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Emerging Alternatives for GLP-1 Prescription Drug Coverage: What Plan Sponsors Need to Know

"Direct-to-consumer reimbursement models have emerged as a compelling alternative, enabling participants to obtain these medications at reduced prices while shifting claims processing outside traditional PBM frameworks. [This article outlines] the key legal and administrative considerations plan sponsors must address before adopting these arrangements."  MORE >>

ERISA Preemption Is Alive and Well

"The Sixth Circuit determined that the Tennessee any-willing-provider provision impermissibly restricted self-funded ERISA plans because by removing the plan sponsor's choice of pharmacy network providers, the law effectively made network decisions, which were 'a central matter of plan administration,' and required plans to be designed in a particular way.... The incentive and disincentive provisions were also held to be impermissible restrictions on self-funded ERISA plans by dictating key plan design and structure requirements[.]" [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

ERISA Welfare Plan Participant Disclosures Checklist (PDF)

8 page chart lists required disclosures, along with required timing for initial disclosure and other periodic disclosures.  MORE >>

Welfare Plan Class Action Litigation Underscores Importance of Minding Your Fiduciary Duties

"The [CAA's] compensation disclosure rules are of particular interest to plaintiffs' attorneys, as they may lead to increased scrutiny of the underlying fees and result in litigation related to unreasonable vendor fees and services.... [Here are] clear, actionable steps employers can take to prepare for this potential new wave of litigation.... [P]olicies and procedures related to retirement plans will serve as a useful guide for health and welfare plan fiduciaries seeking protection from these novel lawsuits."

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Key Benefits Issues to Watch During the Remainder of 2024

"[1] SECURE 2.0 optional provisions & additional regulatory guidance.... [2] Prescription drug prices and state PBM legislation.... [3] Welfare plan compensation disclosure and fee litigation.... [4] Cybersecurity.... [5] Gender affirming care considerations.... [6] ACA affordability threshold."

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CMS and HHS Withdraw Appeal to Federal District Court Decision on Copay Accumulator Rule

"CMS and HHS stated their intent to issue new rulemaking and to exercise enforcement discretion pending issuance of a final new rule, which likely reduces the associated risk of implementing or operating Accumulator Adjustment Programs in the short term.... [B]ecause the 2020 Accumulator Rule is currently in effect per the Court's decision, hubs, copay vendors, and drug manufacturers should prepare to comply with the rule and only utilize Accumulator Adjustment Programs, where allowed by state law, for branded drugs with a generic equivalent." [HIV and Hepatitis Policy Inst. v. HHS, No. 22-2604 (D.D.C. Sep. 29, 2023)]  MORE >>

Common 401(k) Plan Errors and How to Fix Them

"This article summarizes the voluntary correction programs administered by the [IRS] and the [DOL], identifies the most common 401(k) plan errors, walks readers through their corresponding correction methods, and includes a brief 'best practices' section to help safeguard against the occurrence of future plan errors."

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Tolling No More: Preparing for the End of COVID-19 Emergency Declarations

"[T]he Outbreak Period [should] end on July 10, 2023 (60 days after the planned end to the NE).... [P]lan sponsors should consider sending a communication to inform participants about deadline changes ... [and] review plan-related documents and participant communications to ensure they reflect accurate deadlines.... The end of the PHE may permit group health plans and insurers to shift some of these costs to participants.... [Plan sponsors should] ensure proper participant notices and communications are timely distributed and no issues arise under the Mental Health Parity and Addiction Equity Act."

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2022 ERISA Welfare Plan Automatic Participant Disclosures Checklist (PDF)

"The disclosures described in this [6-page] checklist are limited to the disclosures required to be provided automatically at the time of eligibility/enrollment or periodically thereafter for existing welfare plans.... [N]ot all of the items in this checklist will apply to all welfare plans[.]"  MORE >>

2020 ERISA Welfare Plan Checklist for Participant Disclosures

"[Many employers] sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications.... [This] Participant Disclosures Checklist [can be used] during open enrollment and throughout the plan year."  MORE >>

NY District Court Ruling Invalidates DOL's Final Rule Related to FFCRA

"The court's order would seem to render employees who are furloughed for lack of work to be eligible for EPSL if they experience a qualifying reason for EPSL while out on furlough.... The SDNY court also struck down any requirement that the employer must agree to intermittent leave under EPSLA. Intermittent leave is only available for conditions that are unrelated to any possible transmission of the virus by the employee." [New York v. U.S. Dept. of Labor, No. 20-3020 (S.D.N.Y. Aug. 3, 2020)]  MORE >>

2019 ERISA Welfare Plan Checklist for Participant Disclosures (PDF)

"[Many employers] sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. ... [This] Participant Disclosures Checklist [can be used] during open enrollment and throughout the plan year."  MORE >>

2018 Welfare Plan Participant Disclosure Checklist (PDF)

6 pages. Designed for use during open enrollment as well as during the plan year.  MORE >>

2016 Welfare Plan Disclosure Checklist

6 pages. Designed for use during open enrollment as well as during the plan year.  MORE >>

Covered Entities and Business Associates: The Audits are Coming! Is Your HIPAA House in Order?

"[E]ntities receiving communication from OCR at this point are not guaranteed an audit. OCR is currently in its selection process, and will use this initial process of communicating with entities to gather data about the size, type and scope of operations of the potential auditees to determine its pool. After OCR's pool has been determined, selected auditees will receive a document request and specific instructions on how to provide all requested materials."  MORE >>

New Mandatory Paid Sick Leave Rules Could Ensnare Unwary Federal Contractors

"[T]he rules require that the employer make and maintain during the course of the covered contract and for a three year period thereafter several records, including copies of 'balance' notifications sent to employees (at least monthly); copies of employees' requests to use paid sick leave, if in writing, or other documents reflecting such a request; dates and amounts of paid sick leave used by employees ... any records relating to required certification and documentation; or any other records showing any tracking of or calculations related to an employee's accrual and/or use of paid sick leave."  MORE >>

2015 Checklist for ERISA Welfare Plans: Required Disclosures to Participants (PDF)

6 pages. Designed for use during open enrollment as well as during the plan year.  MORE >>

Federal District Court in California Asked to Determine Retroactive Applicability of United States v. Windsor

"The IRS has stated its position. In Notice 2014-19, the IRS stated that retirement plans are not required to recognize same-sex spouses prior to June 26, 2013, the date of the Windsor decision. However, the IRS permits employers to amend their plans to reflect the outcome of Windsor prior to June 26. In other words, employers can provide retroactive benefits, but they are not required to do so. It seems unlikely that the California district court, and perhaps ultimately the Supreme Court, would take a position different from the IRS. Nonetheless, employers should keep a close eye on the outcome of the decision. If the court finds that Windsor should be applied retroactively to employee benefits, it is possible that many other suits may be filed, and those suits may not be limited to surviving spouse benefits."  MORE >>

EEOC Targets Voluntariness of Employer-Sponsored Wellness Programs

"[A table in this article] summarizes certain facts related to the wellness programs at issue. The employee incentives involved in these cases are significant; employees who elect to forgo participation in the programs lose 'incentives' such as eligibility for health insurance coverage or 100% employer-paid premiums.... Although it is clear from the complaints that the EEOC believes the penalties at issue render the wellness programs involuntary, the complaints do not shed much light on the threshold at which an incentive is deemed a penalty that renders a wellness program involuntary."  MORE >>

Court Finds no Discrimination Based on Health Insurance Use

In addition, the court noted that Berry's son's diagnosis preceded his termination by a few months and given his history of disagreements, defendants could have fired him far closer to the son's diagnosis if their true intent was to firm Berry to avoid paying for medical care.

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