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

News Flash:  There’s no actual statutory mandate that employers offer group health coverage at all, much less coverage for specific conditions.  However, federal law requires health plans that provide mental health and substance use disorder coverage to ensure that the financial requirements (like coinsurance) and treatment limitations (like visit limits and provider access) applicable to

An Arkansas law regulating pharmacy benefit managers’ (PBMs) generic drug reimbursement rates, and affecting the cost of prescription drugs provided under ERISA-governed benefit plans and the administration of those plans, is not preempted by ERISA, the U.S. Supreme Court has held unanimously. Rutledge v. Pharmaceutical Care Management Association, No. 18-540, 2020 U.S. LEXIS 5988

The Supreme Court, whose new term begins today, the first Monday in October, will consider a number of cases impacting employee benefits and benefits litigation.  This is the first in a series analyzing these cases as they are heard by the Court.  The first issue up concerns prescription drug benefit regulation, and later in the

 On January 15, 2019, the federal Eighth Circuit Court of Appeals issued its decision in Peterson v. UnitedHealth Group, Inc., 913 F.3d, 769 (8th Cir. 2019), in which the Court upheld the federal district court’s holding that UnitedHealth Group, Inc. (“United”) was not authorized to reduce (or “offset”) payments to medical providers under ERISA