The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
The world of health benefits is constantly evolving. Recent policy shifts and legislative developments are expected to impact the economic landscape and have significant implications for employer plan sponsors, insurers,...more
The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more
The effective date is fast approaching for certain provisions of the Consolidated Appropriations Act of 2021 (“CAA”) and related regulations, and the Transparency in Coverage Rule. You can access previous articles written...more
Permissible Flexibility under Code Section 125 Pursuant to IRS Notice 2021-15 Notice 2021-15 offered plan sponsors the flexibility to adopt any of the following options despite the longstanding rules under Section 125 of the...more
The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more
A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more
On November 15, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Agencies”) issued a proposed "Transparency in Coverage" rule that would require most...more
As 2019 comes to an end, we are pleased to present our traditional End of Year Plan Sponsor “To Do” Lists. This year, we present our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 covers year-end health...more
Health and Welfare Plan Update - It is 9:00 p.m., do you know where your health plan data is? As IT systems continue to expand, and data is accessed, moved and stored in many new and different ways, the Office for Civil...more
Seyfarth Synopsis: The Eighth Circuit upheld dismissal of Title VII claims challenging an employee benefit plan’s blanket transgender exclusion because the exclusion impacted the employee’s transgender son, not the employee....more
In Depth - On Friday, May 13, 2016, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) finalized regulations that provide explicit protections from discrimination on the basis of gender...more
Seyfarth Synopsis: A district court in Minnesota recently found an employee could not challenge a plan’s blanket transgender exclusion under Title VII, when the employee was not transgender but her son was. The Court went on...more
If you had at least 50 but less than 100 full-time employees (on an aggregated basis, including full-time equivalents) in an average month in 2014, then you are an ACA “Applicable Large Employer” with ALE reporting...more
In a set of rules published last week, the government finalized a July 2010 interim final rule (“IFR”) related to coverage of certain preventive services and an August 2014 IFR regarding the definition of an eligible...more
One year ago, the U.S. Supreme Court ruled in the case of Burwell v. Hobby Lobby Stores, Inc. et al, that for-profit closely held corporations must be permitted to opt out of the Affordable Care Act’s contraception mandate on...more
The Affordable Care Act (“ACA”) requires that non-grandfathered health plans make preventive care and screenings available to their members at no cost (i.e. no deductibles, coinsurance, or co-payments). The Department of...more
The term “deer in the headlights” explains the mental state of a person who shows behavioral signs that remind us of a deer subjected to a car’s headlights where the deer is in such panic that they show no motor reaction to...more
On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act...more
Before departing for the 2013 Thanksgiving holiday, the Obama administration released several new regulatory announcements and guidance relating to the implementation of the Affordable Care Act (ACA). The new guidance delays...more