The Senate Finance Committee unanimously voted to advance the Better Mental Health Care, Lower-Cost Drugs and Extenders Act, a comprehensive bill seeking increased transparency and comprehensive PBM reform. The bill also would create a list of discounted drugs with high rebates available in Medicare Part D and address various other healthcare issues. Among the provisions in the bill are the following: The Read More

A panel of the U.S. Court of Appeals for the 11th Circuit recently heard oral arguments in the appeal of an unlawful discrimination case involving a county health plan’s exclusion of coverage of gender transition surgery. The case is Anna Lange v. Houston County, Georgia, et al., case number 22-13626, U.S. Court of Appeals for the Eleventh Circuit. Houston County, Georgia, and its Sheriff, Cullen Talton, appealed Read More

An oboist who performed as an extra musician for the New York Metropolitan Opera for more than 30 years filed suit against the company, alleging that it allegedly restricted access to its retirement plan for extra musicians in violation of ERISA. The case is Sharon Meekins v. The Metropolitan Opera Association Retirement Plan et al., case number 1:23-cv-09990, U.S. District Court for the Southern District of New Read More

A former employee of Advance Publications, Inc., the holding company for Conde Nast, voluntarily dismissed his proposed class action ERISA 401(k) suit over poorly performing BlackRock funds. Ex-worker Jermaine Anderson had the opportunity to raise ERISA claims in a second amended complaint following the dismissal of his amended complaint but instead chose to dismiss the lawsuit. The dismissal comes as similar Read More

Jane Doe, a transgender woman with gender dysphoria, sued Independence Blue Cross (IBX) after it denied coverage for facial feminization surgeries (FFS) as cosmetic and not medically necessary. Doe filed sex and disability discrimination claims under the Affordable Care Act (ACA), Section 504 of the Rehabilitation Act (Section 504), the Americans with Disabilities Act (ADA), as well as claims under the Employee Read More

Although the Internal Revenue Code does not allow employers to exclude part-time employees, it has allowed them to exclude employees from their 401(k) plans until they have worked at least 1,000 hours in a year. As a result, employers historically used this rule to exclude part-time employees from plan participation, including the right to make elective salary deferral contributions to a plan. However, the Setting Read More

As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its “nH Predict” AI algorithm to wrongfully deny elderly patients’ claims for post-acute care, including stays in skilled nursing-care facilities and in-home care. When patients appeal the denials Read More

IBM has notified its employees that it will suspend its current match and 1% automatic contribution to employee 401(k) plans as of January 1, 2024. In lieu of contributing to a 401(k) plan, the industry leader will provide a monthly account credit toward a new Retirement Benefit Account (RBA). Employees also will receive a one-time salary increase to offset the difference between the current 401(k) contribution and Read More

In late October, the U.S. Department of Health and Human Services (HHS) reached a settlement agreement with a medical management company based in Massachusetts over alleged HIPAA violations. Under the settlement terms, the company will pay $100,000 and comply with a three-year corrective action plan (CAP). The company is a HIPAA business associate (BA) that provides services to HIPAA-covered entities (CEs), Read More

The U.S. Department of Labor's (DOL) Employee Benefits Security Administration issued a letter rejecting a request for delays in the rulemaking process concerning the expansion of the definition of "fiduciary" under the Employee Retirement Income Security Act (ERISA). The Securities Industry and Financial Markets Association (SIFMA), American Retirement Association (ARA), and various other financial groups previously Read More