[firm] blog logo

New FAQs Address Transparency in Coverage Disclosures on Health Plan Websites

The Transparency in Coverage Final Rules require an employer-sponsored group health plan to post three machine-readable files on a public website. Two of these files, the network rate and non-network allowed amount files, were required to be posted by July 1, 2022. Recently issued FAQs provide that a plan may satisfy this requirement by entering into a written agreement under which a service provider (such as a TPA) posts the machine-readable files on its public website on behalf of the plan. However, in the case of the non-network aggregated allowed amount files (i.e., the third machine-readable file that must be published), the plan must post a link to the file hosted by the service provider on the plan’s own website, if the plan maintains a public website. It is not clear from this FAQ whether the TPA must post this information on its public website where information is normally made… Continue Reading

DOL Wins ERISA Appeal Authorizing its DOL Cybersecurity Subpoena

A recent Seventh Circuit Court of Appeals case reminds plan sponsors and service providers that ERISA grants the DOL broad authority to seek plan-related information reasonably relevant to an investigation from both fiduciaries and non-fiduciaries. Plan cybersecurity practices have been a recent focus of the DOL and resulted in its 2021 issuance of cybersecurity best practices for plan sponsors, fiduciaries, recordkeepers, and plan participants, which are available here.  In this case, the court ruled in favor of the DOL in connection with the DOL’s 2019 investigation into the processing of unauthorized distributions of plan benefits due to cybersecurity breaches in the ERISA plan accounts serviced by Alight Solutions LLC (“Alight”). The DOL indicated that Alight failed to report, disclose, and restore the distributions. Alight denied any knowledge of the breaches. Alight argued that the subpoena fell outside of the DOL’s authority because the DOL does not have the authority under… Continue Reading

New FAQs Address Issues Related to Contraceptive Coverage under Group Health Plans

The federal Treasury, DOL, and HHS (collectively, the “Agencies”) jointly issued a new set of FAQs to address various issues regarding the requirement for most employer-provided and other applicable group health plans to cover contraceptives without cost-sharing under the preventive care mandate of the Affordable Care Act (the “Contraceptive Coverage Mandate”). In particular, the FAQs are intended to (i) respond to reports that individuals continue to experience difficulty accessing contraceptive coverage without cost sharing; (ii) clarify application of the Contraceptive Coverage Mandate to fertility awareness-based methods and emergency contraceptives; and (iii) address the preemption of state law by the Contraceptive Coverage Mandate.  Specific issues addressed in the FAQs include the following:  The requirement for plans to cover items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure; The requirement for a plan to cover, without cost-sharing, FDA-approved… Continue Reading

Reminder to Review Health Plan Subrogation and Reimbursement Language Before It’s Too Late

A recent case from the U.S. Court of Appeals for the Ninth Circuit serves as a reminder to employers to review the subrogation and reimbursement language in their group health plan documents. In this case, a motion picture industry health plan provided that a participant must reimburse the plan from any amount recovered from a third party who was responsible for the injury. If a participant fails to reimburse the plan from a third-party recovery, under the terms of the plan, the amount of unreimbursed benefit payments is deducted from future benefit payments made on behalf of such participant by the plan. In accordance with the plan’s provisions, when one of the plan’s participants failed to reimburse the plan from a third-party recovery, the plan began deducting the unreimbursed amount from future benefit payments. The participant and other covered family members sued. A federal district court granted summary judgment in… Continue Reading

August 2022
S M T W T F S
 123456
78910111213
14151617181920
21222324252627
28293031  

Archives