Insights

On May 3, 2023, Gov. Moore signed HB 1217/SB 805 into law. The law requires health insurers in Maryland to cover biomarker testing when supported by medical and scientific evidence. Cost-sharing for biomarker testing may not be greater than cost-sharing for similar covered services. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further informati

On May 3, 2023, Gov. Moore signed HB 376/SB 184 into law. The law prohibits health insurers in Maryland from imposing cost-sharing on coverage for diagnostic breast examinations and supplemental breast examinations, with the exception of required cost-sharing under a qualified HDHP prior to meeting the deductible. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact thei

On May 3, 2023, Gov. Moore signed HB 815/SB 965 into law. The law requires health insurers in Maryland to cover follow-up diagnostic lung cancer screenings without cost-sharing, with the exception of required cost-sharing under a qualified HDHP prior to meeting the deductible. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information. H

Recently, Gov. Huckabee Sanders signed several healthcare bills into law. Act 333 (previously HB 1481) requires that prescription drug rebates be shared with enrollees. Specifically, under Act 333, an enrollee's cost-sharing for a prescription drug at the point of sale must be based on a price that is reduced by all rebates received, or to be received, in connection with the dispensing or administration of the drug. Act 333 is directed at both insurers and pharmacy benefit managers and requires

On May 3, 2023, Gov. Moore signed HB 785/SB 515 into law, addressing protocols imposed by health insurers that require an insured to use a certain prescription drug or sequence of prescription drugs before covering a prescription drug ordered by a provider (known as "step therapy" or "fail-first" protocols). Specifically, the law requires health insurers in Maryland to establish a process for insureds to request an exception to a step therapy or fail-first protocol, with deference to the presc

On May 10, 2023, in Su v. Sherrod, the Seventh Circuit affirmed the district court's grant of summary judgment to the DOL in a case involving breaches of ERISA duties of loyalty and prudence. The rulings follow a civil enforcement action brought against Dr. Shirley Sherrod and Leroy Johnson, the trustee and plan administrator, respectively, of a defined benefit retirement plan established in 1987 for employees of Sherrod's ophthalmology practice. The case involved the plan's trust account, whic

On May 15, 2023, in D.K., et al. v. United Behavioral Health, et al., the United States Court of Appeals for the Tenth Circuit (the Tenth Circuit) found that ERISA health claims administrators must engage with treating physician opinions when reviewing claims on appeal and explain their reasoning in denial letters. While deference to a claimant's treating physician is not required, the Tenth Circuit confirmed such evidence could not be completely ignored. The court's opinion is grounded in ERIS

On May 10, 2023, the Department of Commerce and Insurance issued Bulletin 2023-03 to remind Tennesseans of the potential effect of the state’s cost-sharing requirements on HSA eligibility.   Tennessee requires insurers to apply all cost-sharing amounts toward the enrollee’s contribution to any applicable cost-sharing requirements regardless of whether they are paid by an enrollee or on behalf of the enrollee by another person. The bulletin summarizes IRS guidance which provides that an HDH

FSAs and HSAs come with a myriad of compliance rules. In this webinar, the Benefits Compliance team provided a review of the basic rules and nuanced issues surrounding these reimbursement arrangements. Agenda Health Flexible Spending Account (FSA) and Health Savings Account (HSA): Overview Eligibility Contributions Distributions FAQs and Compliance Nuances (throughout) Final Takeaways Key Takeaways FSA Compliance Takeaways FSAs can provide significant tax savings to employees and employers.