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...

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...