On March 19, 2025, the Department of Health and Human Services (“HHS”) issued a Proposed Rule that would eliminate the current requirement that certain health insurance issuers must provide coverage...
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Health Insurance
ERISA Claims Standards Apply to Exceptions in Employee Benefit Plans
The U.S. District Court for the Southern District of New York has ruled, in Doe v. Deloitte, that a group health plan violated ERISA by failing to apply standard ERISA claims requirements to a...
Patients Target Insurers in Suits Over Flawed Doctor Directories
Patients Target Insurers in Suits Over Flawed Doctor Directories - Roberta Casper Watson, Bloomberg Law, March 13, 2025 (PDF)
Pivotal ERISA Case Stalls Amid Mental Health Crisis
Pivotal ERISA Case Stalls Amid Mental Health Crisis - Andrew Oringer, Law360, June 13, 2024 (PDF)
Court Split Spells Trouble on Surprise Billing Award Enforcement
Court Split Spells Trouble on Surprise Billing Award Enforcement - Roberta Casper Watson, Bloomberg Law, June 11, 2024 (PDF)
Notice for Fixed Indemnity Insurance Revised
The Internal Revenue Service, Department of Labor, and Department of Health and Human Services (the “Agencies”) have issued a revised, mandatory notice for fixed indemnity insurance coverage....
Agencies Revise Short-Term Health Insurance Regulations
HHS, DOL and IRS (the “Agencies”) have jointly issued revised final regulations reducing the maximum duration of short-term, limited-duration health insurance (“STLDHI”) coverage. Background. ...
Insurer May Be Liable Under ERISA for Unauthorized Premium Increases
The U.S. Court of Appeals for the First Circuit, in Parameter v. Prudential Insurance and Tufts University, has ruled that an insurer may have breached its fiduciary duty through unauthorized...
IRS Warns Companies are Making False Statements About Health Plan Reimbursements
In IR-2024-65 (the “IR”), the IRS warns taxpayers that some companies are misrepresenting the circumstances under which food and wellness expenses can be paid or reimbursed under health flexible...
Court Finds Health Plan Not Required to Furnish Administrative Service Agreements in Response to ERISA Document Request
In Zavislak v. Netflix, Inc., the U.S. District Court for the Northern District of California has largely rejected a plaintiff’s assertion that an employer/plan administrator for an ERISA...
ICHRAs: The New Health Care Benefit for Advisors to Learn in 2024
ICHRAs: The New Health Care Benefit for Advisors to Learn in 2024 - Thomas Clark, Jr., 401(k) Specialist Magazine, February 5, 2024 (PDF)
Workers Poised to Get Benefits as Rule Creates ‘Employees’
Workers Poised to Get Benefits as Rule Creates ‘Employees’ - Roberta Casper Watson, Bloomberg Law, January 29, 2024 (PDF)
Plan Insurer Held Liable for Failure to Follow Claims Procedures
The U.S. District Court for the District of Utah, in R.E. v. Blue Cross Blue Shield, has ruled that the failure to properly follow ERISA’s claims procedures may result in a reversal of a claims...
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...
Agencies Request for Comments on Issues Related to New Disclosures Under the No Surprises Act Indicate the Importance of Informing Marginalized Populations and Maintaining Privacy of Advance Health Care Information
By Roberta Casper Watson, Dannae Delano and Barry Salkin It should come as no surprise that most Americans do not have the information available to them that is necessary to make informed decisions...
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...
IRS Proposes Delayed Effective Dates for Affordable Care Act (“ACA”) Filing Requirements
The IRS has, in years past, extended deadlines for employer and group health plan ACA reporting. The IRS will not issue extended deadlines for 2021 reporting due in the first quarter of 2022. In...
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...