The Internal Revenue Service (IRS) has issued Rev. Proc. 2024-14, which contains the 2025 indexing adjustments to the dollar amount used to calculate employer shared responsibility payments under the Affordable Care Act (ACA). The ACA provides that applicable large employers (ALEs) can be responsible for an employer shared responsibility penalty under Code § 4980H(a) in some circumstances. More specifically, if Read More

Insurance plan participants urged a California federal court to certify a class of 8,000 members in their lawsuit against Cigna, claiming that class certification is the only efficient and cost-effective remedy. The plan participants claim that Cigna colluded with Multiplan, its third-party billing contractor, and Multiplan’s subsidiary, Viant, to underpay out-of-network claims for substance use disorder treatments. Read More

Before the Mental Health Parity Act of 1996 (MHPA), health insurance plans were not required to cover mental health care, which made treatment expensive and difficult to access. The MHPA was the first piece of legislation that attempted to resolve this issue. It provided that large group health insurance plans could not impose annual or lifetime caps on mental health benefits that are less favorable than caps on Read More

The U.S. Department of Labor (DOL) recently filed suit against the Blue Cross and Blue Shield of Minnesota (BCBSM), alleging various violations of the Employee Retirement Income Security Act (ERISA). The outcome of this case is likely to be significant, as it raises issues concerning legal authority and fiduciary responsibility in the context of third-party administrators (TPAs) of self-funded employee welfare Read More

SECURE 2.0 established various options for individuals to withdraw funds from their retirement accounts without penalties. One such option allows plan sponsors to place funds in a separate emergency savings account for employees making less than $155,000 annually. Plan advisors often refer to these pension-linked emergency savings accounts (PLESAs) as “sidecar” accounts. The Employee Benefits Security Read More

The Affordable Care Act (ACA) requires some employers to file annual information returns with the Internal Revenue Service (IRS) by certain deadlines. These employers also must provide their employees with certain forms related to insurance coverage by a deadline. Failure to meet these deadlines can result in double penalties – one for failure to file an information return and one for failing to provide employees Read More

As former President Donald Trump once again hits the campaign trail, he is doubling down on his previous campaign promise to repeal and replace the Affordable Care Act (ACA), characterizing “Obamacare” as a “catastrophe.” Trump’s insistence on this campaign goal, which failed the first time, comes at a time when the ACA is more popular and widely used than ever among Americans. Despite his fervent campaign promises, Read More

A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable Care Act (ACA). The court ruled that the TPA committed illegal discrimination under the ACA by excluding coverage for gender-affirming care. The case is C.P. v. Blue Cross Blue Shield of Ill., 2023 Read More

The U.S. Court of Appeals for the Fifth Circuit recently heard arguments over the fairness of an arbitration provision in the No Surprises Act. Some medical providers, including the Texas Medical Association, challenged the provision in court, alleging that the arbitration provision unfairly favored insurers and inhibited arbitrators' discretion to resolve certain disputes under the No Surprises Act. The case is Read More

Columbus Regional Healthcare System, Inc., a Georgia company, and a class of some 6,800 retirement plan participants, recently advised a federal district court that they have reached a $2 million settlement in their pending Employee Retirement Income Security Act (ERISA) case. The parties' joint filing detailed the settlement terms, which would end the plan participants’ class action lawsuit in which they accused Read More