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More Health Plan Participants Checking Out Prices (PDF)

The latest Thomson Reuters-NPR Health Poll found that a 16 percent of Americans indicated they sought pricing information before receiving healthcare services, and of those who did, 49 percent received this information from insurance companies. This represents a significant shift from when respondents were asked the same questions in 2010, when only 11 percent said they sought such pricing information.

COBRA Lawsuit Against Tribal Casino Survives Dismissal (PDF)

"ERISA's COBRA provisions generally do not apply to a group health plan sponsored by an Indian tribal government if the plan qualifies as a governmental plan. For this exemption to apply, all participants must be employees of the tribal entity, and substantially all of their services must be in the performance of essential governmental functions -- not commercial activities such as operating a casino or hotel.... [B]ased solely on the facts in the opinion, the Tribe's reliance on COBRA's gross misconduct exception seems shaky at best." [Meilstrup v. Standing Rock Sioux Tribe, No. 25-0162 (D.N.D. Oct. 9, 2025)]

Final Forms and Instructions for 2025 ACA Reporting Are Available (PDF)

"With the issuance of the final forms and instructions ... filers should have all the tools they need to prepare for filing the 2025 forms. Filers should note the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act changes, including that forms can be delivered electronically with consent, the date of birth can be used if a TIN isn't available, and ACA penalty assessments have a six-year limit starting with returns due after December 31, 2024"

Do We Have to File a Gag Clause Prohibition Compliance Attestation Every Year?

"The GCPCA attests to a health plan's (or insurer's) compliance with the prohibition against 'gag clauses' in any agreements with providers, provider networks, or entities offering provider network access -- including downstream agreements entered into by plan service providers.... An attestation of compliance with the gag clause prohibition must be made by December 31 each calendar year."

District Court Dismisses Challenge to Tobacco Surcharges Under Wellness Program

"The court found that the disputed surcharge did not violate rules prohibiting discrimination on the basis of a health-status related factor under [ERISA] ... The court also concluded that the participant lacked Article III standing to bring a fiduciary breach claim under ERISA." [Williams v. Bally's Management Group, LLC, No. 25-00147 (D.R.I. Nov. 4, 2025)]

Do We Still Have to Comply with the HIPAA Privacy Rule to Support Reproductive Health Care? (PDF)

"[C]overed entities and business associates do not need to update HIPAA policies and procedures, risk assessments, business associate agreements, and training for the 2024 Privacy Rule. Covered entities and business associates who took actions to comply with the 2024 Privacy Rule before the nationwide injunction was issued should consult legal counsel regarding further actions."

District Court Vacates ACA Section 1557 Gender-Identity Discrimination Rules

"Focusing on the legal and historical distinctions between Title VII and Title IX, this case limits the scope of Section 1557's protections. Although the gender-identity discrimination provisions had already been blocked from enforcement, this decision officially vacates the rules." [Tennessee v. Kennedy, No. 24-0161 (S.D. Miss. Oct. 22, 2025)]

TPA's Proof of Mailing COBRA Election Notice Defeats Claim of Non- Receipt (PDF)

"While many plans contract with TPAs to provide election notices to qualified beneficiaries, TPAs rarely agree to serve as the plan administrator, so the employer typically remains liable for any failure to provide timely notices. Plan administrators using a TPA to send election notices should verify that the TPA will maintain adequate documentation of what was mailed and when and will agree to indemnify the employer for any failure to properly provide required notice." [Casillas-Guardiola v. Bayer Puerto Rico, Inc., No. 22-1167 (D. P.R. Sep. 30, 2025)]

When Is a Qualified Beneficiary Considered 'Entitled to Medicare' for Purposes of Terminating COBRA Coverage Early? (PDF)

"[T]he Medicare terms 'eligibility' and 'entitlement' are not synonymous, and it is important to understand the difference. 'Entitlement' means that an individual who is eligible for Medicare has actually enrolled in Medicare and may currently receive benefits. An individual who must take additional steps to enroll in Medicare before receiving benefits is not yet 'entitled' to Medicare for purposes of the COBRA rules."

What Are the Disclosure Requirements for Group Health Plan Service Provider Agreements? (PDF)

"For a covered service provider's compensation to be considered reasonable, the service provider must disclose specified information in advance and in writing to a responsible plan fiduciary. Broadly, the disclosure must describe the services to be provided, indicate whether the service provider expects to be a plan fiduciary, and describe all forms of direct and indirect compensation the service provider expects to receive in connection with the arrangement, including the manner in which compensation will be received."