On May 21, 2025, in Tiara Yachts v. Blue Cross Blue Shield of Michigan, the Sixth Circuit Court of Appeals determined that the defendant carrier acted as a fiduciary for a plan governed by ERISA and violated its fiduciary duty to the plan by overpaying providers for services rendered to plan participants. The plaintiff is a company that offered its employees a self-insured benefits plan and hired the defendant carrier to administer it.

On May 22, 2025, the House of Representatives passed the “One Big Beautiful Bill Act” to implement President Trump’s agenda as part of the budget reconciliation process. In addition to the bill’s numerous tax provisions, the legislation includes a large number of sweeping changes to the rules governing tax-advantaged savings accounts, Medicaid, PBM transparency, and Medicare. However, the bill is still in the early stages of the legislative...

On May 20, 2025, in Bokma v. Performance Food Group, Inc., the District Court for the Eastern District of Virginia denied a group health plan sponsor’s motion to dismiss three ERISA claims brought by participants who alleged the plan’s tobacco surcharge was unlawful. The plaintiffs in this case participated in defendant Performance Food Group, Inc.’s ERISA group health plan, which imposed an annual surcharge of $600 on employees...

On May 22, 2025, the DOL, HHS, and Treasury announced important initiatives to enhance and enforce existing healthcare price transparency requirements, particularly with respect to prescription drugs. The release follows President Trump’s February 25, 2025, executive order 14221, which called for rapid action to improve and fully implement health plan and hospital price transparency rules. Employers should be aware of these...

On May 15, 2025, the DOL, HHS, and IRS (the departments) issued a statement indicating they will not enforce the MHPAEA 2024 final rule (the 2024 final rule) while they reconsider whether to rescind or modify it. This nonenforcement policy is welcome news for many plan sponsors. However, it does not alleviate their fiduciary obligations to otherwise comply with MHPAEA, including the CAA 2021 nonquantitative treatment limitation (NQTL)...

On May 8, 2025, in BlueCross BlueShield of Tennessee v. Nicolopoulos, the Sixth Circuit Court of Appeals determined that ERISA did not preempt state law when the defendant, the commissioner of the New Hampshire Insurance Department, sought to enforce state law against the plaintiff, insurance company BlueCross BlueShield of Tennessee. The plaintiff is both the carrier and the fiduciary of a health plan that denied coverage for fertility...

On April 9, 2025, in Holland v. Elevance Health Inc., a U.S. District Court in Maine granted a motion to dismiss a putative class action against Elevance Health Inc., which designs and administers a fully insured plan for the Maine Education Association Benefits Trust (MEABT). The plaintiffs in the case alleged that a coverage exclusion for weight-loss medications was a form of disability discrimination in violation of Section 1557 of the ACA, which...

On May 1, 2025, the IRS released Revenue Procedure 2025-19, which provides the 2026 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2026 annual HSA contribution limit will increase to $4,400 for individuals with self-only HDHP coverage (up $100 from 2025) and to $8,750 for individuals with anything other than self-only HDHP coverage (family or self + one, self + child(ren), or self + spouse/domestic partner coverage), an increase of $200 from 2025. 

On April 17, 2025, the Supreme Court of the United States unanimously held in Cunningham v. Cornell University that ERISA plan participants alleging a fiduciary breach need only plead that a prohibited transaction occurred. The burden then shifts to plan fiduciaries to assert and prove that an exemption applies. The decision, which resolved a split among the federal circuit courts regarding the proper pleading in ERISA litigation, makes it easier for participants to bring prohibited transaction claims and may increase litigation brought against ERISA plan fiduciaries.  

On April 18, 2025, a district court in Washington state held that a health insurer’s categorical exclusion of coverage for mastectomies for transgender youth discriminated on the basis of sex in violation of Section 1557 of the ACA. The case involved a pair of parents who sued the insurer, Premera Blue Cross, after it denied coverage for the dependents’ mastectomies and reconstructive surgeries.