News & Analysis as of

Third Party Administrators

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Yes, I support TPAs

When I was at law school, I was the editor-in-chief of the law school’s newsmagazine. My rise to the top probably had a lot to do with the free time I had by not making law review or any other of the law journals. I failed to...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Advisors should play nicely with other providers

What makes a good retirement plan financial advisor? Well, it takes attention to detail, an understanding of what the role to entails, and dedication to the client. In addition, what I find is the way a good financial advisor...more

Bricker Graydon LLP

The Health Plan Fiduciary Maze: New Lawsuit Highlights Need to Navigate Carefully in the Era of Transparency

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Earlier this month, a Mayo Clinic employee filed a proposed class action against the clinic, arguing that the clinic’s employee health plan and its third-party administrator (TPA) Medica, underpaid for services performed by...more

Husch Blackwell LLP

Mental Health Parity and Addiction Equity Act: Comprehensive Final Rule Expected in 2024

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In the United States, mental health (“MH”) and substance use disorder (“SUD”) (collectively “MH/SUD”) have continued to represent areas of intense concern. During the COVID-19 pandemic, the MH struggles of essential workers...more

Polsinelli

Recent Regulatory Actions Against TPAs in South Dakota

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The South Dakota Division of Insurance (“Division”) recently took regulatory action against a Texas-based Third Party Administrator (“TPA”) regarding its activities in South Dakota. According to the Division, the TPA...more

Polsinelli

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

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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

Hall Benefits Law

The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors

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Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more

Polsinelli

Department of Labor Sues UnitedHealth TPA Over Claim Denials

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The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more

Polsinelli

Louisiana Insurance Department Fines Express Scripts and Medimpact for Delayed Pharmacy Payments

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The Louisiana Insurance Department (“Department”) recently fined Express Scripts Administrators, LLC (“ESA”) $275,000 and MedImpact Healthcare Systems, Inc. (“MedImpact”) $250,000 for allegedly failing to pay electronically...more

Stevens & Lee

Gag Clause Prohibitions in ERISA, the Internal Revenue Code and the Public Health Service Act

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If you work for or represent group health plans or issuers of group health plans, it is important that you take a look at the contracts they have with health care providers before the end of 2023. The Internal Revenue Code...more

Akerman LLP - Health Law Rx

ACTION REQUIRED TO AVOID FINES! DEADLINE APPROACHING: Florida Pharmacy Benefit Managers Must Be Licensed as a Third-Party...

Pharmacy Benefit Managers (PBMs) take note! Under Florida’s new Prescription Drug Reform Act, PBMs must be licensed as an insurance administrator (also known as a third-party administrator, or TPA). Under this new law, any...more

WilmerHale

The Interplay: Key Decisions at the Intersection of Antitrust & Life Sciences - October 2023

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This marks the second issue of WilmerHale’s The Interplay: Key Decisions at the Intersection of Antitrust & Life Sciences, a monthly bulletin that will highlight developments in the antitrust and life sciences space. We will...more

Stikeman Elliott LLP

New GST/HST Notice on Services Provided by Insurance Intermediaries

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In July 2023, the Canada Revenue Agency (“CRA”) released GST/HST Notice 325 (the “Notice”) with respect to services provided by certain insurance intermediaries. The Notice essentially makes official the 180-degree turn the...more

Jackson Lewis P.C.

A Current Roadmap for Complying with Mental Health Parity Requirement

Jackson Lewis P.C. on

Most employers know that if a group health plan provides mental health or substance use disorder (MH/SUD) benefits in any of six specified classifications, the plan must provide MH/SUD benefits in all specified...more

Polsinelli

Louisiana Insurance Department Catastrophe Response Plans

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The Louisiana Insurance Department (“Department”) recently sent e-mail notifications to numerous third party administrators (“TPA”) regarding the failure to file their Catastrophe Response Plans with the Department by June 1,...more

Seyfarth Shaw LLP

Mental Health Parody: In A Cruel Prank, Agencies Respond to Employer Pleas for Guidance with More Stringent Regulations

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans and insurers to cover treatments for mental health and substance use disorders in a manner that is equitable to the...more

Polsinelli

Third Party Administrator & Pharmacy Benefit Manager 2023 Newsletter: TPA & PBM Licensing And Compliance Developments

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Florida OIR Issues Informational Memorandum OIR-23-04M to PBMs - On July 19, 2023, the Florida Office of Insurance Regulation (“OIR”) issued Informational Memorandum OIR-23-04M (“Memorandum”) to Pharmacy Benefit Managers...more

Warner Norcross + Judd

Preparing for Health Plan Anti-Gag Clause Attestation

Although the end of the year seems far away, employers should start preparing for the anti-gag clause attestations for their group health plans that are due December 31. Namely, employers need to determine who is completing...more

Warner Norcross + Judd

Mental Health Parity Guidance is Coming

Warner Norcross + Judd on

NOTE: As we were preparing to publish this eAlert, the DOL issued proposed mental health parity regulations. We will provide an update on the proposed regulations in a future eAlert. Nonetheless, group health plans must still...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

You need the right partner

Whether it’s a partner in your business or a business partnership with another plan provider, it needs to be the right fit. I worked for two third-party administrators (TPAs) where partnership mismatches helped doom them....more

Polsinelli

Third Party Administrator and Pharmacy Benefit Manager Licensing and Compliance Developments

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South Dakota - The South Dakota Division of Insurance (“Division”) recently took regulatory action against a TPA that has held a valid TPA registration in South Dakota since 2006.  In 2021, the TPA submitted its TPA...more

Akerman LLP - Health Law Rx

New Florida Law Will Impose A Third-Party Administrator Licensing Requirement for Pharmacy Benefit Managers

On May 3, 2023, the Florida governor signed a comprehensive law (SB 1550) regarding pharmacy benefit managers (PBMs). This new law imposes significant new requirements on PBMs. This article discusses only one of these new...more

Genova Burns LLC

NJ Appellate Division Rules No Age or Disability Bias in Termination of 60-Year-Old Employee

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On March 29, 2023, the New Jersey Appellate Division affirmed an employer’s win after a former employee claimed he was fired on the basis of his age and disability. In Estate of Zoto v. Cellco Partnership d/b/a Verizon...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Trust is the underpinning behind any plan provider relationship

When working with other plan providers, trust is the biggest underpinning. Without it, you have nothing else. If you can’t trust the plan provider you’re working with, then why are you in business with them?...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

The problem of free or cheap plan documents

As an ERISA attorney who drafts plan documents at a flat fee, my biggest competitors are not other ERISA attorneys, but third-party administration (TPA) firms. ...more

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