On July 7, 2023, the DOL, HHS and Treasury (collectively, the departments) released new FAQs (Part 60) addressing the coordination between the No Surprises Act (NSA) and the ACA annual out-of-pocket (OOP) maximum limit. The FAQs also address the interaction between the NSA and the ACA Transparency in Coverage (TiC) rules with respect to facility fees, which are increasingly charged for services provided even outside of hospital settings. Below is a key summary:

On June 8, 2023, the Eleventh Circuit affirmed a trial court's ruling that denying certain employment benefits to police officers on military leave while providing the same benefits to other employees on nonmilitary paid administrative leave violates the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

On May 30, 2023, the DOL issued an opinion letter that affirms its prior guidance regarding how to calculate the amount of FMLA leave entitlement when a workweek includes a holiday. “Workweek” is defined under the FMLA as the employee’s normal schedule (hours/days per week) prior to the start of FMLA leave.

On May 3, 2023, in Salim v. Health Svc & Indemnity, the United States Court of Appeals for the Fifth Circuit (the Fifth Circuit) affirmed a lower court ruling that Blue Cross abused its discretion when it denied the plaintiff coverage even when substantial evidence did not support that decision.

On May 15, 2023, in D.K., et al. v. United Behavioral Health, et al., the United States Court of Appeals for the Tenth Circuit (the Tenth Circuit) found that ERISA health claims administrators must engage with treating physician opinions when reviewing claims on appeal and explain their reasoning in denial letters. While deference to a claimant’s treating physician is not required, the Tenth Circuit confirmed such evidence could not be...

On May 16, 2023, the IRS released Revenue Procedure 2023-23, which provides the 2024 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2024 annual HSA contribution limit will increase to $4,150 for individuals with self-only HDHP coverage (up $300 from 2023) and to $8,300 for individuals with anything other than self-only HDHP coverage (family or self +1, self + child(ren), or...

On April 13, 2023, in celebration of Autism Awareness Month, the DOL’s Employee Benefits Security Administration (EBSA) Assistant Secretary, Lisa M. Gomez, publicly reaffirmed the agency’s commitment to ensuring access to autism treatment benefits.

The CMS has released the latest update regarding the federal Independent Dispute Resolution (IDR) portal.

On March 29, 2023, the IRS Chief Counsel’s office published a memorandum that addresses the claim substantiation requirements for health FSA and dependent care assistance program (DCAP) expenses. The memo illustrates the situations when an expense fails to be properly substantiated in accordance with IRS rules. The memo affirms that any health FSA and DCAP expense, regardless of the amount, must be fully...

On April 19, 2023, the DOL announced a settlement with Prudential Insurance Company of America (Prudential) following an investigation into the carrier’s group supplemental life insurance claims practices. The DOL investigation found that Prudential, based on the terms of its group life insurance policies, has denied claims for failure to provide evidence of insurability (EOI) after collecting supplemental life insurance premiums...