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

Employee Benefits Developments - October 2015

The Internal Revenue Service (IRS), consistent with prior regulations from the Department of Health and Human Resources (HHS), issued supplemental proposed regulations requiring employer sponsored health plans to provide...more

Second Circuit Finds Member Associations Have Standing to Bring Claims on Behalf of Members

Last month the Second Circuit Court of Appeals reversed the U.S. District Court’s decision to deny the New York State Psychiatric Association (NYSPA) standing in its claim against UnitedHealth Group and related entities...more

Navigating Legal Issues in Connection with Employer Sponsored On-Site Health Clinics

Employers are increasingly concerned with the high cost of health care and executives in the C-Suite are beginning to take notice. The Affordable Care Act (‘‘ACA’’) required employers who sponsor group health plans to adopt a...more

Employee Benefits Developments - September 2015

IRS Issues New Draft Form 1095-C and Instructions. On August 6, 2015, the IRS published its most recent updates to Form 1095-C and the instructions for Forms 1094-C and 1095-C. Beginning in early 2016, applicable large...more

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

Manatt on 1332: Hawaii Posts Nation's First State Innovation Waiver Proposal

Overview - On September 9 Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's waiver proposal is focused on the state's unique 40-year-old employer mandate, the 40-page...more

How Are Your Assignment of Benefits Clauses Drafted? Recent Third Circuit Decision Highlights the Importance of Review of Provider...

Healthcare providers virtually always rely upon assignment of benefits agreements executed by patients as a basis for reimbursement from health insurers. When those insurers fail to reimburse the provider altogether, or fail...more

Court of Appeals to Plan Administrators: Inform Claimants of Time Limits on Front End of Discussions

Recently, in Mirza v. Insurance Administrator of Am., Inc., __ F.3d__ (3d. Cir. 2015), the United States Court of Appeals for the Third Circuit was asked to determine whether plan administrators are required to include a...more

Employee Benefits Alert - August 2015

Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

Employee Benefits Developments August 2015

Certain Closely Held For-Profit Employers Need Not Provide Women’s Contraceptive Services. Under the ACA, non-grandfathered group health plans must cover specified preventive services, including certain women’s preventive...more

Texas Hospital Strikes Back at Aetna

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more

Limiting an Employee’s Hours to Avoid Offering Group Health Plan Coverage Under the Affordable Care Act: Evaluating the Risks...

Business leaders and human resources and employee benefits professionals are well aware of potential minefields for employer group health plan sponsors under the Affordable Care Act (ACA). Large employer plan sponsors are...more

Employee Benefits Alert - July 2015

Major Revisions to Qualified Plan Determination Letter Process Announced - Effective January 1, 2017, the staggered five-year determination letter remedial amendment cycles for individually designed plans will be...more

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

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