Employers should be certain they understand the design of their health plan and its ramifications to avoid legal and other difficulties.
A recent decision by the 6th U.S. Circuit Court of Appeals found that a company could not have its employee health plan provider reimburse it for expenses paid on an employee's short-term disability leave. The plan's terms indicated that coverage did not apply during such leave, according to the ruling, but instead limited coverage to "regularly assigned, full-time employee[s] … regularly scheduled to work a minimum of 40 hours per week," according to Plan Sponsor.
The distinction concerning when employee benefits apply is likely to prove relevant in any number of cases, whether they reach the courts or not. Employee benefit consultants can help employers ensure they understand the specifics of their plans even in complex cases that may involve disabilities, FMLA leave or other factors.
Employers who do not consider this matter and prepare in advance may find themselves arguing untenable positions in such cases and paying more as a result, or missing an opportunity to reduce costs.
