Insights

On May 1, 2024, the Second Circuit declared provisions of an employee stock ownership plan (the Plan) that required participants to resolve any legal claims arising out of or relating to the Plan in individualized arbitration “null and void” because they amounted to prospective waivers of participants’ substantive statutory rights and remedies under ERISA. The plaintiff, Ramon Cedeno, was an employee of Strategic Financial Solutions, LLC, and a participant in its Plan. Because the Plan had i

On May 16, 2024, Gov. Moore signed several healthcare bills into law.  HB 1339/SB 778 requires insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for hearing aids and audiological services for adults in certain situations. Currently, these plans are required to cover hearing aids for minor children. Effective January 1, 2025, these provisions will also apply to adults for whom the hearing aid is prescribed, fitted, and dispensed by a licen

On January 16, 2024, the Division of Insurance issued Bulletin 2024-02 regarding the coverage and content of mandated behavioral health wellness examination coverage.  Applicable state statutes define a "mental health wellness examination" as a "screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment.” Such screenings and assessments can include but are not limited to consultation on healthy lifestyle changes, referral

On January 16, 2024, the Division of Insurance issued Bulletin 2024-03 regarding the state’s new step therapy protocol requirements of Chapter 254 of the Acts of 2022.  Massachusetts law defines a “step therapy protocol” as “a utilization management policy or program that establishes the specific sequence in which a prescription drug for a specified medical condition is covered by a carrier.” Chapter 254 applies to carriers that provide coverage of a prescription drug pursuant to a poli

On May 21, 2024, Gov. Whitmer signed Senate Bill 27 into law. The bill mirrors the federal Mental Health Parity and Addiction Equity Act (MHPAEA), in that it requires insurers regulated by the state to cover mental health and substance use disorder (SUD) treatments in the same way as physical health coverage. The state passed this law partly as a hedge against the possibility that Congress repeals MHPAEA. The law requires insurers that deliver, issue for delivery, or renew in this state a healt

On May 24, 2024, Gov. Walz signed HF 5247 into law. Among other things in the omnibus bill, the bill made several changes to the state’s paid family and medical leave law (PFML). Under the PFML, employees will be entitled to partial wage replacement for 12-20 weeks of leave in a 52-week period for medical leave and bonding or caring for a family member. The law is discussed in an article in the June 6, 2023, edition of Compliance Corner. The law will become effective on January 1, 2026.&

On April 19, 2024, the Office of the Superintendent of Insurance (OSI) confirmed that New Mexico insurance carriers had begun providing coverage for Opill, the first over-the-counter birth control pill approved by the FDA.   The OSI’s announcement came just six weeks after Opill became available over the counter and includes a reminder that New Mexico health insurance carriers are required to cover the cost of certain over-the-counter contraceptives purchased at in-network pharmaci

On February 1, 2024, the Oregon Department of Consumer and Business Services Division of Financial Regulation issued Bulletin 2024-2, which provides interim guidance for health benefit plans regarding the coverage of gender-affirming treatment consistent with Section 20 of 2023 Oregon House Bill 2002.  The interim guidance provides that:  Carriers may not deny or limit coverage under the plan for gender-affirming treatment that is medically necessary and prescribed in accordance

Significant modifications to OFLA will take effect July 1, 2024, pursuant to legislation passed in 2023 and 2024.   The 2023 legislation requires all Oregon employers to adopt a measured forward leave year, while the 2024 legislation makes a number of changes, including:  OFLA will no longer run together with Paid Leave Oregon. Eligible employees may draw on either OFLA or Paid Leave Oregon (but not both) for qualifying events. Accordingly, the list of OFLA qualifying eve