On September 12, 2024, in Amy G. v. United Healthcare, the US District Court of Utah (the court) ruled that the denial of wilderness therapy benefits by defendants United Healthcare and United Behavioral Health (UBH) was arbitrary and capricious because UBH failed to provide a sufficient explanation and analysis for the denial, as required by ERISA. The court remanded the claim back to the defendants for reevaluation and redetermination.

On September 9, 2024, the DOL, HHS, and IRS (the departments) announced final rules implementing MHPAEA, specifically aimed at ensuring equitable access to treatments for mental health and substance use disorders as compared to medical and surgical treatments. 

On September 9, 2024, the IRS published Revenue Procedure 2024-35, which provides the employer contribution percentage requirements applicable for plan years beginning in calendar year 2025 and the 2025 premium tax credit (PTC) table.

On August 28, 2024, the IRS issued a reminder that principal and interest charges on employees’ qualified education loans are eligible expenses under educational assistance programs. Prior to March 27, 2020, eligible expenses were limited to items such as current tuition, fees, books, supplies...

On August 22, 2024, in Synoracki v. Alaska Airlines, the US Court of Appeals for the Ninth Circuit (Ninth Circuit) ruled that a class action lawsuit brought by pilots seeking additional benefit accruals during periods of military leave must be reconsidered in light of its recent decision in Clarkson v. Alaska Airlines, Inc...

On August 19, 2024, the United States Court of Appeals for the Sixth Circuit (Sixth Circuit) held that the federal common law prevented the named beneficiary of ERISA group life insurance from benefiting from his murder of the insured and a co-beneficiary.

HHS recently announced inflation-adjusted penalty amounts related to violations of Summary of Benefits and Coverage (SBC), Medicare Secondary Payer (MSP), and HIPAA privacy and security rule requirements. These new penalty amounts are calculated based on a cost-of-living increase of 1.03241% and are applied to penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015.

On August 5, 2024, the Seventh Circuit Court of Appeals (Seventh Circuit) affirmed the district court’s ruling in favor of insurer Group Health Cooperative (the defendant) when they denied claims for therapy treatment brought by parents on behalf of their autistic child (plaintiffs) based upon then-current medical literature. The plaintiffs asked the defendant health insurer to pay for certain treatments for their autistic child that occurred  between 2017 and 2019. The defendant refused to pay since the medical literature at the time did not support speech therapy as a treatment for autism for...

On August 20, 2024, representatives Robert Scott and Mark DeSaulnier, ranking members, respectively, of the House Committee on Education and the Workforce and the Subcommittee on Health, Education, Labor, and Pensions, sent a letter to the DOL’s Employee Benefits Security Administration (EBSA) assistant secretary Lisa Gomez asking for increased oversight on group health plan service providers. In part, the letter stems from a springtime New York Times (NYT) investigation into a data analytics company, which alleged the company engaged in harmful...

On July 29, 2024, in Mullins v. CONSOL Energy Inc. Long Term Disability Plan, the Third Circuit Court of Appeals (Third Circuit) held that the termination of a coal miner’s ERISA long-term disability benefits by the claims administrator, Lincoln Financial Group (Lincoln), was not based on substantial evidence in the record and was therefore an abuse of discretion. The Third Circuit vacated the prior district court judgment upholding Lincoln’s termination decision and remanded the case back to the district court for reinstatement of the miner’s benefits.