Certain pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment (sometimes referred to as “wellness indemnity plans” or “FICA savings programs”) frequently lack a legitimate basis in tax law (the Internal Revenue Code (IRC)) and consequently are typically too good to be true. 

On September 19, 2024, in Dwyer v. United Healthcare Ins. Co., the United States Court of Appeals for the Fifth Circuit (the court) found that defendant United Healthcare (UHC) improperly denied benefits for the continuing treatment of a participant’s anorexia nervosa, disregarding both the plan’s own coverage terms and its claims and appeals procedures.

HHS's Office for Civil Rights (OCR) has recently released its latest cybersecurity newsletter to remind HIPAA-covered entities, which include employer-sponsored health plans, and business associates (collectively, “regulated entities”), that physical security measures such as facility access controls are essential for HIPAA Security Rule compliance. These measures help prevent unauthorized access to electronic protected health information (ePHI) as the incidences of cyberattacks and breaches of ePHI are increasing.

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.