Health & Welfare Plans

This post was originally published to Seyfarth’s Global Privacy Watch Blog.

As organizations begin renewing and entering into new contractual relationships for 2024, an oft-forgotten aspect of the contracting process is determining whether a Business Associate Agreement (a “BAA”) is required. Under HIPAA, health care providers, health plans and health care clearinghouses (“Covered Entities”)

Seyfarth Synopsis: Fresh on the heels of the IRS Chief Counsel Memorandum on wellness and indemnity products, discussed in our prior post here, the agencies have weighed in with more formal and more expansive guidance throwing more cold water on the tax treatment of these types of products, that the Administration has dubbed “junk insurance”. 

Background

On July 7th, the Treasury Department, Department of Labor, and Health and Human Services (the “agencies”) issued proposed rules impacting “junk insurance”. The guidance proposes (i) changes to what qualifies as short-term, limited-duration insurance, (ii) amendments to the requirements for independent, non-coordinated coverage, and fixed indemnity insurance to be considered an “excepted benefit”, and (iii) clarifications of the tax treatment of fixed amount benefit payments under employment-based accident and health plans. The IRS also asks for comments on coverage limited to specified diseases or illnesses that qualifies as excepted benefits and on level-funded plan arrangements.Continue Reading My Insurance Doesn’t Cover That? Agency Guidance on “Junk Insurance”

Seyfarth Synopsis: Employer health plan sponsors, administrators, and insurers have been eagerly awaiting the U.S. Department of Labor’s upcoming guidance on mental health parity.  According to recent reports, newly proposed MHPAEA regulations have been sent to the White House for review and their public release is imminent. 

In 2020, Congress amended the Paul Wellstone and

Seyfarth Synopsis: In light of the end of the COVID-19 National Emergency and Public Health Emergency (see our prior blog post here), the Internal Revenue Service (“IRS”) has announced the end of prior COVID-19-related special rules for health plan coverage.

On June 23, 2023, the IRS issued Notice 2023-37 to clarify the compatibility of

Seyfarth Synopsis: In light of a recent focus on price transparency, claims data, and hidden fees in the health plan world, employer-sponsored health plans have been bringing their fight to the courtroom in an effort to lower costs and demonstrate good fiduciary governance.

In the wake of the Consolidated Appropriations Act, as well as newly-issued transparency regulations, employers sponsoring group health plans now have access to (or should have access to) a bevy of data not previously available in the notoriously secretive space of health plan pricing. As predicted, this new era of information transparency has spurred a small but growing stream of lawsuits. Surprisingly though, the plaintiffs in these suits are plan sponsors (or their committees) in their role as plan administrator, as opposed to plan participants, and the defendants are health plan third-party administrators rather than the plans themselves. In light of these recent lawsuits, this post focuses on fiduciary considerations for health plans in this new era of fee and price transparency.

While each lawsuit filed to date has unique aspects, they all generally allege some combination of the following:

  • Failure to adequately and fully disclose payment data as required by law;
  • Imposition of hidden and unreasonable fees;
  • Breach of fiduciary duty; and
  • Claims mismanagement and overpayment.

Continue Reading Who Do I Need to Sue to Get a Decent Cup of Coffee? Jittery Fiduciaries Consider Options as Health Plan Litigation Froths Up

On this episode of Coffee Talk With Benefits, Richard and Sarah venture out of the office as part of an Employee Benefits retreat and engage in brief discussions with their colleagues, Diane DygertCaroline PieperAlisha SullivanBen ConleyJen KraftSam Schwartz-Fenwick, and Ada Dolph covering a range

Seyfarth Synopsis: The 5th Circuit Court of Appeals has stayed enforcement of a Texas federal district court ruling that that voided the ACA requirement for health plans to cover preventive care items and services (without cost sharing) recommended by the United States Preventive Services Task Force (“USPSTF”) effective as of March 23, 2010.

Update: On June 13, 2023, the 5th Circuit issued a stay order which freezes the ruling issued by a Texas federal district court that voided the ACA requirement for health plans to cover preventive items and services (without cost-sharing) recommended by the U.S Preventive Services Task Force (USPSTF). For more information, see our blog post

Seyfarth Synopsis: The Consolidated Appropriations Act, 2021 (“CAA”) contains a requirement that that group health plans may not have agreements with service providers that would restrict certain information that the plan may make available to another party (the “Gag Clause Prohibition”) and must attest on an annual basis that they are complying (the “Compliance Attestation”).