News & Analysis as of

Employee Retirement Income Security Act (ERISA) Health Insurance

BCLP

Mental Health Parity Final Rule Imposes Year-end Action Items on Group Health Plan Sponsors

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On September 9th, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Departments”) issued the much anticipated final rule under the Mental Health...more

Zuckerman Spaeder LLP

A Pivotal Moment in the Fight for Behavioral Health Equity: New Parity Regulations and More

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The NAADAC 2024 Conference & Hill Day is an annual conference that brings together thousands of addiction counselors, educators, and other addiction-focused health care professionals from across the country. The conference...more

Verrill

Final Mental Health Parity Rule Spells Compliance Changes

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The long-anticipated final rule under the Mental Health Parity and Addiction Equity Act (MHPAEA) was published on September 9, 2024. The MHPAEA prohibits group health plans that provide mental health and substance use...more

Bricker Graydon LLP

Getting Ahead: Is Your Plan Prepared for the Mental Health Parity Fiduciary Certification Requirements?

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Last month, the Departments of Labor, Health and Human Services and the Treasury (Departments), issued the highly anticipated final rule under the  Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). ...more

Ballard Spahr LLP

Practical Pointers for Compliance With New MHPAEA Regulations

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The Departments of the Treasury, Labor, and Health and Human Services have published final regulations under the Mental Health Parity and Addiction Equity Act that prohibit group health plans and health insurers from imposing...more

Fisher Phillips

Open Enrollment Season in the Workplace: 5 Legal Considerations + Employer Takeaways

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Open enrollment season can put a spotlight on the many complex rules applicable to employer-sponsored health and welfare plans. As you announce your benefit offerings for the upcoming plan year and tirelessly work to inform...more

Groom Law Group, Chartered

Third Circuit Affirms Dismissal of ERISA Claims Based on Employer’s Retention of Prescription Drug Rebates

On September 25, 2024, the United States Court of Appeals for the Third Circuit affirmed the dismissal of a putative class action lawsuit alleging that an employer violated ERISA by retaining approximately $65 million in...more

Bricker Graydon LLP

Does Your Health Plan Meet the New Kentucky Prescription Drug Rules?

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Effective January 1, 2025, Kentucky has new law regulating pharmacy benefit managers (“PBMs”). Earlier this year, the Governor of Kentucky signed SB 188 into law, making Kentucky the latest state to pass legislation...more

Akerman LLP - Health Law Rx

MHPAEA Final Rule: Clarity on Mental Health Parity?

The three federal agencies tasked with enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) — the Departments of Labor, Health & Human Services (through CMS), and Treasury (the Departments) — issued their...more

Troutman Pepper

9th Circ. Clarifies ERISA Preemption for Healthcare Industry

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On May 31, the U.S. Court of Appeals for the Ninth Circuit published an opinion in Bristol SL Holdings Inc. v. Cigna Health and Life Insurance Co., which has significant implications for the healthcare industry. Originally...more

Hall Benefits Law

Federal Agencies Issue Updated Instructions for Annual Submission of Gag Clause Prohibition Compliance Attestation

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​​​​​​​The U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) have updated the Submission Instructions and User Manual for the Gag Clause Prohibition...more

Hall Benefits Law

9th Circuit Explains ERISA Preemption of State Law Claims Arising from Preservice Coverage Communications

Hall Benefits Law on

The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more

Holland & Hart - The Benefits Dial

Hole in the Bottle… Employer Considerations After Another Lawsuit Against an Employer Health Plan

Last week, former Wells Fargo employees filed a class action lawsuit against Wells Fargo and its health plan fiduciaries alleging that Wells Fargo’s self-funded health plan violated ERISA by paying its pharmacy benefits...more

Groom Law Group, Chartered

DOL Finalizes Rescission of Association Health Plan Rule

On April 29, 2024, the Department of Labor (“DOL”) released a final regulation (the “Final Rule”) that rescinded the Trump Administration rule that expanded the availability of association health plans (“AHPs”) (“Trump DOL...more

Robinson+Cole ERISA Claim Defense Blog

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on...

Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more

McDermott Will & Emery

Group Medical Captives, Level Funding and US Healthcare Policy

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In a recent article in Managed Healthcare Executive, Peter Wehrwein examines the trend of self-funding of group health benefits by smaller employers who used to depend mainly or entirely on fully insured programs....more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - June 2024

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This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more

Troutman Pepper

Ninth Circuit Court of Appeals Restricts Out-of-Network Providers’ Ability to Avoid ERISA Preemption of State Law Claims

Troutman Pepper on

On May 31, the Ninth Circuit Court of Appeals published an opinion in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, which has significant implications for the healthcare industry, most notably by...more

Verrill

Can a Self-Funded Group Health Plan Exclude Coverage for Gender-Affirming Care?

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We are sometimes asked whether a self-funded group health plan is required to cover gender-affirming medical services. As this post explains in detail, it is generally impracticable for a self-funded ERISA-covered plan to...more

Seyfarth Shaw LLP

Does Section 1557 Apply to Employer Group Health Plans? (And — Why That Question May Not Even Matter)

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Seyfarth Synopsis: Following years of back and forth, new final rules were published by the Department of Health and Human Services (HHS) on May 6, 2024 reinstituting the Department’s interpretation that the prohibition on...more

Woodruff Sawyer

Navigating Mid-Year Benefit Election Changes

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One of the most common questions that we receive is whether an employee can change their benefits elections after the plan year has already started (also referred to as a mid-year change).  The answer is very fact-specific...more

Ballard Spahr LLP

Final Rules Overturn Trump Era Health Benefit Rules

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The Biden administration has issued two sets of final regulations that overturn rules adopted during the Trump administration pertaining to association health plans and short-term, limited-duration insurance (STLDI). The...more

Arnall Golden Gregory LLP

Appeals Court Revives AGG Class Action Against UnitedHealth Group for Federal Mental Health Parity Law Violations

The United States Court of Appeals for the Ninth Circuit ruled on April 11, 2024, that AGG’s class action lawsuit against UnitedHealth Group and its subsidiaries for the wrongful and systematic denial of mental health and...more

Bass, Berry & Sims PLC

Caution! Contents Hot: Key Benefits Issues to Watch During the Remainder of 2024

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While the sweltering roil of temporary regulatory changes related to the COVID-19 pandemic may have cooled and the initial burst of SECURE 2.0 steam begins to dissipate, sponsors of employee benefit plans should keep their...more

Arnall Golden Gregory LLP

California Federal District Court Rules That AGG Clients’ Case Against Cigna for Institutional Practice of Under-Reimbursing...

U.S. District Court Judge David O. Carter ruled in favor of AGG’s clients on March 18, 2024, in a case involving “matters of widescale public concern” and a strong “public interest in access” to some of Cigna’s most coveted...more

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