News & Analysis as of

Appeals Employer Group Health Plans

Fisher Phillips

Appeals Court Hands Victory to Transgender Employee Seeking Health Benefits: Key Takeaways and 3 Steps Employers Can Take Now

Fisher Phillips on

A federal appeals court recently held that an employer’s health insurance plan wrongly excluded coverage for gender-affirming care in violation of federal civil rights law – offering a warning to employers across the country...more

Foley Hoag LLP

10th Circuit Invalidates Oklahoma Pharmacy Network Law as Applied to ERISA and Medicare Part D Plans

Foley Hoag LLP on

The U.S. Court of Appeals for the 10th Circuit issued a sweeping decision that (1) maintains long-standing federal protections for employer and union-sponsored health plans to design their health benefit plans, including...more

McDermott Will & Emery

Tenth Circuit Reaffirms Preemption of State Pharmacy Network Regulations

McDermott Will & Emery on

The US Court of Appeals for the Tenth Circuit recently held in Pharmaceutical Care Management Association (PCMA) v. Mulready that the Employee Retirement Income Security Act (ERISA) and Medicare Part D preempted several...more

Sheppard Mullin Richter & Hampton LLP

Navigating the Wild West of the New ACA Preventative Care Ruling

On March 30, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a decision in Braidwood Management Inc. v. Becerra (“Braidwood”), invalidating the Affordable Care Act’s (“ACA’s”) mandate...more

McDermott Will & Emery

Tri-Agencies Address Preventive Services Coverage in the Wake of Braidwood

McDermott Will & Emery on

In response to Braidwood Mgmt. Inc. v. Becerra, a recent case striking down part of the Affordable Care Act (ACA) preventive services mandate, the US Departments of Labor, Health and Human Services, and the Treasury...more

McDermott Will & Emery

ERIC Files Amicus Brief Rebutting DOL Attempt to Create New Regulations in Lawsuit

McDermott Will & Emery on

McDermott Will & Emery’s Andrew C. Liazos, Michael B. Kimberly and Charlie Seidell recently filed an amicus brief in the US Court of Appeals for the 10th Circuit on behalf of the ERISA Industry Committee (ERIC). McDermott...more

Verrill

Deciphering First Circuit’s Thirty-page Primer on NQTL Analysis and ERISA Information Requests

Verrill on

The widely publicized 2022 Report to Congress regarding the Mental Health Parity and Addiction Equity Act (“Parity Act”) forewarned greater enforcement efforts by the Department of Labor and highlighted suspected deficiencies...more

Dorsey & Whitney LLP

Wit Is Flipped: The Ninth Circuit Reverses Major ERISA Decision

Dorsey & Whitney LLP on

The Ninth Circuit just reversed decisions from the U.S. District Court for the Northern District of California in Wit v. United Behavioral Health, which had ordered United Behavioral Health (“UBH”) to reprocess thousands of...more

Verrill

Surprise Medical Bills: Texas District Court Vacates Portion of Independent Dispute Resolution (IDR) Process in Agency Rule

Verrill on

The U.S. District Court for the Eastern District of Texas recently vacated a portion of the Requirements Related to Surprise Billing, Part II, Interim Final Rule (the “Rule”) regarding the independent dispute resolution (IDR)...more

Foley & Lardner LLP

ERISA Preemption of State Laws Requiring Employers to Report or Disclose Benefit Plan Information to Employers

Foley & Lardner LLP on

Last December, the U.S. Supreme Court unanimously held that provisions of an Arkansas law that regulated the use by pharmacy benefit managers (“PBMs”) of maximum allowable cost programs to limit retail pharmacy reimbursement...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor - October 2020

As we enter the final months of 2020, this is a time to reflect on a year of unprecedented challenges. Although Covid-19 changed our lives in many ways, it did not halt new legal developments in the life, health and...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor - October 2020: ERISA Plaintiff Has Statutory Standing to Bring Action to Recover Spousal Healthcare...

Plaintiff Doug Heckman participated in Nike's employee welfare benefit plan (the "Plan"), which was funded by UnitedHealthcare Insurance Co. ("UHC"), and included healthcare benefits. Mr. Heckman's wife was covered under the...more

Hogan Lovells

United States Supreme Court recognizes employer religious freedoms in two recent decisions

Hogan Lovells on

On July 8, 2020, the United States Supreme Court decided two cases addressing employers’ religious freedoms in very different contexts: one concerning whether religious school teachers could challenge adverse employment...more

McNees Wallace & Nurick LLC

Supreme Court Rules that Employers May Use Religious and Moral Exemptions for Requirement to Provide Health Plan Coverage for...

On July 8, 2020, in the consolidated cases of Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania et al. and Donald J. Trump, President of the United States, et al. v. Pennsylvania et al., the U.S. Supreme...more

Foley Hoag LLP

Supreme Court Allows Religious Employer Exemptions from Contraceptive Coverage

Foley Hoag LLP on

On Wednesday, July 8, 2020, the Supreme Court weighed in on whether religious employers are required to offer their employees health plans that include contraceptive coverage. In its opinion in Little Sisters of the Poor v....more

Fisher Phillips

Supreme Court Upholds Rules Expanding Exemptions To ACA’s Contraceptive Mandate

Fisher Phillips on

The Supreme Court just upheld two Trump-era rules expanding religious and moral exemptions to the Affordable Care Act’s (ACA) contraceptive mandate. The July 8 decision in Little Sisters of the Poor v. Pennsylvania is just...more

Ballard Spahr LLP

Supreme Court Upholds Exemption to ACA’s Contraceptive Mandate

Ballard Spahr LLP on

In Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, the Supreme Court this week upheld regulations issued by the U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) that...more

Franczek P.C.

SCOTUS Gives Religious Exemptions Wide Berth in Two Key Employment Rulings

Franczek P.C. on

On July 8, the U.S. Supreme Court issued two 7-2 decisions involving religious exemptions to federal employment and benefits laws....more

Burr & Forman

New Supreme Court Ruling Allows Religious Employers to Exempt Birth Control from Health Care Coverage

Burr & Forman on

This week, the Supreme Court ruled that employers may exclude coverage for birth control from their health plans based upon moral or religious objections to contraception. ...more

Bricker Graydon LLP

Religious exemption carries in U.S. Supreme Court decision on preventive reproductive care

Bricker Graydon LLP on

Until this week, federal law required most insurance plans to cover the cost of birth control without a copay. However, the history behind this issue can be traced back much further....more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania and Trump v. Pennsylvania

On July 8, 2020, the U.S. Supreme Court decided Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania and Trump v. Pennsylvania, holding that the Department of Health and Human Services validly created...more

Faegre Drinker Biddle & Reath LLP

Another U.S. Supreme Court Review of Affordable Care Act Could Impact Employer Health Plans

On March 2, 2020, the U.S. Supreme Court granted two petitions by interested states asking the Court to review the constitutionality of the individual health coverage mandate in the Affordable Care Act (ACA) and, if...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: First Circuit Clarifies ERISA's Timing Requirements for Appealing Adverse Benefits Determination

In Fortier v. Hartford Life & Accident Ins. Co., 916 F.3d 74 (1st Cir. 2019) the U.S. Court of Appeals for the First Circuit clarified ERISA's timing requirements with respect to appealing an adverse benefits determination...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Courts Say Abuse of Discretion Standard is "Highly Deferential" to Plan Administrator's Denial of Benefits

In Rittinger v. Healthy Alliance Life Ins. Co., 914 F.3d 952 (5th Cir. Jan. 31, 2019), and Roebuck v. USAble Life, 380 F. Supp. 3d 852 (E.D. Ark. Mar. 30, 2019), the courts found no abuse of discretion where the ERISA plan...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Sixth Circuit Rejects MSPA and ERISA Discrimination Claims

Seeking to control healthcare costs, many group health plans have adopted amendments that lower reimbursement rates for the treatment of end-stage renal disease ("ESRD"), which requires long-term dialysis treatment or a...more

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