News & Analysis as of

Health Insurance Employee Retirement Income Security Act (ERISA)

McDermott Will & Emery

Special Report: Examining Group Health Coverage Alternatives for Small Employers - Update

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Originally published in February 2025, this updated report provides new material on physician practice management (PPM) arrangements, reference-based pricing arrangements, minimum essential coverage (MEC) and MEC+ plans, and...more

Maynard Nexsen

JPMorgan Sued Over Management of Prescription Drug Benefits

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On March 13, 2025, several current and former participants in the JPMorgan Chase Health Care and Insurance Program for Active Employees, as well as its component Medical Plan (collectively referred to as the “Plan”) filed a...more

Holland & Knight LLP

Excessive Fee Cases: Not Just for Retirement Plans Anymore

Holland & Knight LLP on

A recent wave of cases has attempted to apply the theory of liability for retirement plan excessive fee cases to health plans – specifically, arrangements with pharmacy benefit managers. Though the cases thus far have...more

ArentFox Schiff

Navigating Out-of-Network Claims: Key Takeaways for Providers From Surgery Center Case in New York Federal Court

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The US District Court for the Eastern District of New York in Manalapan Surgery Ctr., et al. v. 1199 SEIU National Benefit Fund, No. 23-CV-03525 (EDNY March 12, 2025), recently granted a motion to dismiss a complaint filed by...more

Groom Law Group, Chartered

Plaintiffs Double Down on Challenges to PBM Arrangements in Class Action Lawsuits Involving Johnson & Johnson and JPMorganChase

On March 10, 2024, the plaintiffs filed an amended complaint in a much-followed putative class action lawsuit against Johnson & Johnson (“J&J”) alleging that the plan fiduciaries for J&J’s group health plan violated ERISA by...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - March 2025

The March Monthly Minute brings you three recent case updates addressing 401(k) forfeiture utilization, TPA responsibility for recovering self-insured plan’s fraudulently paid claims, and continued PBM litigation in the wake...more

ArentFox Schiff

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

ArentFox Schiff on

A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...more

Morgan Lewis - ML Benefits

Tobacco Surcharge Lawsuits: Considerations for Plan Sponsors

A growing number of class action lawsuits have been filed against employer-sponsored self-insured group health plans alleging that tobacco cessation wellness programs violate key provisions of the Employee Retirement Income...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Ninth Circuit Affirms ERISA Plan Administrator’s Decision, Validates Use of Industry Guidelines and Medical Evidence

On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how...more

Foley & Lardner LLP

Is Your Nonprofit Slashing Benefits to Offset Federal Funding Cuts?

Foley & Lardner LLP on

On February 6, 2025, the Trump administration (the Administration) issued an executive order (the Review Order) directing the heads of Federal executive departments and agencies (Agencies) to review all funding the Agencies...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

What Will Trump 2.0 Mean for Employee Benefits? - One Place to Look for Clues: Project 2025

Even as high-priority issues such as diversity, equity, and inclusion (DEI), immigration, and Ukraine take center stage in the first months of the new presidential administration, many employers are wondering what the next...more

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Carlton Fields

Eleventh Circuit Holds Arbitration Agreement Unenforceable Against Spouse of Former Employee

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In Lubin v. Starbucks Corp., the Eleventh Circuit Court of Appeals considered defendant Starbucks’ appeal of an order denying its motion to compel arbitration of the plaintiffs’ lawsuit alleging that Starbucks sent deficient...more

Seyfarth Shaw LLP

Executive Order on Health Care Access for Gender-Affirming Treatments for Minors

Seyfarth Shaw LLP on

Following through on a campaign theme focused on transgender issues and access to gender-affirming health care, on Friday, January 28, President Trump signed an Executive Order, titled “Protecting Children from Chemical and...more

Arnall Golden Gregory LLP

Industry Group Challenges Mental Health Parity Act Final Rules

On January 17, 2025, the ERISA Industry Committee (“ERIC”) filed a lawsuit against the U.S. Department of Health and Human Services and other federal agencies, seeking to invalidate the final rules under the Mental Health...more

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

Fennemore on

In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more

Saul Ewing LLP

Organizing Your Company’s Health and Welfare Plans Part 2: Creating a Committee Checklist

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In the prior article we discussed the reasoning behind creation of a health and welfare committee to oversee administration of the health and welfare plans. In creating a charter, a plan sponsor will need to decide whether to...more

Saul Ewing LLP

Organizing Your Company’s Health and Welfare Plans Part 1: Creating a Framework

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Following the flurry of regulatory guidance and informal comments from officials at the Employee Benefits Security Administration, and other agencies of the Federal government, health and welfare plans should be a primary...more

Polsinelli

Kansas Insurance Department Issues Data Call to All Third Party Administrators Licensed in Kansas

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The Kansas Insurance Department (“Department”) recently issued a Data Call to all Third Party Administrators (“TPAs”) licensed in the state of Kansas. Pursuant to the Data Call, the Department has requested information...more

Groom Law Group, Chartered

DOL & Treasury Extend Certain ERISA-Related Deadlines for Helene and Milton Impacted Areas

On November 8, the Departments of Labor and Treasury (the “Departments”) issued guidance extending certain deadlines related to retirement, health, and welfare plans in response to Hurricane Helene, Tropical Storm Helene, and...more

Fisher Phillips

Rising ERISA Class-Action Lawsuits Over Tobacco Surcharges in Health Plans: What Employers Need to Know + 6 Steps to Stay...

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A wave of ERISA class-action lawsuits is challenging tobacco surcharge programs in employer-sponsored health plans across the U.S. These cases center on potential fiduciary breaches, with plaintiffs arguing that surcharges...more

UB Greensfelder LLP

What Employers Should Know About Tobacco Surcharge Litigation

UB Greensfelder LLP on

Tobacco surcharges have become the focus of class action litigation in recent months. Although corporate wellness programs are commonplace, employers that impose a tobacco surcharge (or other premium discount) in connection...more

Alston & Bird

Final Mental Health Parity Rules: A Plan Sponsor’s Implementation Guide

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Our Employee Benefits & Executive Compensation Group discusses what health plan sponsors need to know about the final rule on nonquantitative treatment limitations (NQTLs) and NQTL comparative analysis under the Mental Health...more

Jackson Lewis P.C.

Conjuring Health Plan Hygiene: The Final Chapter

Jackson Lewis P.C. on

As we conclude our “Health Plan Hygiene” blog series, we reflect on the important insights shared about fiduciary responsibilities under the Employee Retirement Income Security Act of 1974 (ERISA) and highlight the risk posed...more

BCLP

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

BCLP on

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

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