In Santana-Diaz v. Metropolitan Life Ins. Co., No. 15-1273 (1st Cir. Mar. 14, 2016), Appellant Dionisio Santana-Díaz (“Santana-Díaz”) challenges the district court’s dismissal of his suit as time-barred, arguing that he is entitled to equitable tolling, in part because the plan administrator, Appellee Metropolitan Life Insurance Company (“MetLife”), failed to include the time period for filing suit in its denial of benefits letter.

The First Circuit Court of Appeals (the “Court”) held that ERISA requires a plan administrator in its denial of benefits letter to inform a claimant of not only his right to bring a civil action, but also the plan-imposed time limit for doing so. Because MetLife violated this regulatory obligation, the plan’s limitations period in this case was rendered inapplicable, and Santana-Díaz’s suit was therefore timely filed. Accordingly, the Court reversed and remanded the case.

The Court said the following about the statute of limitations. ERISA itself does not contain a statute of limitations for bringing a civil action, so federal courts usually borrow the most closely analogous statute of limitations in the forum state. But where the employee benefit plan itself provides a shorter limitations period, that period will govern as long as it is reasonable. In this case, the plan contained a three-year limitations period that ran from the date proof of disability was due. MetLife included no mention of this time limit in its final denial letter. In failing to provide such notice, MetLife was not in substantial compliance with the ERISA regulations (see 29 C.F.R. § 2560.503-1(g)(1)(iv)) and that rendered the plan’s limitations period altogether inapplicable.

A new Frequently Asked Question (“FAQ”) regarding implementation of the Affordable Care Act has been issued (Affordable Care Act Implementation (Part 30)). This FAQ has been prepared jointly by the Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”). Like previously issued FAQs (available here), this FAQ answers questions from stakeholders to help people understand the Affordable Care Act and benefit from it, as intended. Here is what the new FAQ says.

Summary of Benefits and Coverage

Public Health Service (“PHS”) Act section 2715, as added by the Affordable Care Act and incorporated by reference into the Employee Retirement Income Security Act and the Internal Revenue Code, directs the Departments to develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage in compiling and providing a summary of benefits and coverage (“SBC”) that “accurately describes the benefits and coverage under the applicable plan or coverage.” On June 16, 2015, the Departments published revised joint final regulations regarding the requirements for the SBC. Separately, on February 26, 2016, the Departments published a coordinated information collection request proposing a new SBC template and instructions, an updated uniform glossary, and other associated materials consistent with the requirements of the Paperwork Reduction Act.

In IRS Health Care Tax Tip 2016-29, March 9, 2016, the IRS discusses new reporting responsibilities for certain employers in 2016. Here is what the IRS says:

Under the Affordable Care Act, certain employers – known as applicable large employers or ALEs – may potentially be required to make an employer shared responsibility payment to the IRS if they do not offer health coverage that is “affordable” and that provides “minimum value” to full-time employees and their dependents.

Employers that are subject to the employer shared responsibility provisions have new information reporting responsibilities that require them to report information about health coverage offered to each full-time employee, or to report that the ALE didn’t offer coverage to the full-time employee. This includes the requirement to send information statements to full-time employees and to the IRS on new forms. This information will help the IRS determine whether an employer shared responsibility payment applies to the ALE and is also used in determining eligibility for the premium tax credit for the full-time employee and his or her family.

In IRS Health Care Tax Tip 2016-26, March 2, 2016, the IRS discuss the filing of health coverage information returns. Here is what the IRS says:

If you are a health coverage provider or an employer of a certain size, the health care law requires you to prepare new information returns starting for 2015. If you are a health coverage provider, the returns provide information about the health coverage you provided for individuals. If you are an employer of a certain size, the returns provide information about the coverage you offered -or did not offer- to your full-time employees. You must report the information to the relevant individuals and the IRS.

The reporting requirements for health coverage providers and applicable large employers are new. There are new IRS forms that health coverage providers and applicable large employers will use to complete this reporting. The first information reporting returns are due in 2016 for coverage in 2015. Coverage providers – other than self-insured applicable large employers – file Form 1095-B, Health Coverage. Applicable large employers file Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. If you file either of these forms with the IRS, you must also file the associated transmittal form. Use Form 1094-B, Transmittal of Health Coverage Information Returns, or, Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns.

In Gobeille v. Liberty Mutual Insurance Co., No. 14-181 (U.S. Supreme Court 2016), the Court considered Vermont law, which requires certain entities, including health insurers, to report payments relating to health care claims and other information relating to health care services to a state agency for compilation in an all-inclusive health care database.

In this case, Respondent Liberty Mutual Insurance Company’s health plan (the “Plan”), which provides benefits in all 50 States, is an “employee welfare benefit plan” under ERISA. The Plan’s third party administrator, Blue Cross Blue Shield of Massachusetts, Inc. (“Blue Cross”), which is subject to Vermont’s disclosure statute, was ordered to transmit its files on eligibility, medical claims, and pharmacy claims for the Plan’s Vermont members. Respondent, concerned that the disclosure of such confidential information might violate its fiduciary duties, instructed Blue Cross not to comply and filed suit, seeking a declaration that ERISA pre-empts application of Vermont’s statute and regulation to the Plan and an injunction prohibiting Vermont from trying to acquire data about the Plan or its members. The District Court granted summary judgment to Vermont, but the Second Circuit reversed, concluding that Vermont’s reporting scheme is pre-empted by ERISA.

Upon reviewing the case, the Supreme Court held that ERISA pre-empts Vermont’s statute as applied to ERISA plans. Why? The Court noted that ERISA expressly pre-empts “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.” 29 U. S. C. §1144(a). As relevant here, the clause pre-empts a state law that has an impermissible “connection with” ERISA plans, i.e., a law that governs, or interferes with the uniformity of, plan administration.

In IRS Health Care Tax Tip 2016-22, February 23, 2016, the IRS discusses what a taxpayer needs to do with Form 1095-B. Here is what the IRS says:

This year, you may receive one or more forms that provide information about your 2015 health coverage. These forms are 1095-A, 1095-B and 1095-C. This tip is part of a series that answers your questions about these forms.

Form 1095-B, Health Coverage, provides you with information about your health care coverage if you, your spouse or your dependents enrolled in coverage through an insurance provider or self-insured employer last year.

The IRS discusses the small business health care tax credit in IRS Health Care Tax Tip 2016-20, February 17, 2016. Here is what the IRS said:

The Affordable Care Act includes the small business health care tax credit, which can benefit small employers who provide health coverage for their employees.

The small business health care tax credit benefits employers who:

The case of Gallo v. Moen Incorporated, Nos. 14-3633 and 14-3918 (6th Cir. 2016), involved the question of whether several collective bargaining agreements (the “CBAs”) entitle a class of retirees from Moen Inc. to unalterable, vested healthcare benefits for life. The district court ruled in favor of the class.

However, the Sixth Circuit Court of Appeals (the “Court”) reversed, finding that nothing in the CBAs-read by applying ordinary contract principles- committed or showed the intention of Moen to provide unalterable healthcare benefits to retirees and their spouses for life. This obtains despite use in the CBAs of phrases like “continued” and “will be provided” and “will be covered” when discussing the retiree health care, which could imply lifetime benefits, since the CBAs made commitments only for 3-year terms.

In IRS Health Care Tax Tip 2016-18, February 11, 2016, the IRS discussed reporting health coverage on IRS tax forms. Here is what the IRS said:

While most taxpayers will simply need to check a box on their tax return to indicate they had health coverage for all of 2015, there are a few forms and specific lines on Forms 1040, 1040A, and 1040EZ that relate to the health care law.

To help navigate health coverage reporting, you should consider filing your return electronically. Using tax preparation software is the best and simplest way to file a complete and accurate tax return as it guides you through the process and does all the math. There are a variety of electronic filing options, including free volunteer assistance, IRS Free File for taxpayers who qualify, commercial software, and professional assistance.