"[T]he 6th Circuit Court of Appeals held that the employer adequately alleged that its third-party claims administrator (TPA) was a fiduciary and, as such, violated ERISA by causing the employer's welfare plan to overpay medical claims. It also held that the employer is authorized under ERISA to seek equitable remedies from the TPA in the form of disgorgement of profits." [Tiara Yachts, Inc. v. Blue Cross Blue Shield of Mich., No. 24-1223 (6th Cir. May 21, 2025)]  MORE >>

"The court ruled that a mere 'good faith effort' to comply with COBRA notice requirements is an insufficient reason to dismiss a lawsuit from a former employee, claiming that a defective COBRA notice ... influenced her decision to reject continuation coverage.... The employer did not use DOL's Model COBRA notice and instead provided a notice that, among other things, provided incorrect or inconsistent information about the time frame for her to make an election and the required time for making COBRA payments." [Marrow v. E.R. Carpenter Company, Inc., No. 23-2959 (M.D. Fla. Feb. 4, 2025)]  MORE >>

"For employers who sponsor group health plans, it is critical to understand how ERISA fiduciary duties apply to PBM selection, oversight and cost containment. As the courts begin to adjudicate these cases, the outcomes may significantly alter how employers manage and monitor prescription drug benefits."  MORE >>

"As some health insurance companies have come under fire for allegedly using computer systems to shoot down claims, an Arizona law will soon make the practice illegal ... House Bill 2175 requires a physician licensed in the state to conduct an 'individual review' and use 'independent medical judgment' to determine whether the claim should actually be denied."  MORE >>

"Flexible work arrangements, including hybrid and remote options, remain a cornerstone of modern benefits packages ... Mental health benefits are gaining traction as employees demand holistic well-being support.... Employers are offering benefits like student loan repayment assistance, emergency savings plans, and financial planning workshops.... 35% of companies now tie benefits to corporate social responsibility ... AI and automation are transforming benefits administration, making it more efficient and user-friendly."  MORE >>

"From flexible reimbursement models to lean compliance-focused plans to transparency-first pricing strategies, you have more than one option of traditional group insurance. Each approach comes with its own pros and cons -- and understanding those trade-offs is key to making the best decision for your business and your employees."  MORE >>

"According to data from [CMS], a total of 1,265,737 disputes were initiated through the IDR process in 2023 and the first half of 2024, spanning emergency and non-emergency services. Providers and facilities initiated the vast majority of these disputes (90%) and won 80% of the time. The top ten initiating parties were all affiliated with private equity."  MORE >>

"Residents of Utah are the most covered by employer provided health insurance, according to the report, with 60% of residents covered. Eighty-two percent of workers in Utah work for companies offering insurance coverage; the average employer contribution for single coverage is $5,016.... Florida has the least amount of residents with employer provided health insurance coverage, with only 40% covered. Eighty-four percent of workers in Florida work for companies offering insurance and the average employer contribution for single coverage is $5,942."  MORE >>

"[S]upport for procedures such as IVF and artificial insemination has increased in recent years through employer-sponsored insurance plans, including those contracted to the federal government through the Federal Employees Health Benefits (FEHB) program. Focusing on policy change within the FEHB would build on this momentum[.]"  MORE >>