Insights

On September 6, 2024, the DOL issued Compliance Assistance Release No. 2024-01, which provides updated cybersecurity guidance for employee benefit plans. The DOL also clarified that the cybersecurity guidance applies to all employee benefit plans, including retirement plans and health and welfare plans. In recent years, the DOL has increasingly focused on cybersecurity measures for ERISA plans. Release No. 2024-01 enhances the DOL’s 2021 cybersecurity guidance and is intended to help plan spons

On August 19, 2024, the United States Court of Appeals for the Sixth Circuit (Sixth Circuit) held that the federal common law prevented the named beneficiary of ERISA group life insurance from benefiting from his murder of the insured and a co-beneficiary. In November of 2016, Joel M. Guy, Jr. murdered his mother, the named insured of an employer-sponsored group life plan which named Guy as one of the two beneficiaries, and his father, the other named beneficiary, in their Knoxville, Tennessee,

The SFHCSO requires covered employers (generally, employers with 20 or more employees, at least one of whom works in San Francisco) to spend a minimum amount on healthcare for their San Francisco employees. The healthcare expenditure rate varies depending on the size of the employer. As of January 1, 2025, the healthcare expenditure rate for large employers with 100 or more employees increases to $3.85 per hour payable (up from $3.51 per hour in 2024). For medium-size employers with 20 to 99 em

On August 30, 2024, the New York Department of Financial Services (NY DFS) announced its decision concerning the applicable premium rate and maximum employee contribution for New York Paid Family Leave (NY PFL) coverage beginning January 1, 2025. NY PFL applies to all private employers, including out-of-state employers, with at least one employee working in New York. The state’s PFL program provides eligible employees with a portion of their wages while taking time off to bond with a child, car

Recently, the Colorado Paid Family and Medical Leave (FAMLI) division director has announced that there will be no change to the rate for premiums for 2025. The 2025 rate will remain at the current rate of 0.9% of wages, with 0.45% paid by the employer and 0.45% paid by the employee, though employers may choose to pay the full 0.9% as an added benefit for their employees. While access to FAMLI leave benefits began on January 1, 2024, for eligible Colorado employees, premium payments have been r

There are a few different notice requirements in play when an employer makes a midyear change to benefits. First, ERISA includes a summary of material modification (SMM) requirement. The SMM requirement pertains to material changes in a group health plan. ERISA does not define “material,” but this term would generally refer to any information or changes that impact the rights or obligations of plan participants and beneficiaries. Such changes may include, but are not limited to, changes in plan

HHS recently announced inflation-adjusted penalty amounts related to violations of Summary of Benefits and Coverage (SBC), Medicare Secondary Payer (MSP), and HIPAA privacy and security rule requirements. These new penalty amounts are calculated based on a cost-of-living increase of 1.03241% and are applied to penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015. Summary of Benefits and Coverage (SBC) The ACA requires insurers and group health pla

On August 5, 2024, the Seventh Circuit Court of Appeals (Seventh Circuit) affirmed the district court’s ruling in favor of insurer Group Health Cooperative (the defendant) when they denied claims for therapy treatment brought by parents on behalf of their autistic child (plaintiffs) based upon then-current medical literature. The plaintiffs asked the defendant health insurer to pay for certain treatments for their autistic child that occurred between 2017 and 2019. The defendant refused to pay

On August 20, 2024, representatives Robert Scott and Mark DeSaulnier, ranking members, respectively, of the House Committee on Education and the Workforce and the Subcommittee on Health, Education, Labor, and Pensions, sent a letter to the DOL’s Employee Benefits Security Administration (EBSA) assistant secretary Lisa Gomez asking for increased oversight on group health plan service providers. In part, the letter stems from a springtime New York Times (NYT) investigation into a data analytics c