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15 Health Plan Law Guidance Pointers from the Department of Labor

Health Plan Law Blog Adds Due Diligence Page

Health Plan Law Blog's ERISA TOOLKIT Page, Updated April 4, 2007

Third Quarter State Law Overview: A Surge in Activity Affecting Health Plan Compliance

"Over the past quarter, federal and state actions continued to reshape the legal and compliance landscape for health plans in the areas of abortion and gender-affirming care.... [This article highlights] the most consequential legal shifts and emerging trends that health plan sponsors and employers should be tracking as they navigate an increasingly complex regulatory environment."

Self-Funded Plans Take Note: Supreme Court Holds that ERISA Preempts Vermont Health Plan Reporting Law

"On top of the numerous reporting requirements for group health plans imposed by the [IRS] and other federal agencies, state laws, including Vermont's, add a layer of state reporting obligations for plans, including self-funded group health plans. In welcome news for employers and plan sponsors, this added state law burden has been lessened by the U.S. Supreme Court's finding that certain state laws are preempted by federal law." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)]

NY Governor Signs Law to Allow Dependent Children to Remain Covered Under the Employer's Health Plan Through Age 29

Excerpt: Governor Paterson has signed a law that revises New York State Insurance Law section 3221 to require a commercial insurer, which provides a group health insurance policy to an employer, to offer an election to an employee under that policy to continue the health care coverage of his or her dependent children who have otherwise 'aged off' of the coverage. These children may continue to be covered under the group policy through age 29, as long as they do not become eligible for other employer sponsored health insurance coverage, and are not covered by Medicare. The children need not be financially dependent on their parents to receive this coverage. For purposes of the new law, a 'dependent child' is any child of an employee who is unmarried and is under age 30.

New Federal SCHIP Law Requires Cafeteria and Health Plan Amendments

Excerpt: Before April 1, 2009, you will need to amend your health plan and your cafeteria plan to accommodate the new special enrollment rights. You should also look at your health plan's coordination of benefit rules to see if they need to be updated to reflect that SCHIP supplemental coverage will pay secondary to your plan. You will not need to start using the new notice and disclosure forms until the first plan year that follows their availability. Although the Department of Health & Human Services has until February of 2010 to develop the forms, we expect that the Department will push to have these forms out in 2009.

Self-Funded Health Plan Sponsors Are Required to Comply with Illinois Disclosure Law

"Who is required to disclose the comparison to group health plan participants? ... Does this requirement apply to ERISA self-funded plans? ... When should the disclosure be provided to employees? ... Will a business be penalized if its group health insurance coverage benefits are not the same as those included in the Essential Health Benefits list?"

Eleventh Circuit Finds Employer's Health Plan Violated Federal Law by Denying Coverage for Gender-Affirming Care

"A federal appeals court has upheld a lower court's ruling that the Houston County, Ga., Sheriff's Office violated antidiscrimination law by denying transition-related health care to a deputy.... It is only the second decision by a federal appellate court affirming that it is unlawful for an employer to discriminate against transgender people in an employee health plan ... [and] is immediately binding on employers in Georgia, Florida, and Alabama, the states covered by the 11th Circuit[.]" [Lange v. Houston County, Georgia., No. 22-13626 (11th Cir. May 13, 2024)]

New Michigan Law Will Increase Employers' Health Plan Costs

The Michigan legislature has passed a new law which will impose a 1 percent assessment on all paid claims under fully-insured and self-funded employer group health plans beginning in 2012.