News & Analysis as of

Employer Liability Issues Health Insurance Benefit Plan Sponsors

Bricker Graydon LLP

Can you Charge Smokers More for Your Health Plan?  

Bricker Graydon LLP on

Several new lawsuits have been filed recently alleging that employers violated HIPAA’s non-discrimination rule by charging higher health insurance premiums to employees who use tobacco products. ...more

Hall Benefits Law

PBM Contracts Could Expose Plan Sponsors to Fiduciary Liability

Hall Benefits Law on

A plan sponsor’s fiduciary duty to be transparent in Pharmacy Benefit Manager contracts safeguards plan participants’ interests and mitigates the risk of litigation, regulatory penalties, and reputational harm, say Hall...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

McDermott Will & Schulte

Special Report - Examining Group Health Coverage Alternatives for Small Employers

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

McDermott Will & Schulte

Complying With the ‘Relevant Data’ Requirement Under the Final 2024 Mental Health Parity and Addiction Equity Act: A Proposal for...

McDermott Will & Schulte on

The Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires group health plans and health insurance issuers to ensure that financial requirements (such as copays and deductibles), quantitative treatment...more

McDermott Will & Schulte

Employee Benefit Plans: Important Considerations for Year-End and 2025

McDermott Will & Schulte on

For calendar-year plans, the 2025 plan year is right around the corner. And even for non-calendar-year plans, January 1, 2025, is a key implementation date for certain plan features. This is the ideal time for plan sponsors...more

Verrill

Final Mental Health Parity Rule Spells Compliance Changes

Verrill on

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

Schwabe, Williamson & Wyatt PC

Year-End Compliance Considerations for Employee Benefit Plans

Open enrollment is right around the corner (at least for employers that run calendar-year health benefit plans), so many employers will be updating their benefit communication plans. Though not comprehensive, the following is...more

Mayer Brown

United States: Health and Welfare Hot Topics

Mayer Brown on

At A Glance - In recent months, there have been a number of important developments in the United States relating to health and welfare plans. This list of hot topics identifies the key areas for employers and plan sponsors to...more

McDermott Will & Schulte

Group Medical Captives, Level Funding and US Healthcare Policy

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

Fenwick & West LLP

The Shifting Regulatory Landscape for Level-Funded Plans: An Alternative for Group Health Insurance

Fenwick & West LLP on

In the constantly changing health insurance landscape, level-funded health plans are steadily gaining ground as a viable middle approach between fully insured health plan and self-funded health plans—arguably offering...more

Morgan Lewis - ML Benefits

Managing Welfare Plan Risk: The Fiduciary Committee

Fiduciary committees have long been established in connection with retirement plans to manage the investment, legal compliance, and operational risks that can arise under the Employee Retirement Income Security Act of 1974,...more

Dickinson Wright

10 Important Issues For Employers During the 2024 Open Enrollment Season

Dickinson Wright on

Open enrollment is rapidly approaching for employers with calendar-year employee benefit plans. Following are ten important issues for employers to consider for the 2024 open enrollment season...more

McDermott Will & Schulte

New MHPAEA Guidance Regarding NQTLs: Network Access and Composition

Recently proposed regulations attempt to ensure that health plans allow access to mental health or substance use disorder (MH/SUD) benefits as easily as medical or surgical (M/S) benefits. The proposed regulations, issued by...more

McDermott Will & Schulte

Preparing for the End of the COVID-19 Emergency: Deadline Tolling

The Biden administration previously announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our series introduction for more information). On April...more

Sheppard Mullin Richter & Hampton LLP

Navigating the Wild West of the New ACA Preventative Care Ruling

On March 30, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a decision in Braidwood Management Inc. v. Becerra (“Braidwood”), invalidating the Affordable Care Act’s (“ACA’s”) mandate...more

Verrill

The End of the COVID-19 Emergency Declarations Raises Questions, but We’ve Got Answers

Verrill on

It seems the COVID-19 pandemic is ending in the benefits world the same way it started: in a flurry of new laws, announcements, and notices intended to offer clarity but sowing confusion. To begin, it is important to remember...more

Bradley Arant Boult Cummings LLP

Departments Issue Guidance on Preventive Services under the ACA Following the Braidwood Decision

In light of the March 30 Braidwood Mgmt. Inc. v. Becerra decision, the Department of Labor, Department of Health and Human Services, and Department of the Treasury (the “departments”) have issued FAQ guidance on how the...more

Bass, Berry & Sims PLC

Tolling No More: Preparing for the End of COVID-19 Emergency Declarations

On January 30, President Biden announced his intention to end the COVID-19 National Emergency (NE) and Public Health Emergency (PHE) effective May 11, 2023. Both emergency declarations resulted in various forms of relief for...more

McDermott Will & Schulte

Preparing for the End of the COVID-19 Emergency: Coverage of COVID-19 Vaccines

The Biden administration has announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our prior article for more information). A topic of great...more

McDermott Will & Schulte

IRS Issues Final Regulations Extending ACA Information Reporting Deadlines, Clarifies Additional ACA Issues

McDermott Will & Schulte on

On December 15, 2022, the Internal Revenue Service (IRS) finalized regulations regarding Information Reporting of Health Insurance Coverage and Other Issues Under Internal Revenue Code (Code) Sections 5000A, 6055 and 6056...more

Faegre Drinker Biddle & Reath LLP

Navigating Open Enrollment Notice Requirements

Fall open enrollment is upon us, and plan sponsors and administrators are preparing to provide their employees with the required notices related to their health and welfare plans. Notice and disclosure obligations for health...more

McDermott Will & Schulte

DOL Issues Clarification for ERISA-Governed Group Health Plans

Two days before the one-year anniversary of the official start of the COVID-19 outbreak, the US Department of Labor (DOL) issued a last-minute notice clarifying its prior guidance that relaxed the deadlines for the Employee...more

Bass, Berry & Sims PLC

2019 ERISA Welfare Plan Checklist

Bass, Berry & Sims PLC on

We recognize that many of our clients sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. To assist our clients with that process, we...more

Seyfarth Shaw LLP

Different Strokes for Different Folks: The Feasibility of Implementing Different Benefits Plans for Different Categories of...

Seyfarth Shaw LLP on

In the growth of the gig economy, many employers are increasing the number of categories of their employees and associates. One challenge of the gig economy is determining when a worker qualifies as a full-time employee for...more

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