Compliance Corner Archives

A recently filed putative class action lawsuit, Barbich et al v. Northwestern University et al, raises concerns that a new wave of ERISA fiduciary breach claims may be on the horizon. In Barbich, the plaintiffs allege that Northwestern University, as the group health plan sponsor, breached its fiduciary duties by failing to prudently select and monitor their medical plan options and by not disclosing material plan information to participants. The case, which was filed in the federal district co

On August 26, 2025, the Fifth Circuit Court of Appeals remanded Braidwood Management Inc. v. Becerra, Inc. back to the district court for further proceedings. The Fifth Circuit made this move in response to the recent Supreme Court ruling in this case. Background The Braidwood case concerns the ACA’s preventive care mandate. Under the ACA, insurers and group health plans offering non-grandfathered individual or group health coverage must cover certain preventive services without cost-sharing. T

On August 12, 2025, in Erban v. Tufts Medical Center Physicians Organization, et al., a Massachusetts district court found that the fiduciaries of an ERISA group life insurance plan breached their fiduciary duties to provide accurate and complete information to a terminally ill participant and his spouse regarding coverage continuation options. The ruling provides helpful insights for ERISA plan fiduciaries regarding their disclosure obligations to participants and beneficiaries, particularly t

On August 13, 2025, the District Court of the Eastern District of Pennsylvania vacated federal rules that provided exemptions for contraceptive coverage requirements imposed by the ACA. The court determined that those rules violated the federal Administrative Procedure Act (APA). Background The ACA requires health insurance plans to cover women’s preventive services, including contraceptive services. However, due to rulemaking and several court cases, exemptions were allowed for religious organ

On July 28, 2025, in Express Scripts, Inc. et al v. Richmond et al, the United States District Court for the Eastern District of Arkansas granted the plaintiffs’ motion for a preliminary injunction to prevent enforcement of Arkansas Act 624, which restricts pharmacy benefit managers (PBMs) from owning and operating pharmacies in the state. The court agreed with the plaintiffs, several PBMs and an industry trade group, that Act 624 likely violates the Commerce Clause of the U.S. Constitution and

On August 6, 2025, the IRS issued a reminder that principal and interest charges on employees’ qualified education loans are eligible expenses under educational assistance programs. Employers can either reimburse the employee or pay the lender directly for qualified education loan expenses up to the $5,250 annual limit. Note that other eligible expenses include items such as current tuition, fees, books, and supplies. To qualify as a Section 127 educational assistance program, the employer plan

On August 4, 2025, the Ninth Circuit Court of Appeals held that an employer cannot unilaterally impose arbitration provisions on plan participants through plan amendments. Specifically, the court held that employers cannot bind participants to arbitrate ERISA claims without their express consent and that the plaintiff in the case had not agreed to arbitrate ERISA claims as required under the Federal Arbitration Act (FAA). Background The plaintiff in the case, Robert Platt, brought an ERISA clas

On July 18, 2025, the IRS published Revenue Procedure 2025-25, which announces the ACA affordability percentage (termed the required contribution percentage) for medical plan years beginning in 2026. Under the ACA employer-shared responsibility rules (also known as the employer mandate), an applicable large employer (ALE) must provide affordable, minimum-value coverage to its full-time employees or risk being subject to penalties (An ALE is an employer that employed at least 50 full-time employ

On July 22, 2025, the IRS released Revenue Procedure 2025-26, which in part provides indexing adjustments for penalties under the ACA employer mandate. The ACA requires applicable large employers (ALEs), those with 50 or more full-time employees and full-time equivalent employees, to offer affordable minimum value (MV) coverage to all full-time employees and their dependents or risk a penalty. Notably, the employer mandate penalty amounts for 2026 are increased from the 2025 penalty amounts. Fo

On June 20, 2025, CMS issued the “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability Final Rule.” The rule makes several changes to annual cost-sharing limits and the definition of essential health benefits. The rule updates the methodology for calculating the “premium adjustment percentage,” which results in a revision of the previously announced maximum annual limit on cost-sharing for 2026 (which we originally reported on in an article in the October 22, 2024

On June 16, 2025, in J.H. et al v. United Behavioral Health et al, the United States District Court for Utah ruled that the defendant insurer’s decision to deny residential treatment benefits for an ERISA plan participant was arbitrary and capricious. The court granted summary judgment to the plaintiffs and remanded the case back to the insurer for reconsideration of the denied claims. Background In this case, the plaintiffs are parents of a daughter who was treated in a residential treatment f

On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. While the final bill omitted several of the benefit provisions included in the initial House legislation, it includes some noteworthy changes for employers as group health and welfare plan sponsors. (We previously provided our initial insights on the OBBBA in an article on July 8, 2025, which is included here with some additional commentary.) Extended Telehealth Provisions Relating to HSA Eligibility First,