Insights

Recently, the New Hampshire Insurance Department Commissioner issued Bulletin Docket No INS 24-001-AB to all health insurers. The bulletin confirms that the ACA and NH law require blood lead level testing for one- and two-year-old patients without cost-sharing.  Employers with insured coverage in New Hampshire should be aware of this required coverage.  Bulletin Docket No INS 24-001-AB 

No. Both fully insured and self-insured plans must determine the applicable premium for each 12-month COBRA determination period before the beginning of the period and cannot increase the applicable premium during the determination period. In other words, plan sponsors that experience rate changes during a 12-month determination period (e.g., if the policy year and determination period start and end at different times) generally will not be able to pass along rate increases to COBRA participant

Lenders can seize opportunity by incorporating sound home equity protection policies to lessen the negative impact of loan defaults, while continuing to develop growth strategies that generate additional revenue.

On June 13, 2024, the Supreme Court of the United States held in Food and Drug Administration v. Alliance for Hippocratic Medicine that a consortium of doctors and medical organizations opposed to abortion did not have legal standing to challenge the FDA’s actions regarding mifepristone. Mifepristone is an oral abortifacient available to patients in both brand name form (Mifeprex), which the FDA approved in 2000, and generic form, which the FDA approved in 2019. In 2016, the FDA relaxed its ori

On May 31, 2024, in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, the Ninth Circuit Court of Appeals (Ninth Circuit) held that ERISA preempts state law claims challenging the denial of out-of-network provider reimbursements by group health plans. The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of Cigna, the TPA for the ERISA plans, in the action brought by a drug treatment center’s successor-in-interest, Bristol SL Holdings, Inc. (Brist

On June 11, 2024, the DOL announced a recent settlement with Unum Life Insurance Company of America (Unum) following an investigation into the carrier’s group supplemental life insurance claims practices. The DOL investigation found that Unum routinely accepted premiums (via employer payroll deductions) for many years without verifying if participants satisfied an evidence of insurability (EOI) standard. Then, when a plan participant died, Unum would deny the death benefit, claiming it never re

On June 6, 2024, in N.C., individually and on behalf of minor A.C., v. Premera Blue Cross (Premera), the Ninth Circuit Court of Appeals (Ninth Circuit) affirmed the district court’s grant of summary judgment in favor of plaintiff-appellee N.C. regarding their ERISA claim for recovery of residential treatment benefits. Premera (the defendant) challenged the district court’s conclusion on de novo review that A.C.’s 14-month residential treatment at Change Academy was medically necessary under the

The ACA’s employer mandate does not have special rules for interns. The same rules covering other employees will apply here too. However, there is a window within which an employer is not penalized if it doesn’t offer coverage to an employee who works less than three months, and seasonal employees (who meet the definition under the rules) may be exceptions too. Generally, an employee who is hired to work 30 or more hours per week is considered full-time and therefore must be offered coverage un

Effective June 6, 2024, Article 4C of Chapter 16 of the West Virginia Code was amended to provide that an emergency medical services agency (e.g., a ground ambulance) may triage and transport a patient to an alternative treatment destination or treat in place if the agency is coordinating the care of the patient through medical command or telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. The bill requires