In February the Department of Labor issued an updated definition of “spouse” under the Family and Medical Leave Act (FMLA) to make compliance easier, and defined “spouse” as a husband or wife, which refers to a person “with whom an individual entered into marriage as defined or recognized by state law.” The governing state law is that of the celebration state or where the marriage took place. This definition was set to go into effect on March 27, 2015. A federal judge in Texas has issued a temporary injunction blocking the ruling from going into effect after the attorneys general in several states that do not recognize same-sex marriage challenged it. The final outcome of the injunction remains to be seen, and might be affected by an anticipated Supreme Court ruling in one of the same-sex marriage cases pending before it. In the meantime employers in all states should apply the old rule (that the law of the state in which the person lives determines whether FMLA must be granted to care for a same-sex spouse).
King v. Burwell
On March 4, 2015, the U.S. Supreme Court heard oral arguments in King v. Burwell, a case that centers on the meaning of statutory language regarding premium subsidies in the Patient Protection and Affordable Care Act (PPACA). This PPACA Advisor will give you an overview of the case and the arguments that were made before the Court. A ruling is anticipated from the Court in late May to early June 2015. As we await the decision, employees will still receive premium subsidies and employers should continue preparations to meet the employer-shared responsibility/play or pay requirements.
Cost-Sharing Limits for Individuals
In the Benefit and Payment Parameters for 2016 Final Rule issued in February 2015, federal agencies included a clarification that annual cost-sharing limitations for self-only coverage apply to all individuals, regardless of whether the individual is covered by a self-only plan or a non-self-only plan. After initial uncertainty over the information, which was not included in the Final Rule’s regulatory language, a “Cost-Sharing FAQ” was issued confirming that the self-only limitation will apply to each individual, regardless of the type of plan the individual is enrolled in, beginning in 2016.
Wraparound Excepted Benefits
Health plan sponsors would be permitted to offer wraparound coverage to employees purchasing individual health insurance in the private market, including the Marketplace, in limited circumstances, under a new Final Rule issued by the Department of Labor and other federal agencies. The Final Rule, published March 18, 2015, sets forth two narrow pilot programs for the limited wraparound coverage. One pilot program allows wraparound benefits only for multi-state plans (MSPs) in the Health Insurance Marketplace. The second pilot program allows wraparound benefits for part-time workers who enroll in an individual policy or in Basic Health Plan coverage for low-income individuals, which was established under the Patient Protection and Affordable Care Act (PPACA).
Question of the Month
Q. How should employers count the hours of substitute teachers?
A. Substitute teachers are a difficult kind of employee to track for purposes of play or pay. There are no special rules for counting the hours of substitute teachers. Generally speaking, employers should disregard the term of employment they anticipate a substitute teacher will have, and instead focus on how many hours per week they anticipate the substitute teacher will work.
The substitute teacher’s status during the stability period as full or part time will be determined by the hours they worked in the measurement period.