News & Analysis as of

Employer Group Health Plans Fiduciary Duty

Jackson Lewis P.C.

Health Plan Hygiene Part 1: A Spoonful of Sugar Helps the Medicine Go Down

Jackson Lewis P.C. on

During the next several weeks, we will publish a series of articles that dive deeply into “health plan hygiene” relating to health and welfare benefit plan fiduciary issues and how employers can protect themselves in this...more

Fisher Phillips

Don't Forget About ERISA in Your Health Plan’s Cybersecurity Efforts: Important Reminders for Plan Fiduciaries in the Wake of...

Fisher Phillips on

Earlier this year, a cyberattack on a leading healthcare claims processing provider had an unprecedented impact on patients and healthcare providers across the country. While group health plans were not directly targeted in...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - June 2024

Saul Ewing LLP on

This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more

Groom Law Group, Chartered

ERISA Group Health Plans – The New Target in Fee Cases

Earlier this year, a Johnson & Johnson (“J&J”) employee brought a class action complaint (the “Complaint”) against J&J alleging fiduciary breaches under ERISA related to the prescription drug coverage under J&J’s self-funded...more

Verrill

Health and Welfare Benefit Plan Fiduciary Governance in the Wake of the Johnson & Johnson Lawsuit

Verrill on

For the past few years, we have encouraged plan sponsors to focus on matters of fiduciary governance for their health and welfare benefit plans (see our 2021 blog post). Yet many plan sponsors overlook the fact that the...more

Dickinson Wright

Why Establish a Fiduciary Committee for Welfare Benefit Plans?

Dickinson Wright on

Many plan sponsors have read about the lawsuit filed against Johnson & Johnson alleging that it breached its fiduciary duties with regard to the prescription drug component of its group health plan, causing participants to...more

DRI

What Is the Future of Monetary Relief under ERISA, Section 502(a)(3)?

DRI on

The Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, regulates virtually every private employee benefit program in the United States. Among other things, ERISA contains its own civil enforcement section,...more

Jones Day

Fiduciaries Beware: Employer Health Plan Under Fire for Alleged Prescription Drug Mismanagement

Jones Day on

An employer health plan is the latest target of class action litigation seeking redress for the alleged conduct of the plan's pharmacy benefit manager ("PBM")....more

Polsinelli

Department of Labor Settles with TPA to End Cross-Plan Offsetting Practice

Polsinelli on

The U.S. Department of Labor (“DOL”) recently entered into a settlement agreement with a New York-based insurer and third-party administrator (“Company”) of employer group health plans governed by the Employee Retirement...more

McDermott Will & Emery

Special Report - Funding Employer-Sponsored Group Health Coverage: The Group Captive Solution - November 2023

McDermott Will & Emery on

Employer-sponsored health insurance covers almost 159 million non-elderly US workers and their dependents, and employees and jobseekers alike view group health coverage as the single most important non-cash job-related...more

McDermott Will & Emery

Takeaways from a Recent COBRA Notice Class Action Settlement

Recent years have seen a barrage of class action lawsuits alleging that group health plan continuation coverage election notices, required under the Consolidated Omnibus Budget Reconciliation Act (COBRA), are deficient in one...more

Seyfarth Shaw LLP

Who Do I Need to Sue to Get a Decent Cup of Coffee? Jittery Fiduciaries Consider Options as Health Plan Litigation Froths Up

Seyfarth Shaw LLP on

Seyfarth Synopsis: In light of a recent focus on price transparency, claims data, and hidden fees in the health plan world, employer-sponsored health plans have been bringing their fight to the courtroom in an effort to lower...more

Jackson Lewis P.C.

Ads Related to Health Plan Fees Raise Questions on the Next Excessive Fee Suit Targets

Jackson Lewis P.C. on

Is a new wave of ERISA fiduciary litigation targeting group health plan sponsors on the horizon? There have already been a few examples of health plan fee cases, such as claims challenging the billing practice between...more

Dickinson Wright

Avoiding the Storm of Excessive Fee Litigation: How Fiduciaries of ERISA Health Plans Can Get Ahead of the Weather

Dickinson Wright on

For some group health plan fiduciaries, there could be a storm brewing. Changes to the Employee Retirement Income Security Act of 1974 (“ERISA”), buried within the 5,593 pages of the Consolidated Appropriations Act, 2021...more

Verrill

Reasonable Compensation Under ERISA: Thoughts on Two Recent Cases

Verrill on

Two recent court decisions bring into focus two seldom-asked questions about the reasonable compensation requirement under ERISA. When must an ERISA plan’s service provider compensation be reasonable?...more

Husch Blackwell LLP

New York District Court: The Choice of Medical Necessity Criteria is a Fiduciary Act

Husch Blackwell LLP on

We continue to see an increase in fiduciary litigation involving employer-sponsored group health plans, particularly litigation involving mental health. A recent New York Federal District Court case, Collins et al. v....more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - February 2022

The February Monthly Minute examines the DOL’s recent focus on mental health parity compliance, the Hughes vs. Northwestern University retirement plan fee litigation, and the latest COVID-19 testing coverage guidance....more

Foley & Lardner LLP

CAA Requires Employers to Request and Review Fee Information from Certain Group Health Plan Service Providers

Foley & Lardner LLP on

The Consolidated Appropriations Act, 2021 (CAA) generally requires group health plan sponsors to request and review fee information from their plan service providers who provide brokerage services or consulting. This fee...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor: District Court Holds that Plan Administrator Was ERISA Fiduciary

In Technibilt Grp. Ins. Plan & Technibilt, Ltd v. Blue Cross & Blue Shield of North Carolina (W.D. N.C., Feb. 3, 2020), a North Carolina district court held that a plan administrator was an ERISA fiduciary for the purpose of...more

Perkins Coie

COVID-19: Employee Health Plan Administration Considerations

Perkins Coie on

As federal and state governments respond to COVID-19, employers and plan fiduciaries must also address the evolving issues arising under employer-sponsored health plans. The specific considerations covered in this update are...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #5 – Establishing (and Following) a Good Claims Process

This week we discuss the importance of establishing good claims procedures and the benefits of following those procedures. A plan’s claims procedures should be spelled out clearly in both the plan document and the summary...more

McDermott Will & Emery

Class Certification Denied in ERISA Health Coverage Lawsuit

McDermott Will & Emery on

A federal district court denied class certification to health plan participants who claimed the plan promised them lifetime benefits. The court found too many individualized questions about what the plan told each...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #4 – Know (and Understand) the Law: Full and Fair Review

This week in our blog series on best practices in administering benefit claims, we discuss the importance of knowing and, importantly, understanding the laws governing benefit claim administration. Section 503 of ERISA...more

ArentFox Schiff

Buyer Beware: Health Plans Need to Exercise Caution in Retaining Third-Party Administrators and Medical Claim Reviewers

ArentFox Schiff on

A federal court in Nebraska recently rejected a health plan’s fiduciary breach claims under the Employee Retirement Income Security Act of 1974 (ERISA) against third-party service providers, holding that the service providers...more

Proskauer Rose LLP

ERISA Newsletter - Third Quarter 2019

Proskauer Rose LLP on

In this edition of our Newsletter, we take a look at a pair of cases that, while unrelated, together remind us of the importance of having clear plan rules in place that reflect the plan sponsor’s intention. The first article...more

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