EBIA Weekly Newsletter

Seventh Circuit Enforces Plan Clause Restricting Where Participants May Sue

   September 7, 2017

In re Mathias, 2017 WL 3431723 (7th Cir. 2017) Available at http://media.ca7.uscourts.gov/cgi-bin/rssExec.pl?Submit=Display&Path=Y2017/D08-10/C:16-3808:J:Sykes:aut:T:fnOp:N:2009479:S:0 The Seventh Circuit has determined that ERISA does not preclude a plan document from designating the venue for lawsuits against the plan. (“Venue” refers to the place where a court is located.) ERISA’s venue provision allows a lawsuit to … Read More

Health Benefit Arrangement for Tribal Members Is Not Part of Tribe’s ERISA Plan for Employees

   September 7, 2017

Saginaw Chippewa Indian Tribe of Mich. v. Blue Cross Blue Shield of Mich., 2017 WL 3007074 (E.D. Mich. 2017) Available at https://www.gpo.gov/fdsys/pkg/USCOURTS-mied-1_16-cv-10317/pdf/USCOURTS-mied-1_16-cv-10317-4.pdf An Indian tribe sued its third-party administrator (TPA) for breach of fiduciary duty under ERISA, asserting that undisclosed fees were charged for administering its health benefit program. A Sixth … Read More

Can a Health Plan Impose a Fail-First Requirement for Opioid Use Disorder Treatments?

   September 7, 2017

QUESTION: Our health plan requires a participant to try and fail at counseling as a treatment for opioid use disorder before it will authorize coverage for medication assisted treatment (MAT), which involves both counseling and medication and is more costly. Would this be considered an impermissible “fail-first” requirement? ANSWER: A “fail-first” requirement is a health … Read More