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ERISA self-insured health plan not required to cover same sex spouses

In Roe v. Empire Blue Cross Blue Shield, No. 12–cv–04788 (NSR), 58 EBC 1077, 2014 WL 1760343 (S.D. N.Y. May 1, 2014), the United States District Court for the Southern District of New York held a self-insured health plan that...more

The Federal Court for the Southern District of New York Rules that Employers with Self-Insured Health Plans Need Not Offer Medical...

The issue of same-sex spousal rights is now largely resolved for qualified retirement plans. However, substantial questions about same-sex spouse health benefits remain unanswered. In Roe v. Empire Blue Cross Blue Shield,...more

Medicare Appeals Panel Invalidates National Coverage Determination Prohibiting Coverage for Gender Reassignment Surgery

On May 30, 2014, the Departmental Appeals Board (DAB) issued a decision invalidating the long-standing National Coverage Determination (NCD) prohibiting Medicare payment for transsexual surgery (now known as gender...more

Health Care Reform Implementation Update

Affordable Care Act (ACA) action on Capitol Hill this past week centered on investigations into improper ACA subsidy payments, a potential constitutional amendment proposal, and support for an appeal of the ACA in favor of a...more

OFCCP Setting Its Sites On TRICARE Providers?

Healthcare providers are waiting anxiously to see the Office of Federal Contract Compliance Programs’ (OFCCP) most recent position on whether it will continue trying to assert jurisdiction over them on the basis of...more

HHS Guidance Clarifies that Insurance Companies Must Make Available Health Insurance Coverage for Same-Sex Spouses

On March 14, 2014, the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released guidance clarifying the final regulations implementing Section 2702 of the Public Health Service Act...more

Health Alert (Australia) - 28 October 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Judgments: Commonwealth - 23 October 2013 - Maiocchi v Royal Australian & New Zealand College of Psychiatrists [2013] FCA...more

State and Federal False Claims Act Defendant Seeks to Prevent Use of Claims Documents in Case Filed By Former Employees

United States ex rel. Bahnsen v. Boston Scientific Neuromodulation Corp., No. 11 CV 1210 (SDW) (MCA) (D.N.J.).: Two former employees of Boston Scientific Neuromodulation Corporation (BSNC) – one from its Customer Service...more

Courts Split On Whether Mandatory Contraceptive Coverage Violates Religious Freedoms Of For-Profit Corporations

Under the Patient Protection and Affordable Care Act’s preventive services mandate, non-grandfathered group health plans must provide 100% coverage of contraceptives for women, subject to exemptions and safe harbors for...more

New Wellness Program Rules for 2014

Employers continue to look for ways to manage the cost of employee health care coverage as they navigate the turbulent waters of healthcare reform, and wellness programs continue to be a popular strategy. However, adoption...more

ACA Not Enough to Save Penn State’s Employee Wellness Program

Recent negative media reports caused Pennsylvania State University to modify its employee wellness program, making clear that considering compliance with the Patient Protection and Affordable Care Act of 2010 (ACA) alone is...more

WANTED: EEOC Guidance On Wellness Plans Under The ACA

Employee wellness plans have been in the spotlight lately. This is because new wellness plan rules published in the Patient Protection and the Affordable Care Act (informally called Obamacare) are slated to take effect in...more

The Key to a Healthy Corporate Wellness Program

As employers and lawmakers seek creative solutions to rising health-care costs, corporate wellness programs have exploded in popularity. Many employers have embraced corporate wellness programs as a means of controlling...more

Carrot Or Stick? When Does A Voluntary Wellness Program Become Involuntary?

Employer wellness programs, which are designed to stem rising health care costs by encouraging healthy behaviors among employees, are rising in popularity. Such programs will receive another boost when certain provisions of...more

DOL FAQ Confirms No Penalty For Failure To Distribute Exchange Notice, Obligation Still Remains

On Wednesday, September 12, the Employee Benefits Security Administration (EBSA), which is a division of the Department of Labor (DOL), released another FAQ indicating that no penalty or fine will be applied for failing to...more

Balancing the Affordable Care Act and ERISA

Looming implementation of the Affordable Care Act's (ACA) so-called “play or pay” provision has large employers evaluating the alternatives it presents: “play,” by offering health insurance coverage to full-time employees; or...more

Wellness Programs Final Regulations

On May 29, 2013, the Departments of the Treasury, Labor and Health and Human Services issued final regulations on wellness programs based on statutory changes made by The Patient Protection and Affordable Care Act and the...more

Health Care Reform Implementation Update - September 3, 2013

There is only one week left of Congress’ summer recess. While the members have been in their home districts, the agencies in Washington have been finalizing Affordable Care Act (ACA) regulations on everything from the...more

Now for Everything Else: What Employers Still Need To Worry About Between Now And 2015

For the past several months (and, in many cases, years), most large employers have been preparing for the consequences of offering (or not offering) their workforce health coverage and complying with the complexities...more

Benefits Update, No. 3, August 2013: Healthcare Reform: What Was and Was Not Delayed?

On July 2, 2013, the U.S. Treasury Department delayed enforcement of the employer “play or pay” mandate penalties and reporting requirements one year to 2015, stating that covered employers should still comply with the...more

Health Insurer Settles OFCCP Retaliation Allegations for $372,000

A health insurance provider in Massachusetts has agreed to pay $372,739 to resolve an Office of Federal Contract Compliance Programs (OFCCP) investigation into claims of discrimination and retaliation....more

Health Care Reform Update -- July 1, 2013

In This Issue: Leading the News; Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

Whistleblowing Protections Under the Affordable Care Act – It’s The Law Now

When most employers think of the Patient Protection and Affordable Care Act (ACA), the focus is on the countdown to January 1, 2014, when the employer mandate kicks in. However, the ACA has been law since March 23, 2010....more

Healthcare Reform White Paper: Countdown To 2014

Although the Patient Protection and Affordable Care Act (“PPACA” or the “Act”) is now over three years old, the Act’s core requirements will not take effect until 2014....more

PPACA/HIPAA Wellness Programs and Rewards Final Regulations Issued

The Treasury Department, Department of Labor and Department of Health and Human Services issued final regulations on wellness programs and rewards for group health plans on May 29, 2013. The regulations implement provisions...more

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