"The guidance permits most sponsors of group health plans that annually calculate whether their coverage is creditable for Medicare Part D purposes to use either existing calculation methods or a revised simplified determination for 2026 benefit designs.... The Inflation Reduction Act made substantial improvements to the value of the standard Part D prescription drug benefit ... [G]roup health plan coverage generally would have to be richer to meet the creditable coverage standard."  MORE >>

"While we don't know the exact number of class action plaintiffs, we do know that Ms. Marrow was one of three covered participants in her family.... For the Marrows alone, this would amount to $452,100 ... The plaintiffs argue that the COBRA notice incorrectly stated that qualifying beneficiaries had 60 days from their last day of employment to elect COBRA continuation coverage.... The plaintiffs also argue that expressing the deadline as a number of days from a specific date requires qualified beneficiaries to perform calendar calculations." [Marrow v. E.R. Carpenter Company, Inc., No. 23-2959 (M.D. Fla. Feb. 4, 2025)]  MORE >>

"The court found that Barrera's expressed intent and actions, including notifying Walgreens and the subsequent actions taken by Prudential, met this standard. Prudential's recognition of Christine Morgan as a beneficiary, as evidenced by their communications, further supported the conclusion that there was substantial compliance." [Morgan v. Barrera, No. 21-20497 (5th Cir. Apr. 21, 2025)]  MORE >>

"Employees have filed more than 30 putative class actions against employers challenging tobacco premium surcharges.... Defendants in four cases have entered into settlements on a class action basis, with the settlements ranging from 35-62% of the value of the tobacco premium surcharges collected by the employers over a multi-year time period. Motions to dismiss are pending in more than a dozen cases in federal district courts across the country. One district court has allowed the tobacco premium surcharge claims to proceed past a motion to dismiss." [Mehlberg v. Compass Group, USA, Inc., No. 24-4179 (W.D. Mo. Apr. 15, 2025)]  MORE >>

"[P]laintiffs alleged that the internal guidelines for deciding when to cover residential mental health treatments are misaligned with the medical community and focus too much on short-term crisis intervention while minimizing the importance of chronic and persistent symptoms that require different types of care. These actions were alleged to be in violation of [ERISA] and the [MHPAEA]." [Collins v. Anthem, Inc., No. 20-1969 (E.D.N.Y. status report filed Apr. 15, 2025)]  MORE >>

"[T]he complexity and opacity of TPA and PBM arrangements present unique legal and financial risks to plan sponsors.... This article highlights key legal standards, common contractual pitfalls and practical steps that plan sponsors can take to proactively and strategically mitigate fiduciary breach risk, while maximizing value for participants with respect to TPA and PBM agreements."  MORE >>

20 pages; updated Apr. 2025. "For small employers, there are, broadly speaking, three commonly encountered alternative approaches that have gained traction in the marketplace.... This Special Report examines and explains these options available to, and the obstacles routinely encountered by, small employers as they seek to make affordable health insurance coverage available to employees and their families."  MORE >>

"Critical illness insurance is typically offered through an employer's benefit plan. It pays a lump-sum benefit directly to an employee when a certain type of disease or condition is diagnosed. The funds can be used any way the beneficiary chooses -- whether it's treatment expenses left uncovered by health insurance or incidental expenses incurred, like family hotel stays next to a faraway medical facility."  MORE >>

"CVS plans to close up to 23 of its pharmacy locations in Arkansas as a result of the signing of HB1150, which bans pharmacy benefit managers (PBMs) from owning pharmacy storefronts. This statewide event could serve as a precursor to significant change in the U.S. pharmacy industry if similar federal bills are signed into law."  MORE >>

20 pages. "Health plans must cover pharmacists' patient care services under the medical benefit regardless of setting and align coverage and reimbursement with that of other provider types.... When coverage and sustainable reimbursement for pharmacists' patient care services are available under the medical benefit, pharmacists and pharmacies should actively partner with health plans to deliver services and drive collective patient care outcomes."  MORE >>

"To keep the total cost of care reasonable, some entity must be responsible for limiting both fees and use of care, and for the most part, employers have ceded this responsibility to health plans.... Employers and employees can use their health insurance benefit designs to make health care more affordable, and without the need for further taxpayer subsidies, be designing tiered networks of providers who are responsible for meeting specific total cost of care benchmarks."  MORE >>

"Until now, Rule 7 has not been commonly invoked in ERISA cases, but the Court's invitation will likely prompt an increased resort to that procedural device. In the face of this lower pleading standard, courts must be prepared to more aggressively manage litigation so that the ability to plead a bare-boned prohibited transaction claim does not become a cudgel to extract unwarranted settlement payments." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]   MORE >>

"This holding will impact ERISA breach of fiduciary pleadings and procedural practice. Defendants' ability to obtain a dismissal of prohibited transaction claims under Rule 12 will be severely limited. However, the Court points defendants to another procedural mechanism to curtail unfettered ERISA fiduciary duty litigation: Rule 7(a) of the Federal Rules." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]  MORE >>

"In this white paper, Cassidy is proposing to: [1] Establish a safe harbor for companies, so they can offer portable benefits to independent workers without the fear of misclassification lawsuits. [2] Give workers clarity and consistency by instituting a single employment test under federal law. [3] Increase health care coverage options for independent workers.... [4] Empower independent workers to participate in retirement plans, like pooled employer plans and single employee pension IRAs, that are already available under federal law."  MORE >>