Insights

Gov. Kemp recently signed the Consumer Access to Contracted Healthcare Act (CATCH Act), which amends the state's Surprise Billing Consumer Protection Act to ensure participant access to quality healthcare by setting adequacy standards for network plans offered by an insurer and providing for telehealth services, among other items. Specifically, the CATCH Act requires an insurer providing a network plan to contract with and maintain a network of participating providers in sufficient number and a

On May 16, 2023, the IRS released Revenue Procedure 2023-23, which provides the 2024 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2024 annual HSA contribution limit will increase to $4,150 for individuals with self-only HDHP coverage (up $300 from 2023) and to $8,300 for individuals with anything other than self-only HDHP coverage (family or self +1, self + child(ren), or self + spouse/domestic partner coverage), an increase of $550 from 2

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