Health & Welfare

OOP Limits and Marketplace Special Enrollment Period

The U.S. Department of Health and Human Services (HHS) has announced the inflation-adjusted maximum out-of-pocket (OOP) limits that will apply to non-grandfathered plans for plan years beginning in 2022.  The OOP limit includes the plan’s deductible and cost sharing for essential health benefits (EHBs) under the Affordable Care Act (ACA). HHS has also clarified the duration of the special open ...

Ninth Circuit Confirms ERISA Preempts State-Law Claims Against Health Plan’s Insurer

The Ninth Circuit Court of Appeals has ruled, in Meyer vs. United Healthcare, that a health plan participant’s lawsuit alleging that the plan’s insurer violated state law by improperly handling his claim for medical benefits is preempted by ERISA.   

Will Federal Rules on Mental Health Parity Work This Time?

Agencies Issue Guidance Regarding Consolidated Appropriations Act, 2021 (“CAA”) Amendments to Mental Health Parity and Addiction Equity Act (“MHPAEA”)

Court Finds Cost of Heart Transplant Could Be Appropriate Equitable Remedy

A federal district court has ruled, in Rose vs. PSA Airlines, Inc. Group Insurance Plan, that a decedent’s estate may be entitled to recover the cost of a heart transplant as equitable relief under ERISA. 

Court Says Group Health Plan May Not Exclude Specified Autism Treatments

The District Court for the Northern District of California has ruled, in Doe v. United Behavioral Health, that the exclusion of certain specified procedures related to the treatment of autism violates the Mental Health Parity and Addiction Equity Act (“MHPAEA”).

Important Benefit Plan Provisions of the American Rescue Plan Act of 2021

By Dannae Delano, Israel Goldowitz, Barry Salkin and Roberta Casper Watson

Court Says Welfare Plan Fiduciary Breached Duties by Misusing Participant Contributions

A federal district court in the Western District of Virginia has held, in Hammer v. Johnson Senior Ctr., that the fiduciary for a welfare plan violated its duties of loyalty, care and prudence by misusing a health plan participant’s premium payments to pay operating expenses of the employer. 

EEOC Explains Application of ADEA to ICHRAs

On January 7, 2021 the Equal Employment Opportunity Commission (“EEOC”) issued an opinion letter explaining the application of the Age Discrimination in Employment Act (“ADEA”) to individual coverage health reimbursement arrangements (“ICHRAs”).

Stimulus Package Makes Major Changes with Respect to Employer Sponsored Benefit Plans

By Dannae Delano, Barry Salkin and Roberta Casper Watson

Arkansas Pharmacy Law Not Preempted by ERISA

In Pharmaceutical Care Management Association v. Rutledge, the U.S. Supreme Court has held that ERISA does not preempt an Arkansas statute that imposes rules on pharmacy benefits managers (“PBMs”).