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Insurance Industry Health Insurance

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

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In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Bressler, Amery & Ross, P.C.

The New York Department of Financial Services (DFS) considers Regulations to Promote Health Equity

DFS has developed a draft pre-proposal notice regarding proposed amendments to 11 NYCRR 52 (Insurance Regulation 62) which, if adopted, would amend the minimum standards for form, content, and sale of health insurance in New...more

McGlinchey Stafford

Podcast: Reflections on Insurance Regulation: A Conversation with McGlinchey’s Newest Member, Former Commissioner Donelon, Part 1...

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In this installment of the More with McGlinchey Podcast, Insurance Regulatory Member Lauren Ybarra interviews Member and Former Louisiana Insurance Commissioner Jim Donelon. They reflect on Jim’s tenure as Louisiana’s...more

Mandelbaum Barrett PC

HMO Assessment Rate Increased: What You Need to Know

Mandelbaum Barrett PC on

Effective June 28, 2024, a significant change has been enacted through L. 2024, A4705 (c. 21), which increases the annual assessment rate for Health Maintenance Organizations (HMOs). This new legislation raises the HMO...more

Bressler, Amery & Ross, P.C.

New Jersey Extends the Enrollment Period for "Get Covered NJ" to October 31, 2024

With issuance of Bulletin No. 24-12, the New Jersey Department of Banking & Insurance has extended the time for enrollment in the state insurance exchange, “Get Covered New Jersey” through October 31, 2024. This extension...more

Hall Benefits Law

9th Circuit Explains ERISA Preemption of State Law Claims Arising from Preservice Coverage Communications

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The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more

McDermott Will & Emery

Six Wishes for the Forthcoming Final Regulations Under MHPAEA

McDermott Will & Emery on

On July 1, 2024, the US Department of Labor (DOL) submitted final regulations to the Congressional Budget Office (CBO), implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) as most recently amended by the...more

McDermott+

Regs, Regs and More Regs: The Biden Administration Releases Spring 2024 Unified Agenda

McDermott+ on

We are in the midst of a storm of regulations that are being released by the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services (HHS), including the Calendar Year (CY) 2025...more

Hall Benefits Law

HHS Issues Proposed Rule on Nondiscrimination in Health Programs and Activities

Hall Benefits Law on

The U.S. Department of Health and Human Services (HHS) has issued a proposed rule entitled “Nondiscrimination in Health Programs and Activities.” The proposed rule, designed to advance health equity and protect people from...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

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

Hall Benefits Law on

A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

Groom Law Group, Chartered

Tri-Agencies Finalize Rule on STLDI, but Kick the Can Down the Road on Fixed Indemnity and the Health Plan Tax Exclusion

On March 28, 2024, the Departments of Labor, Treasury, and Health and Human Services (the “Tri-Agencies”) issued final regulations on short-term, limited-duration insurance (“STLDI”), hospital and other fixed indemnity...more

Eversheds Sutherland (US) LLP

AI Litigation Insights - Jeremy Jong, individually and on behalf of similarly situated individuals v. Blue Shield of California

Plaintiff Jeremy Jong filed a putative class-action complaint against Blue Shield of California (Blue Shield), one of the largest medical insurance companies in the United States....more

Locke Lord LLP

Colorado Division of Insurance Holds Second Health Insurance Stakeholder Meeting for ‎Implementing AI Requirements

Locke Lord LLP on

On Tuesday, April 2, 2024, the Colorado Division of Insurance (“Division”) held its second Unfair Discrimination in Insurance Practices – Health Insurance Stakeholder meeting where the Division discussed efforts to develop...more

Sheppard Mullin Richter & Hampton LLP

Closing the Loopholes: The Biden-Harris Administration’s Action Against “Junk Insurance”

On March 28, 2024, the Biden-Harris Administration released final rules intended to lower health care costs and protect consumers from being induced into purchasing so-called “junk insurance” policies (the “Final Rules”)....more

Sheppard Mullin Richter & Hampton LLP

OIG Sparks Public Excitement about Managed Care and Alludes to Incoming Enforcement Guidance

“The American people deserve to know that the insurance companies receiving more than $700B annually in taxpayer funds are working to ensure you receive effective, high-quality care. Remember, you have rights and options to...more

Bressler, Amery & Ross, P.C.

New York Department of Financial Services Provides Guidance in the Face of the Change Healthcare Cyber Incident

On February 21, 2024, Change Healthcare, a platform that provides certain technology solutions for the health care industry, experienced a nationwide network interruption related to a cybersecurity issue (cyber incident) and...more

Arnall Golden Gregory LLP

OIG Approves Arrangement Incentivizing Medigap Policyholders to Seek Treatment From PHO Network Hospitals

The Department of Health and Human Services, Office of Inspector General (“OIG”) recently released a favorable advisory opinion, OIG Advisory Opinion No. 24-01 (the “Opinion”), to a Medicare Supplemental Health Insurance...more

Mintz - Health Care Viewpoints

New Mexico’s Health Care Consolidation Oversight Act: An Overview

On March 1, 2024, New Mexico joined a growing number of states in enacting legislation that increases oversight of certain health care transactions. Senate Bill 15 (S.B. 15), which adds a new section to the New Mexico...more

Epstein Becker & Green

Fifth Circuit Poised to Uphold Ruling Striking Down Preventive Coverage Requirement

A federal appeals court panel in New Orleans is poised to uphold a lower court ruling enjoining the enforcement of the Affordable Care Act's (ACA) requirement that most private health insurance cover recommendations of the...more

ArentFox Schiff

NYS Insurance Regulators to Health Insurers: Ensure Your Networks Are Adequate

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On February 21, Superintendent Adrienne A. Harris of the New York State Department of Financial Services (DFS) unveiled a proposed regulation, 11 NYCRR 38. If adopted, this regulation, would establish network adequacy...more

McDermott Will & Emery

Gender-Affirming Benefits: Best Practices for Group Health Plans

McDermott Will & Emery on

Federal legislative and regulatory activity related to employer-sponsored group health plans shows no signs of slowing, particularly with the issuance of interpretive guidance regarding the transparency and surprise-billing...more

McDermott Will & Emery

[Webinar] Gender-Affirming Benefits: Best Practices for Group Health Plans - February 29th, 1:00 pm - 1:30 pm EST

McDermott Will & Emery on

Employers and plan sponsors are facing growing – and often conflicting – pressures related to the coverage of gender-affirming care. Join McDermott lawyers Sarah G. Raaii and Alden J. Bianchi for a webinar to review recent...more

Verrill

ACA Compliance When Employees Move from Full-Time to Part-Time Mid-Year

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We are well into the Affordable Care Act (“ACA”) information reporting season. Forms 1095-B/1095-C must be provided to employees by March 1, 2024, and the deadline for electronic transmittal of Forms 1094-B/1094-C to the IRS...more

Carlton Fields

Lawsuits Alleging Violations of Illinois’ GIPA Are Piling Into Court Like Clowns Out of a Circus Car

Carlton Fields on

A string of putative class actions has been filed against life insurance companies for allegedly violating section 20(b) of Illinois’ Genetic Information Privacy Act (GIPA) by using applicants’ family medical history in...more

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