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...

On April 12, 2023, the HHS Office of Civil Rights (OCR) issued a Notice of Proposed Rulemaking that will expand reproductive healthcare privacy under HIPAA.

Following the US Supreme Court’s lead, a trial court has changed its view as to whether a church-affiliated hospital’s retirement plan qualifies as a “church plan” under ERISA.

The ACA requires the DOL to provide Congress with an annual report regarding private-sector self-insured health benefits plans and financial information of employers that sponsor such plans. The DOL recently released the 2023 annual report based on 2020 Form 5500 filings, including the number of participants, benefits offered, funding arrangements and plan assets. Along with the annual report, the DOL released two detailed appendices to complement the report: Appendix A, which describes the abstract of 2020 Form 5500 Annual Reports and Appendix B,...

CMS recently released the Prescription Drug Data Collection Reporting Instructions for the 2022 calendar year (the 2022 RxDC instructions). The 2022 RxDC instructions reflect numerous changes from the prior year’s instructions.

On February 23, 2023, in Yates v. Symetra Life Insurance Company, the Eighth Circuit Court of Appeals (the “Eighth Circuit”) affirmed a district court ruling that an ERISA plan participant is not required to exhaust administrative remedies before challenging a benefit denial in court when the written plan documents do not mention any review process or administrative remedies to be exhausted.

On March 7, 2023, in Schuyler v. Sun Life Assurance Co. of Canada (Sun Life), the US District Court for the Southern District of New York found ERISA rights were waived through an employment separation agreement.

On March 17, 2023, the IRS published new frequently asked questions (FAQs) that address whether certain costs related to nutrition, wellness and general health, such as nutritional counseling, weight-loss programs, and mental health-related therapies, are medical expenses that may be paid or reimbursed under a HSA, health FSA, Archer MSA or HRA.

The DOL, HHS, and IRS recently issued revised Federal Independent Dispute Resolution (IDR) Process Guidance for certified IDR entities and for disputing parties. The Federal IDR Process Guidance outlines the IDR process used by plans, insurers, providers, and certified IDR entities in resolving claims for payment for out-of-network services that are subject to the federal No Surprises Act surprise billing rules.

The Department of Labor’s Advisory Council on Employee Welfare and Pension Benefit Plans has issued a report addressing cybersecurity issues affecting health plans. While the Council has issued two reports on cybersecurity issues affecting employee benefit plans in the past (the first in 2011; the second in 2016), this report marks the first time the Council has focused exclusively on cybersecurity regarding health benefit plans alone.