Federal Health & Welfare Updates

May 28, 2025

Departments Announce Important Actions to Increase Healthcare Price Transparency

On May 22, 2025, the DOL, HHS, and Treasury announced important initiatives to enhance and enforce existing healthcare price transparency requirements, particularly with respect to prescription drugs. The release follows President Trump’s February 25, 2025, executive order 14221, which called for rapid action to improve and fully implement health plan and hospital price transparency rules. Employers should be aware of these...

May 20, 2025

Departments Announce MHPAEA 2024 Final Rule Nonenforcement Policy

On May 15, 2025, the DOL, HHS, and IRS (the departments) issued a statement indicating they will not enforce the MHPAEA 2024 final rule (the 2024 final rule) while they reconsider whether to rescind or modify it. This nonenforcement policy is welcome news for many plan sponsors. However, it does not alleviate their fiduciary obligations to otherwise comply with MHPAEA, including the CAA 2021 nonquantitative treatment limitation (NQTL)...

May 20, 2025

Sixth Circuit Affirms Denial of Fertility Coverage Not Preempted by ERISA

On May 8, 2025, in BlueCross BlueShield of Tennessee v. Nicolopoulos, the Sixth Circuit Court of Appeals determined that ERISA did not preempt state law when the defendant, the commissioner of the New Hampshire Insurance Department, sought to enforce state law against the plaintiff, insurance company BlueCross BlueShield of Tennessee. The plaintiff is both the carrier and the fiduciary of a health plan that denied coverage for fertility...

May 20, 2025

Court Dismisses Weight Loss Drug Discrimination Claim

On April 9, 2025, in Holland v. Elevance Health Inc., a U.S. District Court in Maine granted a motion to dismiss a putative class action against Elevance Health Inc., which designs and administers a fully insured plan for the Maine Education Association Benefits Trust (MEABT). The plaintiffs in the case alleged that a coverage exclusion for weight-loss medications was a form of disability discrimination in violation of Section 1557 of the ACA, which...

May 8, 2025

IRS Releases 2026 HSA and EBHRA Limits

On May 1, 2025, the IRS released Revenue Procedure 2025-19, which provides the 2026 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2026 annual HSA contribution limit will increase to $4,400 for individuals with self-only HDHP coverage (up $100 from 2025) and to $8,750 for individuals with anything other than self-only HDHP coverage (family or self + one, self + child(ren), or self + spouse/domestic partner coverage), an increase of $200 from 2025. 

May 8, 2025

SCOTUS Clarifies Pleading Standards for ERISA Prohibited Transaction Claims and Raises Litigation Concerns for Plan Sponsors

On April 17, 2025, the Supreme Court of the United States unanimously held in Cunningham v. Cornell University that ERISA plan participants alleging a fiduciary breach need only plead that a prohibited transaction occurred. The burden then shifts to plan fiduciaries to assert and prove that an exemption applies. The decision, which resolved a split among the federal circuit courts regarding the proper pleading in ERISA litigation, makes it easier for participants to bring prohibited transaction claims and may increase litigation brought against ERISA plan fiduciaries.  

May 8, 2025

Court Finds Gender-Affirming Care Exclusion Violates ACA Section 1557

On April 18, 2025, a district court in Washington state held that a health insurer’s categorical exclusion of coverage for mastectomies for transgender youth discriminated on the basis of sex in violation of Section 1557 of the ACA. The case involved a pair of parents who sued the insurer, Premera Blue Cross, after it denied coverage for the dependents’ mastectomies and reconstructive surgeries. 

May 8, 2025

Court: ERISA Plan Has Fiduciary Duty to Negotiate Provider Rates

On April 21, 2025, in Mejia v. Credence Mgmt. Solutions, a federal court in the Central District of California denied the defendants’ motion for judgment on the pleadings. The court determined that the plaintiff had grounds to bring this suit due to allegations that the defendants had a fiduciary duty to their health plan to negotiate provider rates, and they violated that duty. 

Apr 23, 2025

District Court Determines IRS Lacks Authority to Impose ACA Penalties

On April 10, 2025, Faulk Co. vs. Becerra, a federal court in the Northern District of Texas Fort Worth Division granted the plaintiff’s motion for summary judgment after determining that the IRS lacked the authority to impose penalties on the plaintiff for failing to offer its employees coverage as required under the ACA. The plaintiff stopped offering minimum essential health insurance coverage to its employees in 2019. The ACA requires employers with 50 or more employees to offer that coverage or face potential penalties...

Apr 23, 2025

Trump Issues Executive Order to Lower Prescription Drug Prices

On April 15, 2025, President Trump signed an executive order titled “Lowering Drug Prices by Once Again Putting Americans First.” As outlined in the accompanying fact sheet, the new executive order expands upon numerous initiatives introduced during the first Trump administration and calls for improved disclosure of PBM compensation to group health plans. It follows a February executive order focused on healthcare transparency requirements...

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PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.

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