Employer Defeats COBRA Claims of Employee Offered Subsidized Coverage in Severance Agreement

EBIA Newsletter April 19, 2018

Thorson v. Aviall Servs., Inc., 2018 WL 1426971 (N.D. Tex. 2018) Available at https://www.gpo.gov/fdsys/pkg/USCOURTS-txnd-3_15-cv-00571/pdf/USCOURTS-txnd-3_15-cv-00571-3.pdf The mother of a deceased employee sued her son’s former employer and benefits administrator, alleging breach of a severance agreement and numerous COBRA violations. As part of a corporate restructuring, the employer and employee had entered into … Read More

CMS Issues 2019 Medicare Part D Benefit Parameters Used for Creditable Coverage Disclosures

EBIA Newsletter April 19, 2018

Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter (Apr. 2, 2018) Available at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf Under Medicare Part D regulations, most group health plan sponsors offering prescription drug coverage to Part D eligible individuals (including active or disabled … Read More

HHS Finalizes 2019 Benefit and Payment Parameters and Extends Transition Policy Allowing Certain Noncompliant Policies

EBIA Newsletter April 19, 2018

PPACA; HHS Notice of Benefit and Payment Parameters for 2019, 45 CFR Parts 147, 153, 154, 155, 156, 157, and 158, 83 Fed. Reg. 16930 (Apr. 17, 2018); HHS Notice of Benefit and Payment Parameters for 2019 Fact Sheet (Apr. 9, 2018); Insurance Standards Bulletin Series—INFORMATION—Extension of Transitional Policy through 2019 (Apr. 9, 2018) Read More

Mental Health Parity Claim Challenging Nutritional Counseling Treatment Limitation Can Proceed

EBIA Newsletter April 19, 2018

Bushell v. Unitedhealth Group Inc., 2018 WL 1578167 (S.D.N.Y. 2018) An individual with anorexia nervosa sued the insurer of her group health plan after it denied her claim for nutritional counseling to treat her condition. The insurer asserted that nutritional counseling was not covered under the plan. However, the individual claimed that the insurer covered … Read More