On June 20, 2025, CMS issued the “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability Final Rule.” The rule makes several changes to annual cost-sharing limits and the definition of essential health benefits. The rule updates the methodology for calculating the “premium adjustment percentage,” which results in a revision of the previously announced maximum annual limit on cost-sharing for 2026 (which we originally reported on in an article in the October 22, 2024, edition of Compliance Corner). The maximum annual limit is now...

On June 16, 2025, in J.H. et al v. United Behavioral Health et al, the United States District Court for Utah ruled that the defendant insurer’s decision to deny residential treatment benefits for an ERISA plan participant was arbitrary and capricious. The court granted summary judgment to the plaintiffs and remanded the case back to the insurer for reconsideration of the denied claims.

On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. While the final bill omitted several of the benefit provisions included in the initial House legislation, it includes some noteworthy changes for employers as group health and welfare plan sponsors.

On July 1, 2025, the Senate narrowly approved its amended version of the One Big Beautiful Bill Act (OBBBA), clearing the way for a vote in the House of Representatives. Significantly, for group health and welfare plan sponsors, the Senate measure includes several noteworthy provisions. Specifically, the...

On June 27, 2025, the U.S. Supreme Court announced its long-awaited opinion in Kennedy v. Braidwood Management, Inc., which challenged the legality of ACA preventive care coverage requirements. The Court ruled that members of the U.S. Preventive Services Task Force (USPSTF), an HHS entity that makes evidence-based recommendations regarding preventive healthcare services, were properly appointed under the U.S. Constitution. As a result, group health plans must continue to cover all ACA-required preventive care without...

On June 18, 2025, a federal court in the Northern District of Texas ordered that the 2024 HIPAA Privacy Rule to Support Reproductive Healthcare Privacy be vacated. This is the latest order in the Purl v. HHS case, which was the subject of an article in the February 11, 2025, edition of Compliance Corner. In this case, the plaintiffs are a doctor and her clinic. They argued that the rule will impair their ability to report child abuse or participate in public health investigations and that HHS violated the federal Administrative Procedures Act by acting in an arbitrary and capricious manner when the agency promulgated the rule outside its statutory authority. The plaintiffs obtained a preliminary injunction so that they could continue to work

On May 7, 2025, in Watson v. EMC Corp., a U.S. District Court in Colorado ruled in favor of a plaintiff’s claim against the defendant, EMC Corporation, granting the plaintiff’s request for equitable relief on an ERISA fiduciary breach claim. The plaintiff, Marie Watson, sued EMC Corporation, her husband’s former employer, for leading her husband to believe his basic life insurance coverage remained in force following the termination of his employment...

On May 23, 2025, the Congressional Research Service (CRS) published an overview of the ACA’s preventive services coverage requirement. According to this report, between 150 million and 180 million individuals are enrolled in a plan subject to the preventive services coverage requirement. The ACA requires group health plans (including most private health insurance plans, but not grandfathered plans) and insurers to cover certain preventive care...

On June 2, 2025, the DOL introduced its enhanced opinion letter program. The program is designed to help employers and other stakeholders understand and comply with federal laws, including employee benefit laws that are enforced by the DOL. The recently announced program spans five key DOL enforcement agencies, including the Employee Benefits Security Administration (EBSA), which oversees private retirement and health and...

On March 20, 2025, in Owens v. Blue Shield of California et al., a U.S. District Court in California granted and denied in part a motion to dismiss a claim involving the applicability of ERISA to state continuation coverage. The plaintiff was employed with one of the defendants, Fredrickson and Company, through March 2020 and received employer-sponsored health coverage through Blue Shield of California. The plaintiff’s health benefits ceased on...