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In 2021, the U.S. Department of Labor (DOL) issued 3 documents outlining guidance on cybersecurity practices for benefits plans, which we discussed in a blog post at the time. The DOL recently issued revised versions of the original three documents in its Compliance Assistance Release No. 2024-01. The revised versions of these documents clarify…

Both companies and their C-suite executives should be mindful of the interactions between COBRA and Medicare and their implications when negotiating a severance or retirement arrangement. This is because Medicare enrollment can terminate COBRA coverage, depending on the timing of when an executive elects COBRA and when they enroll in Medicare, and because an executive…

Last week, the Departments of Labor, Treasury and Health and Human Services (“the Departments”) issued an FAQ about the final Transparency in Coverage rules (“TiC Rules”). This FAQ addresses compliance with cost‑sharing disclosure requirements where a plan is providing cost estimates based on claims data but there is extremely low utilization of the item or…

Last week, the Departments of Labor, Treasury and Health and Human Services rolled back two non-enforcement policies related to the machine-readable file requirements included in the transparency in coverage (TIC) final rules: (1) deferred enforcement of the requirement that health plans post a machine-readable file listing negotiated rates and historical net prices for covered prescription drugs, and (2) an enforcement safe harbor with respect to the requirement that dollar amounts be listed in the in-network rate machine-readable file for items and services for which it is difficult to ascertain dollar amounts in advance. The guidance was released in the form of FAQs, which can be viewed here.

By way of brief background, for plan years starting on or after July 1, 2022, non-grandfathered health plans are required to post three machine-readable files (updated monthly) covering the following: (1) in-network rates (expressed as a dollar amount) for covered items and services, (2) allowed amounts for covered items and services furnished by out-of-network providers, and (3) negotiated rates and historical net prices for covered prescription drugs. 

On December 30, 2021, the U.S. Department of Labor (“DOL”) issued Field Assistance Bulletin No. 2021-03 (“FAB”), announcing its temporary enforcement policy for group health plan service provider disclosures under ERISA section 408(b)(2)(B).

The Consolidated Appropriations Act of 2021 (“CAA”) amended ERISA section 408(b)(2) to require “covered service providers”…

Formally wading into the cybersecurity discussion for the first time, on April 14, 2021, the U.S. Department of Labor (DOL) posted on its website a suite of new guidance, including Tips for Hiring a Service Provider with Strong Cybersecurity Practices, Cybersecurity Program Best Practices, and Online Security Tips for Participants and Beneficiaries.…

Our blog series on best practices in administering benefit claims has thus far stressed the importance of knowing and reading the plan document and summary plan description.  This week, we take a look at a plan term that has been the subject of frequent dispute in health and welfare benefits claim litigation—interpretation of plan provisions…

The Third Circuit recently held that anti-assignment clauses in ERISA-governed healthcare plans are enforceable as long as they are unambiguous.  The Court concluded that the anti-assignment clause clearly stated that participants could not assign their rights under the plan; and the plan’s statement that payments made directly to a provider did not transfer to that…