Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront recently due to a wave of class action lawsuits that have been brought against group health plan fiduciaries. In our last post
Health Plan Hygiene Part 3 – Best Practices for TPA Evaluation, Selection, and Contracting
A health plan’s fiduciaries are responsible for administering the health plan. Because most employers are not in the business of administering health benefits, they outsource the day-to-day health plan administration to a third-party health plan administrator (TPA). This outsourcing does not mean the employer is off the hook for their fiduciary obligations under ERISA. Even
Developments Around IVF Benefits
A recent Alabama Supreme Court case, LaPage v. Center for Reproductive Medicine, has made headlines and raised questions about the legal implications of providing in vitro fertilization (IVF) benefits. During IVF, eggs are fertilized outside the body to create an embryo, and in the case at hand, the parents sued after several embryos were
Health Plan Sponsors in the Crosshairs?
America’s cultural wars may be opening up a new front, and group health plans may be caught in the fray. Since the US Supreme Court decision in Dobbs ended almost fifty years of constitutional protection for abortion rights and gave states the authority to regulate abortion, lawmakers (or citizens) have either enacted new prohibitions on
Self-Insured Health Plans: Adjusted PCORI Fee Announced for 2024
As discussed in a previous blog, the Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through annual fees — provided for in the Affordable Care Act — paid by insurers of fully insured health plans and sponsors of self-insured health
December 27, 2022, Deadline for Mandatory Rx Data Collection Reporting
As group health plan sponsors, employers are responsible for ensuring compliance with the prescription drug data collection (RxDC) reporting requirements added to ERISA by the Consolidated Appropriations Act of 2021 (CAA). Under ERISA section 725, enforced by the US Department of Labor (DOL), group health plans (not account-based plans, e.g., health reimbursement arrangements and health
U.S. Supreme Court Overturns Roe and Casey: What This Decision Means for Employers
As many expected based on the draft opinion that was leaked months ago, the U.S. Supreme Court has held the U.S. Constitution does not protect the right to obtain an abortion. Dobbs v. Jackson Women’s Health Organization, No. 19-1392 (June 24, 2022).
Dobbs overturns nearly 50 years of precedent from the Court’s decision in
At Home COVID-19 Testing and the Path out of the Pandemic
Testing for COVID-19 certainly has evolved over the past 18 months or so. As supply and allocation continue to face challenges, guidance on serological/antibody versus viral testing, testing in the workplace, informed consent, among other things have emerged to help guide coronavirus testing in the workplace. President Biden’s Path out of the
Health Plan Premium Surcharges For Those Not Vaccinated for COVID-19?
According to Forbes.com, more employers are considering imposing a premium surcharge on employees participating in the company’s health plan who are not vaccinated for COVID-19. Whether positioned as rewards or penalties, wellness program incentives have become vehicles of choice for encouraging behaviors believed to be healthy and reducing health plan costs. For years, tobacco
LGBTQ+ Protections Under the ACA are in Effect …Again!
The Department of Health and Human Services (HHS) announced Monday it now interprets—and will enforce—Section 1557 of the Affordable Care Act (ACA) to prohibit discrimination based on sexual orientation and gender identity, effective immediately. Section 1557 generally prohibits discrimination based on race, color, national origin, sex, age, and disability in any health program or activity