On April 11, 2024, in Ryan S. v UnitedHealth Group, Inc., et al., the Ninth Circuit Court of Appeals (Ninth Circuit) filed a decision reversing a Middle District of California District Court dismissal of a class action suit brought under ERISA by a beneficiary (Ryan S.) of a group health plan insured, managed, and administered by UnitedHealthcare (UHC). The lawsuit, which alleged a MHPAEA violation and breach of an ERISA fiduciary duty, was remanded for further proceedings.

On April 13, 2024, the IRS released a set of FAQs concerning the tax treatment of work-life referral (WLR) services that employers may provide to employees. The FAQs establish that WLR services are a de minimis fringe benefit excluded from an employee’s gross income and from the employer’s employment taxes.

In response to a request by Congress, the Government Accountability Office (GAO) recently released a report focusing on state regulation of PBMs serving private health plans. Among other things, the report describes actions selected states have taken to regulate PBMs and the views of various stakeholders regarding such state regulation.

The final rules follow several Biden Administration Executive Orders, which direct the departments to review policies for consistency with the goals of strengthening ACA protections and providing access to affordable, comprehensive healthcare. The Biden Administration also seeks to ensure individuals understand their coverage options so they do not unknowingly purchase low-quality coverage (referred to as “junk insurance”) that may result in burdensome household medical debts. Accordingly, the final rules impose new restrictions on coverage not fully subject to the ACA...

On April 2, 2024, the HHS, CMS, and IRS released the 2025 Notice of Final Benefit and Payment Parameters (the 2025 final rule), an accompanying fact sheet, and, in coordination with the DOL, a related FAQ. The 2025 final rule, which follows a proposed rule issued on November 15, 2023, is primarily directed at health insurers and the ACA marketplace but includes certain information that directly or indirectly impacts group health plans.

On March 24, 2024, in McKee Foods Corporation v. BFP, Inc. dba Thrifty Med Plus Pharmacy, the Sixth Circuit US Court of Appeals (Sixth Circuit) held that McKee Foods’ claims that Tennessee’s “any willing pharmacy” (“any-willing-pharmacy”) laws are preempted by ERISA, and that state law does not require it to include Thrifty Med in its approved network of pharmacies, were not rendered moot following changes to the underlying state laws and other factual developments in the case. The Sixth Circuit reversed and remanded the case for further proceedings.

On March 19, 2024, a federal trial court held that the hearing-impaired mother and daughter stated a sufficient claim of “proxy” discrimination under ACA Section 1557 against Regence BlueShield, a health insurer, for its plans’ exclusion of all hearing devices except cochlear implants to proceed to trial.

On February 29, 2024, the Federal District Court of Northern District of California denied Aetna Inc. and Aetna Life Insurance (collectively, Aetna)’s motion to dismiss a case alleging that Aetna health insurance plans discriminate against LGBTQ members seeking fertility treatment coverage by placing additional burdens on couples in same-sex partnerships.

On January 31, 2024, the US District Court for the Northern District of California (the court) filed a ruling on motions for summary judgement in Zavislak v. Netflix, Inc. , determining, among other issues, that an ERISA health plan beneficiary is not entitled to receive copies of all plan documents under ERISA Section 104.

In February 2024, HHS and the National Institute of Standards and Technology (NIST) released an updated cybersecurity resource guide to help HIPAA-regulated entities, which include group health plans and their business associates, comply with the HIPAA Security Rule (the Security Rule). This practical guide is organized into five main sections, followed by a wide variety of related resources in the appendices.