Employee Retirement Income Security Act Healthcare

Employee Retirement Income Security Act is a United States federal law enacted in 1974 to set minimum standards for pension and health plans in the private sector and to protect participants in those plans.... more +
Employee Retirement Income Security Act is a United States federal law enacted in 1974 to set minimum standards for pension and health plans in the private sector and to protect participants in those plans.  ERISA requires plans to provide information to participants, establishes a grievance process,  and allows participants to sue for benefits or breach of fiduciary duties.  less -
News & Analysis as of

Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company

The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage...more

Changes to the Terms of BCBSM’s Administrative Services Contracts in the Wake of Hidden Fees Suits

Effective January 1, 2016, Blue Cross Blue Shield of Michigan ("BCBSM") will implement significant changes to the Administrative Services Contracts ("ASCs") issued to its self-funded customers. Notably, BCBSM has attempted to...more

ERISA’s Exhausting and Exasperating Exhaustion Requirement and the Exceptions Medical Providers Seeking Full Reimbursement From...

The first Alert in this two-part series discussed three common issues facing out-of-network medical providers in asserting reimbursement claims against employee benefits plan administrators (whether an insurance company or...more

A Review of the Supreme Court’s 2014 - 2015 Term

During the United States Supreme Court’s 2014-2015 term, the Court departed from the pro-business reputation it had developed in labor and employment cases. This term, employees prevailed more often than not, including in...more

Expect Focus - ONLINE HEALTH CARE: NOT SO FAST Telemedicine Hits A Few Speed Bumps, Volume II, Spring 2015

In This Issue: - IN THE SPOTLIGHT • Risky Business: Common Cyber Security Risks, Expensive Consequences - LIFE INSURANCE • Ninth Circuit Finds Bonus Indexed Annuity Delivers Exactly...more

The skinny on narrow networks

The insurance exchanges created under Affordable Care Act have facilitated increased competition. Old version managed care models implemented cost-savings measures like pre-authorizations for medical care, hospital length of...more

May Companies Reduce Employee Hours to Avoid ACA Requirements?

The Affordable Care Act (the “ACA”) generally requires that large employers offer health coverage that meets certain requirements to their full-time employees (i.e., employees working 30 hours or more per week) and their...more

Appropriations Subcommittee Rejects Efforts to Strip Funding Bill of Pro-Employer Riders

The day after the House Appropriations Committee released a draft bill that would significantly limit certain federal agency rules and initiatives, the Subcommittee on Labor, Health and Human Services, and Education held a...more

Out-of-Network, Out of Luck? A Growing Body of Caselaw Addressing Claims by Out-of-Network Providers Seeking Full Reimbursement...

It’s become a common scenario for medical providers: a provider treats a patient covered by employer-provided health insurance for which the provider is out-of-network, receives an assignment of benefits from the patient and...more

Employee Benefits Developments - April 2015

Health Insurance Company’s HIPAA Breach Affects Millions. At the end of January, a national BlueCross BlueShield affiliate, Anthem, Inc., discovered that its information technology systems were hacked. The information...more

CMS Proposes Expansion of Medicaid Mental Health Parity Requirements

The Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule, on April 10, 2015, addressing the application of the Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) to the Medicaid and CHIP...more

EEOC Proposes Wellness Program Regulations

The Equal Employment Opportunity Commission (EEOC) has proposed much-anticipated regulations regarding the use of employee health program under the Americans with Disabilities Act (ADA). The regulations are an attempt to...more

Fifth Circuit: Hospital Enjoys Standing to Seek ERISA Benefits

The Fifth Circuit ruled that an out-of-network medical provider that was assigned a patient’s rights to health insurance benefits has standing to sue a health plan that underpays its portion of the benefits due even if the...more

Employee Benefits Developments - March 2015

The Internal Revenue Service recently issued Notice 2015-16, intending to initiate and inform the process of developing regulatory guidance regarding the excise tax on high-cost employer-sponsored health coverage. The...more

Employee Benefits Developments - February 2015

ERISA § 4062(e) Liability Enforcement Returns--Applicable to Defined Benefit Plans and Succession of Operations at Facility. The Employee Retirement Income Security Act of 1974 (ERISA) § 4062(e) originally imposed liability...more

Excepted Benefits: Final regulations provide guidance on dental, vision and employee assistance plans

The Departments of Labor, the Treasury, and Health and Human Services (the “Departments”) have recently published final regulations related to when limited scope dental and vision benefits and employee assistance programs...more

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

Mental Health Parity Act: A Litigation Update

The Federal Mental Health Parity and Addiction Equity Act (the “Federal Parity Act”), like many similar state parity laws, mandates that financial requirements (e.g., copayments, coinsurance, or deductibles) and treatment...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 16: So What, Exactly, is an “Offer of Coverage”?

Whether an employer makes the requisite offer of group health plan coverage is critical to the application of the Affordable Care Act’s employer shared responsibility rules as reflected in final implementing regulations...more

Resistance WAS Futile—California Conforms to ACA Waiting Period Requirement

After wandering in the wilderness for a year, California has now come in from the cold and conformed its requirements for eligibility waiting periods to the federal standard adopted in the Affordable Care Act (ACA). Effective...more

Monthly Benefits Update - July 2014

Two federal appeals courts issued contradictory rulings on the validity of subsidies for the purchase of health insurance under the federal marketplace established pursuant to the Affordable Care Act (ACA). On July 22, a...more

ERISA (8th Circuit): Over-The-Counter Vitamin Supplements Trigger Pre-Existing Condition Exclusion

What sort of “medical treatment” triggers the pre-existing condition exclusion in an ERISA-governed disability policy?...more

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 26: Fitting a Round Peg (the Public Health Service Act 90-day...

The Departments of the Treasury/IRS, Labor and Health and Human Services (the “Departments”) recently issued a final regulation under the 90-day waiting period limitation, which is included among the Affordable Care Act’s...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

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