Federal Health & Welfare Updates

Jun 19, 2024

Ninth Circuit Affirms ERISA Preempts State Law Claims by Out-of-Network Provider

On May 31, 2024, in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, the Ninth Circuit Court of Appeals (Ninth Circuit) held that ERISA preempts state law claims challenging the denial of out-of-network provider reimbursements by group health plans. The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of Cigna, the TPA for the ERISA plans, in the action brought by a drug treatment center’s successor-in-interest, Bristol SL Holdings, Inc. (Bristol).

Jun 19, 2024

DOL Settlement with Unum Highlights Risks for Employers Administering Supplemental Life Coverage

On June 11, 2024, the DOL announced a recent settlement with Unum Life Insurance Company of America (Unum) following an investigation into the carrier’s group supplemental life insurance claims practices. The DOL investigation found that Unum routinely accepted premiums (via employer payroll deductions) for many years without verifying if participants satisfied an evidence of insurability (EOI) standard. Then, when a plan participant died,

Jun 19, 2024

Ninth Circuit Upholds ERISA Claim for Recovery of Residential Treatment Benefits

On June 6, 2024, in N.C., individually and on behalf of minor A.C., v. Premera Blue Cross (Premera), the Ninth Circuit Court of Appeals (Ninth Circuit) affirmed the district court’s grant of summary judgment in favor of plaintiff-appellee N.C. regarding their ERISA claim for recovery of residential treatment benefits.

Jun 5, 2024

DOL Bulletin Addresses Artificial Intelligence and the FMLA

On April 29, 2024, the DOL’s Wage and Hour Division (WHD) published a Field Assistance Bulletin (FAB) on the application of the Fair Labor Standards Act (FLSA) and other federal labor standards regarding the use of artificial intelligence (AI) and other automated systems in the workplace. The FAB also provides detailed guidance on the challenges that may arise with the use of AI and compliance with the FMLA. or purposes of FMLA compliance, AI...

Jun 5, 2024

Appeals Court Addresses When Military Leave May Need to Be Paid Leave

On May 21, 2024, in Scanlan, et al. v. American Airlines, the US Court of Appeals for the Eleventh Circuit ruled that employees are entitled to paid military service leave where their employer provides paid leave for bereavement and jury duty leave if the leaves are comparable in duration, frequency, purpose, and control. The plaintiffs in this case, a group of American Airlines pilots, sued their employer under the Uniformed Services...

Jun 5, 2024

Agencies Release 2024 Gag Clause Compliance Attestation Submission Instructions and User Manual

The DOL, HHS, and IRS have jointly updated the Submission Instructions and User Manual for the Gag Clause Prohibition Compliance Attestation (GCPCA), dated May 2024. Group health plans and health insurance issuers (insurers) offering group or individual health insurance coverage must annually submit a GCPCA to the DOL, HHS, and IRS (collectively, the agencies). The statutory provisions added by the CAA 2021 generally prohibit...

Jun 5, 2024

Federal Trade Commission Releases Final Rule on Health Breach Notification

On May 30, 2024, the Federal Trade Commission (FTC) published its amended final rule covering health breach notifications (HBNs) in the Federal Register. The HBN rule requires vendors of personal health records (PHRs) and related entities that are not covered by HIPAA to notify individuals, the FTC, and, in some cases, the media of a breach of unsecured personally identifiable health data. 

May 22, 2024

Fourth Circuit Rules Health Plan Exclusion for Gender-Dysphoria Treatment Violates Equal Protection Clause

On April 29, 2024, the Fourth Circuit, sitting en banc, affirmed district court findings that coverage exclusions of gender-affirming care for the treatment of gender dysphoria violated both the 14th Amendment’s Equal Protection Clause and Section 1557 of the ACA, which in part prohibits discrimination in coverage based on sex. The Fourth Circuit’s decision regarded two cases. In the first, the trial court found in favor of transgender North Carolina and West Virginia state employees who sued those states’ health plans for their exclusions of “treatment or studies leading to or in connection.. 

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PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.

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