participant may bring a lawsuit seeking plan benefits – even when the time limitation is shorter than what would otherwise be permitted under the Employee Retirement Income Security Act of 1974 (ERISA) and analogous state statutes.

In Heimeshoff v. Hartford Life & Accident Ins. Co., Case No. 12-729 (Dec. 16, 2013), Petitioner Julie Heimeshoff, a long-term Wal-Mart executive, began to suffer from a multitude of ailments caused by fibromyalgia. As a result, in August 2005, she filed a claim for disability benefits with the plan administrator for Wal-Mart’s disability plan – Hartford Life & Accident Insurance Co. On December 8, 2005, after considering the medical evidence offered by Ms. Heimeshoff, Hartford denied her claim for failure to provide sufficient proof of loss.
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This post was contributed by Eric N. Athey, Esq., a Member in McNees Wallace & Nurick LLC’s Labor and Employment Practice Group. 

Flexible spending arrangements, or FSAs, have gained popularity among employers over the past fifteen years.  Today, approximately 14 million families participate in these benefit plans.  An FSA enables employees to set

Employers are required to provide a notice to employees regarding coverage options under the new Health Insurance Marketplaces created by the Affordable Care Act that are scheduled to be up and running on October 1. Much is uncertain about how the rollout of the Health Insurance Marketplaces will go on October 1; however, one thing is for certain: employees are likely to have many questions and misunderstandings regarding their options under the Affordable Care Act.
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In light of the Supreme Court’s recent decision in United States v. Windsor, the U.S. Department of Labor has just issued updated guidance for employers concerning the rights of same-sex spouses under the Family and Medical Leave Act. As you may recall from our earlier blog post on the legal implications of the Windsor case, in a 5-4 ruling, the Supreme Court struck down a key provision of the Defense of Marriage Act, which defined marriage under federal law as “a legal union only between one man and one woman as husband and wife.”
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As readers of this blog are surely aware, the Patient Protection and Affordable Care Act (PPACA) imposes a number of new obligations on employers and private health insurance plans. Effective January 1, 2013, most private employers with 50 or more employees must provide health insurance coverage for women’s preventative services, including reproductive health screenings and contraception, without charging a co-pay, deductible, or co-insurance. Failure to provide such coverage can lead to financial penalties of up to one hundred dollars per day per employee who is not provided with the required coverage. A limited exception is available for religious institutions, giving such employers the option of whether to cover contraception services. Over 60 lawsuits are pending around the country by for-profit companies and non-profits alike, challenging the constitutionality of the contraception requirement on religious grounds and seeking to block its enforcement. Late last week, the Third Circuit Court of Appeals issued a ruling on one such challenge brought by a private family-owned business in Pennsylvania.
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