News & Analysis as of

Plan Administrators Health Insurance

Fisher Phillips

Federal Appeals Court Decision Reminds Employers About Their Duty to Monitor Service Providers of ERISA-Covered Health and Welfare...

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A federal appeals court just illustrated the importance of an employer’s duty to monitor service providers that assist with the administration of employee welfare benefit plans. In the May 21 decision of Tiara Yachts v. Blue...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

Alston & Bird

New Year Brings New Tri-Agency FAQs About Gag Clause Prohibitions and Attestations, No Surprises Act

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Our Employee Benefits & Executive Compensation Group discusses new guidance for group health plans and insurers on complying with federal gag clause prohibitions and No Surprises Act requirements....more

Alston & Bird

When Disaster Strikes: Issues and Relief for Health Benefit Plans

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In the wake of a federally declared disaster, employees may face issues with their benefit plans. Our Employee Benefits & Executive Compensation Group discusses what plan administrators should know and the agency guidance...more

Epstein Becker & Green

Three Things That Employer Health Plan Sponsors Should Do When the New MHPAEA Rules Are Published

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The U.S. Departments of Labor (DOL), Health and Human Services, and the Treasury (collectively, the “Tri-Departments”) published a Notice of Proposed Rulemaking (NPRM) on August 3, 2023, to propose new regulations for the...more

Hall Benefits Law

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

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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

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

Troutman Pepper Locke

Case Update: Tenth Circuit Denies Petitions for Rehearing in Decision Requiring Substantial Changes to Health Plan Denial Letters

Troutman Pepper Locke on

As discussed here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its impact on what health plan administrators must include in adverse benefit...more

Woodruff Sawyer

Agencies Release Revised Instructions for 2022 Reference Year RxDC Reporting

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On March 3, 2023, federal agencies released revised Prescription Drug Data Collection (RxDC) Reporting Instructions applicable to the 2022 reference year. RxDC reporting for the 2022 reference year is due on or before June 1,...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - October 2022

The October Monthly Minute highlights a class action that hinges on deficient COBRA notices, the new 2023 benefit plan limits, and a case that held the benefit plan provisions in effect at the time of a claim denial control....more

Polsinelli

Ninth Circuit Reverses Landmark Wit Case Addressing Behavioral Health Coverage

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The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...more

K&L Gates LLP

Recent District Court Decision Highlights the Importance of Adequate Behavioral Health Claims Processing Guidelines for ERISA...

K&L Gates LLP on

On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more

Carlton Fields

Cutting Costs With Employee Benefit Plans (Part 3 of 5) – Medical Benefit Costs

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Carlton Fields tax attorney Lowell Walters suggests potential ways to reduce the costs of employer-sponsored group health plans....more

Rivkin Radler LLP

Employee Relations Law Journal – From the Courts

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North Carolina District Court Permits Plan’s Lawsuit Against Third Party Administrator to Continue A federal district court in North Carolina has ruled that a plan subject to the Employee Retirement Income Security Act of...more

Seyfarth Shaw LLP

Does My Health FSA Cover My Surgical Mask Bulk-Purchase? (and other pressing questions about the intersection of coronavirus,...

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Seyfarth Synopsis: Because everything has a coronavirus angle now….this blog post covers various issues and considerations plan sponsors and administrators should keep in mind as the coronavirus outbreak continues to...more

K&L Gates LLP

K&L Gates Triage: Important Takeaways from Omega Hospital, LLC v. United Healthcare Services, Inc.

K&L Gates LLP on

In this episode, Gary Qualls discusses a recent development in payer litigation which implicates a number of recurring issues often raised in Employee Retirement Income Security Act (ERISA) cases. Specifically, a federal...more

Proskauer Rose LLP

ERISA Newsletter - Fourth Quarter 2018

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As we closed the door on 2018, we were met by two surprising decisions—one from a panel of the Second Circuit addressing employer stock drop litigation, and one from a federal district court in Texas declaring the entire...more

Williams Mullen

Plan Administrators' 2018 Year-End Checklist

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Plan administrators should review the following actions to be taken before the end of 2018 and focus on what to expect for 2019. The following checklist addresses plan amendments, notices and other considerations for...more

McNees Wallace & Nurick LLC

Pennsylvania Court Addresses Individual Liability Under COBRA (and How to Avoid it)

With increasing frequency, when employees sue their employer or former employer, they also name individual managers or the company’s owners as defendants in their suit. ...more

Snell & Wilmer

Air Ambulance Services – What Does Your Plan Cover?

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Due to the increased litigation of air ambulance claims, employers may want to review their plan language to see whether their group health plan covers air ambulance services, and if so, to better understand the terms of the...more

Proskauer - Employee Benefits & Executive...

Health Care Reform Update – American Health Care Act Shelved

The American Health Care Act (“AHCA”), the legislation intended to “repeal and replace” the Affordable Care Act (“ACA”), was shelved on Friday, March 24, 2017, ending for now efforts to repeal the ACA. The AHCA, described in...more

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

More Clarity on Expatriate Health Plans and the ACA

Expatriate health plans have been surprisingly difficult to reconcile with the Affordable Care Act (ACA). Proposed regulations set to take effect in 2017 provide some useful guidance to U.S. employers that sponsor expatriate...more

Polsinelli

Third Party Administrator Update: TPA Regulatory and Legislative Developments - July 2016

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Polsinelli is pleased to share the June 2016 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that impact TPAs. Information specific to Polsinelli's TPA practice is also included. ...more

King & Spalding

November and December 2015 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

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Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

Proskauer - Employee Benefits & Executive...

New Affordable Care Act FAQs Provide Guidance on Preventive Services, Wellness Programs and Mental Health Parity

On October 23, 2015, the Departments of Labor, Health and Human Services and Treasury (the “Agencies”) jointly released their twenty-ninth (XXIX) set of Frequently Asked Questions (FAQs) about Affordable Care Act (ACA)...more

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