On February 23, 2023, in Yates v. Symetra Life Insurance Company, the Eighth Circuit Court of Appeals (the “Eighth Circuit”) affirmed a district court ruling that an ERISA plan participant is not required to exhaust administrative remedies before challenging a benefit denial in court when the written plan documents do not mention any review process or administrative remedies to be exhausted.

On March 7, 2023, in Schuyler v. Sun Life Assurance Co. of Canada (Sun Life), the US District Court for the Southern District of New York found ERISA rights were waived through an employment separation agreement.

On March 17, 2023, the IRS published new frequently asked questions (FAQs) that address whether certain costs related to nutrition, wellness and general health, such as nutritional counseling, weight-loss programs, and mental health-related therapies, are medical expenses that may be paid or reimbursed under a HSA, health FSA, Archer MSA or HRA.

The DOL, HHS, and IRS recently issued revised Federal Independent Dispute Resolution (IDR) Process Guidance for certified IDR entities and for disputing parties. The Federal IDR Process Guidance outlines the IDR process used by plans, insurers, providers, and certified IDR entities in resolving claims for payment for out-of-network services that are subject to the federal No Surprises Act surprise billing rules.

The Department of Labor’s Advisory Council on Employee Welfare and Pension Benefit Plans has issued a report addressing cybersecurity issues affecting health plans. While the Council has issued two reports on cybersecurity issues affecting employee benefit plans in the past (the first in 2011; the second in 2016), this report marks the first time the Council has focused exclusively on cybersecurity regarding health benefit plans alone.

On February 17, 2023, the HHS Office for Civil Rights (OCR) released two annual reports to Congress summarizing the agency’s key HIPAA enforcement activities during the 2021 calendar year as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The first report, HIPAA Privacy, Security, and Breach Notification Rule Compliance, identifies the number of complaints received, the method by which those complaints were resolved, and other OCR HIPAA compliance enforcement activities. The second report, Breaches of Unsecured Protected...

On February 23, 2023, in Hayes v. Prudential Insurance Company of America, the US Court of Appeals for the Fourth Circuit found that courts cannot extend plan deadlines for converting group life insurance coverage to individual coverage, even where extraordinary circumstances prevented an individual from meeting the deadline. The court’s conclusion was grounded in ERISA’s cornerstone principle to adhere to the plan terms.

The IRS has released updated versions of Publications 502 and 503 for the 2022 tax year. Publication 502 describes medical expenses taxpayers can deduct on the 2022 federal tax returns, while Publication 503 explains the requirements necessary for taxpayers to claim the dependent care tax credit for child and dependent care expenses.

On January 26, 2023, the US Court of Appeals for the Ninth Circuit released an opinion that expands upon its previously released memorandum disposition reversing a district court’s judgment that United Behavioral Health (UBH) wrongfully denied benefits to plaintiffs by using overly restrictive criteria for administering claims for treatment of mental health and substance abuse disorders.

On January 19, 2023, the federal Office of Child Support Enforcement (OCSE) issued updates to the National Medical Support Notice (NMSN) and the instructions for the form. OCSE is the federal government agency that oversees the national child support program. It maintains the NMSN, which is the official form child support agencies send to employers to ensure that children receive healthcare coverage when available and required as part of a child support order.