On April 9, 2025, in Holland v. Elevance Health Inc., a U.S. District Court in Maine granted a motion to dismiss a putative class action against Elevance Health Inc., which designs and administers a fully insured plan for the Maine Education Association Benefits Trust (MEABT). The plaintiffs in the case alleged that a coverage exclusion for weight-loss medications was a form of disability discrimination in violation of Section 1557 of the ACA, which...

On May 1, 2025, the IRS released Revenue Procedure 2025-19, which provides the 2026 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2026 annual HSA contribution limit will increase to $4,400 for individuals with self-only HDHP coverage (up $100 from 2025) and to $8,750 for individuals with anything other than self-only HDHP coverage (family or self + one, self + child(ren), or self + spouse/domestic partner coverage), an increase of $200 from 2025. 

On April 17, 2025, the Supreme Court of the United States unanimously held in Cunningham v. Cornell University that ERISA plan participants alleging a fiduciary breach need only plead that a prohibited transaction occurred. The burden then shifts to plan fiduciaries to assert and prove that an exemption applies. The decision, which resolved a split among the federal circuit courts regarding the proper pleading in ERISA litigation, makes it easier for participants to bring prohibited transaction claims and may increase litigation brought against ERISA plan fiduciaries.  

On April 18, 2025, a district court in Washington state held that a health insurer’s categorical exclusion of coverage for mastectomies for transgender youth discriminated on the basis of sex in violation of Section 1557 of the ACA. The case involved a pair of parents who sued the insurer, Premera Blue Cross, after it denied coverage for the dependents’ mastectomies and reconstructive surgeries. 

On April 21, 2025, in Mejia v. Credence Mgmt. Solutions, a federal court in the Central District of California denied the defendants’ motion for judgment on the pleadings. The court determined that the plaintiff had grounds to bring this suit due to allegations that the defendants had a fiduciary duty to their health plan to negotiate provider rates, and they violated that duty. 

On April 10, 2025, Faulk Co. vs. Becerra, a federal court in the Northern District of Texas Fort Worth Division granted the plaintiff’s motion for summary judgment after determining that the IRS lacked the authority to impose penalties on the plaintiff for failing to offer its employees coverage as required under the ACA. The plaintiff stopped offering minimum essential health insurance coverage to its employees in 2019. The ACA requires employers with 50 or more employees to offer that coverage or face potential penalties...

On April 15, 2025, President Trump signed an executive order titled “Lowering Drug Prices by Once Again Putting Americans First.” As outlined in the accompanying fact sheet, the new executive order expands upon numerous initiatives introduced during the first Trump administration and calls for improved disclosure of PBM compensation to group health plans. It follows a February executive order focused on healthcare transparency requirements...

In 2023, Cigna Corporation and Cigna Health and Life Insurance Company (Cigna) were sued in U.S. District Court following the release of a ProPublica report that they relied on PxDx algorithms to reject plan participant claims without review by Cigna doctors. The case cited reporting by ProPublica that PxDx denied more than 300,000 requests for payments over two months in 2022, with Cigna doctors spending an average of 1.2 seconds reviewing each claim. The participants argued that use of the PxDx system constituted an ERISA fiduciary breach...

On March 24, 2025, in Navarro v. Wells Fargo & Co., a federal court in the District of Minnesota dismissed a case alleging that an employer failed to meet its fiduciary duty to its group health plan when it mismanaged the plan’s prescription drug benefit. The plaintiffs were former employees of the defendant employer, which sponsors and administers the health plan the plaintiffs participated in. The plaintiffs alleged that the defendant violated the fiduciary duties imposed upon it by ERISA when it mismanaged the health plan’s employee prescription drug benefits program.

On March 31, 2025, in McKee Foods Corporation v. BFP, Inc., the U.S. District Court for the Eastern District of Tennessee ruled that ERISA preempts key provisions of Tennessee laws that require employers to include “any willing pharmacy” in their group benefit plan networks. The court’s ruling is a positive development for sponsors of self-insured ERISA plans.