The Centers for Medicare & Medicaid Services (“CMS”) has issued final rules on the penalties imposed when Responsible Reporting Entities (“RREs”) fail to meet their Medicare as Secondary Payer...
Sophisticated Legal Solutions Boutique-Style Service
Group Health Plan
Group Health Insurer Need Not Cover Certain Autism Treatments
The U. S. Court of Appeals for the Seventh Circuit, in Hensen v. Group Health Plan Cooperative of South Central Wisconsin, has ruled that the Mental Health Parity and Addiction Equity Act (“MHPAEA”)...
Eleventh Circuit Adopts Strict Standard for FMLA Claims
The Eleventh Circuit Court of Appeals, in Lapham v. Walgreen Co., has ruled that the “but for” legal standard applies to Family and Medical Leave Act (“FMLA”) retaliation claims. Law. The FMLA...
DOL Proposes to Rescind 2018 Association Health Plan Rule
DOL Proposes to Rescind 2018 Association Health Plan Rule - Roberta Casper Watson, PLANSPONSOR, December 22, 2023 (PDF)
Plan Must Consider All “Independent Grounds” for Claims Coverage
The U.S. Court of Appeals for the Tenth Circuit, in Ian C. v. UnitedHealthcare Ins. Co., has ruled that a group health plan violated ERISA’s claims procedures by failing to separately evaluate each...
IRS Announces PCORI Fee
IRS has released Notice 2023-70, which provides the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“ PCORI” ) fee for plan years ending before October 1, 2024....
Participant May Receive Monetary Damages for Plan’s Failure to Approve Procedure
In Rose v. PSA Airlines, Inc., the Fourth Circuit Court of Appeals ruled that a self-funded group health plan may be sued for monetary damages for failure to approve a medical procedure for a plan...
Claims Denial Overturned for Failure to Follow Claims Procedures
The U.S. Court of Appeals for the Tenth Circuit, in David P. v. United Healthcare Ins. Co., has reversed a group health plan’s benefits claim denial because the plan’s claims administrator failed to...
ERISA Group Health Plan’s Self-Help Provision is Enforceable
The Ninth Circuit Court of Appeals, in Mull v. Motion Picture Industry Health Plan; Board of Directors of Motion Picture Industry Health Plan, has determined that an ERISA-covered group health plan...
Federal Agencies Issue Group Health Plan Guidance
By Roberta Watson, Barry Salkin and Dannae Delano On December 23, 2022, new guidance applicable to group health plans was issued by federal agencies, as described more fully below. The Center for...
“Probate Exception” Precludes Federal Jurisdiction over ERISA Lawsuit
The Sixth Circuit Court of Appeals, in American Electric Power Service Corporation v. John K. Fitch et al., has affirmed a district court’s dismissal of a group health plan’s ERISA action seeking...
Court Finds Employee-Paid LTD Policy Was Part of Employer’s ERISA Plan
A federal district court in the Middle District of Tennessee has held, in Insurance Company of America, that a long-term disability (“LTD”) policy offered under an employer’s group health plan was...
Plans Must Cover Over-the-Counter COVID Tests
The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions #51 (“FAQs”) regarding implementation of the Families First...
Increased Contribution Requirement Upon Retirement is a COBRA Qualifying Event
The Fifth Circuit Court of Appeals has confirmed, in Randolph v. East Baton Rouge Parish School System, that a change in required contributions upon retirement is a COBRA qualifying event. Facts. An...
The Families First Coronavirus Response Act Updated to Include Coronavirus Aid, Relief, and Economic Security Act Provisions
by Roberta Watson, Barry Salkin and Virginia Peabody This Law Alert serves as an update to the Law Alert sent out on March 19, 2020 concerning the paid leave and group health plan provisions of The...