News & Analysis as of

Employer Group Health Plans Healthcare

McDermott Will & Emery

A win for telehealth providers, health plans, and participants: HDHP telehealth safe harbor permanently reinstated

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On July 4, 2025, the president signed the One Big Beautiful Bill Act (H.R. 1) into law. Among many other healthcare provisions, the bill permanently extends the telehealth safe harbor for high-deductible health plans (HDHPs)...more

Seyfarth Shaw LLP

Supreme Court Upholds Tennessee Transgender Care Ban

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In a widely awaited for decision, the Supreme Court in a 6-3 opinion authored by Justice Roberts held that a Tennessee law which prohibits certain medical treatments (puberty blockers and hormones) for transgender minors,...more

Quarles & Brady LLP

Departments Will Not Enforce 2024 Final Rule under MHPAEA

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The Trump Administration has just announced that it will pause enforcement of the September 2024 final rule (“Final Rule”) under the Mental Health Parity and Addiction Equity Act (“MHPAEA”)....more

Seyfarth Shaw LLP

Cutting Out the Middle Man

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Arkansas has become the first state in the nation to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. We take a look at...more

ArentFox Schiff

Anthem Set to Settle Five-Year Long Mental Health Coverage Class Action

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Anthem Inc. has agreed to settle a class action lawsuit brought by participants in employee health plans administered by the insurer....more

Saul Ewing LLP

Trump on Transparency: Making America Healthy Again Through Executive Order 14221; How Plan Sponsors Can Respond

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One mandate under the PPACA required health care providers, non-grandfathered health insurance issuers and self-insured group health plans to provide consumers with access to information about the cost of services before they...more

McDermott Will & Emery

Special Report: Examining Group Health Coverage Alternatives for Small Employers

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Small employers seeking to offer robust major medical coverage to employees and their dependents face daunting price and transparency hurdles. Employers with 50 or fewer full-time equivalent employees, so-called “small...more

McAfee & Taft

Challenge to copay assistance strategy, another PBM ERISA preemption lawsuit, and other compliance issues for 2025

McAfee & Taft on

The end of 2024 gave group health plan sponsors several new lawsuits to watch in 2025. Gurwitch v. SAVE ON SP LLC - On December 26, 2024, a class action complaint was filed in the U.S. District Court for the Northern District...more

Wiley Rein LLP

PBM Contracting and Administration: What Are the Rules of the Road for Self-Insured Employees?

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In February 2024, a group representing (among others) the Johnson & Johnson Group Health Plan and its component plans (Plaintiffs) sued Johnson & Johnson and The Pension & Benefits Committee of Johnson and Johnson (J&J) over...more

Quarles & Brady LLP

Final Rule under MHPAEA Clarifies NQTL Comparative Analysis Requirement

Quarles & Brady LLP on

On September 23, 2024, the Departments of Labor, Treasury, and Health and Human Services (together, “Departments”) issued a final rule (“Final Rule”) under the Mental Health Parity and Addiction Equity Act (“MHPAEA”). The...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

Seyfarth Shaw LLP

Agencies Release 2026 Out-of-Pocket Limits and 2025 Limits for Health FSAs

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Recently HHS issued a memorandum announcing the maximum annual limitation on cost sharing (a/k/a out-of-pocket maximum) for 2026 and the IRS issued Rev. Proc. 2024-40 announcing the cost-of-living adjustments to certain...more

Proskauer - Employee Benefits & Executive...

Deadlines Approaching for New ACA Section 1557 Nondiscrimination Requirements: Action Items for Covered Group Health Plans

Earlier this year, the Department of Health and Human Services (“HHS”) released a final rule under Section 1557 of the Affordable Care Act (“ACA”), which prohibits discrimination in health programs and activities. The 2024...more

McDermott Will & Emery

Election 2024: Gender-Affirming Care in the US

McDermott Will & Emery on

On the issue of gender-affirming care, how would a Harris-Walz administration affect clients in your practice? Bottom line: A Harris-Walz administration would likely provide health plans and health plan sponsors with...more

Bradley Arant Boult Cummings LLP

Group Health Plan Sponsors Take Note: New Developments Relating to the Privacy and Cybersecurity of Plan Participants’ Health...

There have been two important developments in the law applicable to the privacy and cybersecurity of group health plan participants’ health information. Plan sponsors must review plan policies and procedures, provider...more

Seyfarth Shaw LLP

Final Rules Related to the Mental Health Parity and Addiction Equity Act May Drive You Wild

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Seyfarth Synopsis: On September 9, 2024, the Departments of the Treasury, Labor, and Health and Human Services (the “Departments”) released highly anticipated Final Rules under the Mental Health Parity and Addiction Equity...more

Bass, Berry & Sims PLC

More Losses than Gains? OIG Declines to Approve Certain Medicare Advantage Gainsharing Arrangements in Advisory Opinion 24-08

Bass, Berry & Sims PLC on

On September 13, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 24-08, in which it declined to approve a proposal by a Medicare Advantage organization (MAO)...more

McDermott+

Biden Administration Issues Final Reg on Mental Health Parity Requirements

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Biden Administration Issues Final Reg on Mental Health Parity Requirements McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. Click here to subscribe to future blog posts....more

Seyfarth Shaw LLP

Agencies Release Final Mental Health Parity Rule

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On Monday, September 9, 2024, the Departments of Health and Human Services, Labor and Treasury (the “Departments”) issued their final rule regarding the nonquantitative treatment limitation (NQTL) comparative analysis...more

Hall Benefits Law

Biden’s Proposed FFY 2025 Budget Seeks Mental Health Access Expansion

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The Biden administration unveiled its FFY 2025 budget, which calls for $7.3 trillion in spending. In the proposed budget, Biden maintains his pledge to focus on expanding and transforming the nation’s mental health system. He...more

Davis Wright Tremaine LLP

San Francisco’s Health Care Security Ordinance – Five Traps for the Unwary

Do you have any San Francisco-based employees? If so, you may be subject to the San Francisco Health Care Security Ordinance ("SFHCSO"), a complex set of rules requiring certain minimum employer contributions toward San...more

Mintz - Antitrust Viewpoints

Reversible Error: District Court Stutters, Ninth Circuit Shudders, Litigation Continues for Sutter

Over ten years ago, individuals and businesses insured by health plans that contract with Sutter Health filed a class action lawsuit against Sutter Health alleging antitrust violations under federal and California laws....more

Akerman LLP - HR Defense

Employers Must Keep Reproductive Health Information About Their Plan Participants Private Under New HIPAA Privacy Rule

Imagine you are a corporate Human Resources/Total Rewards leader who receives a request from a state’s law enforcement agency for health plan records about a plan participant’s abortions or other reproductive health care. How...more

Verrill

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

Verrill on

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

Akerman LLP - Health Law Rx

Attention, Group Health Plans: New HIPAA Privacy Rule Governing Reproductive Health Care Information Imposes Obligations,...

It is critical for employers and plan fiduciaries/administrators to stay informed of HIPAA privacy and security-related legal developments because most employer sponsored group health plans — regardless of the employer’s...more

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