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.

On February 4, 2025, a federal court in the Middle District of Florida Tampa Division denied a defendant’s motion to dismiss a case alleging that the defendant issued a deficient COBRA election notice. The plaintiff is a former employee of the defendant's employer, which sponsors and administers the health plan the plaintiff participated in. The defendant terminated the plaintiff’s employment, but not for gross misconduct. The defendant is subject to federal COBRA, and the plaintiff’s termination was a qualifying event, so the defendant was obliged to... 

The Council of Insurance Agents & Brokers (CIAB) and the American Benefits Council (ABC) recently released a study by Ernst & Young (E&Y), which examined the impact of the tax exclusion on employer-provided health insurance. The study reviewed the effects of limiting the income and payroll tax exclusion for employment-based health insurance to the 75th percentile of premiums, effective January 2026. The study was based on a model similar to those used by the Congressional Budget Office, the Joint Committee on Taxation, and the U.S. Treasury Department.

On March 10, 2025, in Lewandowski v. Johnson & Johnson, et al., the original plaintiff, Ann Lewandowski, amended her ERISA fiduciary breach complaint and added another plaintiff, Robert Gregory, to the putative class action lawsuit. The amended complaint attempts to address deficiencies in the plaintiff’s prior claims, which were previously dismissed by a New Jersey district court due to lack of legal standing.

On February 22, 2025, a federal court in the District of Maine dismissed a proposed class action lawsuit which sought to characterize obesity as a disability under Section 1557 of the ACA. The plaintiff brought the case against the insurance carrier that administered the health plan the plaintiff participated in. The plan does not provide prescription drug coverage for weight loss. The plaintiff claimed that this was discrimination based on a disability and a violation of Section 1557 of the ACA. 

The DOL's Advisory Council on Employee Welfare and Pension Benefit Plans (the Council) recently issued a report examining the group health plan benefit claims and appeals process. In particular, the report studies the reasons behind low participant appeal rates and makes recommendations to address this concern.

Among the proposals currently being considered is the taxation of certain employer-sponsored health plans. Under existing tax law, employer-paid premiums for group health plans are exempt from federal income and payroll taxes. The potential impact of taxing employer-sponsored insurance could be far-reaching.

the newly published executive order directs the DOL, HHS, and Treasury (including the IRS) to take certain steps within 90 days to improve and enforce existing price transparency requirements. Specifically, the agencies are tasked with two main directives. One is issuing updated guidance that ensures pricing information is standardized and easily comparable across health plans. The other is updating enforcement policies designed to ensure...

On January 28, 2025, the Trump administration issued Executive Order 14187, which declares that it is the policy of the United States not to “fund, sponsor, promote, assist, or support” gender transition for people under 19, which includes 18-year-olds who are legal adults in the states where they reside. Among other things, the order requires federal agencies, such as HHS, to take all appropriate actions to end the “chemical and surgical...