Insights

On January 26, 2023, the US Court of Appeals for the Ninth Circuit released an opinion that expands upon its previously released memorandum disposition reversing a district court's judgment that United Behavioral Health (UBH) wrongfully denied benefits to plaintiffs by using overly restrictive criteria for administering claims for treatment of mental health and substance abuse disorders. Plaintiffs initially filed suit against UBH in 2014, bringing claims under ERISA against the insurer for br

On January 19, 2023, the federal Office of Child Support Enforcement (OCSE) issued updates to the National Medical Support Notice (NMSN) and the instructions for the form. OCSE is the federal government agency that oversees the national child support program. It maintains the NMSN, which is the official form child support agencies send to employers to ensure that children receive healthcare coverage when available and required as part of a child support order. The NMSN has two parts, Part A an

On January 10, 2023, the Department of Insurance and Financial Services published a consumer guide to help consumers in the state understand the state's surprise billing law. Act 368, signed into law in 2020, prohibits out-of-network providers in the state from billing a patient for an amount greater than the applicable in-network coinsurance, copay or deductible. Instead, the out-of-network provider must submit a claim to the patient's insurer for an amount established in the law. This prohibi

On February 6, 2023, the Division of Insurance issued a Consumer Advisory reminding insurers regulated by the state of their obligation to cover contraceptive services to insureds at no cost. This obligation prohibits insurers from charging copayments, deductibles or coinsurance amounts to the individual seeking those services. The ACA requires insurers to provide this coverage for a range of recommended preventative services (including tubal ligation surgery) and prohibits imposing any cost-s

On January 20, 2023, the Division of Insurance issued a Consumer Advisory that announced that plans issued in the state must cover certain gender-affirming care services starting in 2023. Gender-affirming care services are also included as an essential health benefit (EHB) in the state's benchmark plan. The division also prepared a PDF guide for this coverage. Employers with plans governed by the state or with policies that adopted the state's benchmark plan should be aware of this new area of

As medical debt is pervasive in nearly every corner of society, stakeholders across the healthcare continuum are urged to aid consumers in figuring out how to better predict and manage their healthcare costs. Both public and private entities are aware of the problem and working towards solutions. Yet despite progress, few demonstrable results have emerged. Employers who take advantage of transparency data, benefit design, and targeted mental well-being programs can holistically address the prob

As companies continue to expand geographically and hire more remote employees, it is important to remember some states have additional benefits obligations for some employers. In this webinar, the Benefits Compliance team discussed state-specific compliance considerations such as annual filings, mini-COBRA laws, paid leave and more. Agenda State Individual Mandate Reporting Requirements (a.k.a. MEC Reporting) Other States Reporting/ Disclosure (e.g., SF HCSO, MA HIRD, IL EHB Disclosure) Mi

Largely in response to Congress reducing the federal ACA individual mandate penalty to $0 (effective since 2019), several states have passed their own individual mandates. Similar to the ACA's federal mandate reporting requirements, each state's individual mandate, as applicable, generally requires employers to submit employee coverage reports and distribute statements to covered employees. Meaning, employers with employees located in the states with an individual mandate may have to comply wit

On January 23, 2023, in Erban v. Tufts Medical Center Physicians Organization, et al., the US District Court for the District of Massachusetts found that employers and human resources personnel, when acting as plan fiduciaries, have an affirmative obligation to not make any harmful omissions in communications with participants and beneficiaries regarding options to continue life insurance coverage. The plaintiff in this case, Lisa Erban, sued Tufts Medical Center Physicians Organization (Tufts