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Articles by Benjamin Conley
SCOTUS On ACA Challenge: Seriously Guys, We're Doing This Again?
Seyfarth Synopsis: In a closely watched decision, the Supreme Court has upheld the authority of the U.S. Preventive Services Task Force (Task Force), preserving the Affordable Care Act's (ACA) requirement that health plans cover preventive services–such as HIV prevention medication–without cost sharing. The ruling ensures continued access to a wide range of preventive care for millions of Americans.
SCOTUS on ACA Challenge: Seriously Guys, We’re Doing This Again? | JD Supra
Seyfarth Synopsis: In a closely watched decision, the Supreme Court has upheld the authority of the U.S. Preventive Services Task Force (Task Force), preserving the Affordable Care Act’s (ACA) requirement that health plans cover preventive services–such as HIV prevention medication–without cost sharing. The ruling ensures continued access to a wide range of preventive care for millions of Americans.
States Seeking Remedies For The Rising Costs Of Prescription Drugs
Seyfarth Synopsis: As expected, the lawsuits have commenced following the enactment of the Arkansas legislation prohibiting pharmacy benefit managers (PBM's) from owning or operating actual pharmacies within the state. Michigan has filed its own lawsuit against PBMs. Further, a similar bill targeting PBMs is winding its way through the Illinois legislature.
States Seeking Remedies for the Rising Costs of Prescription Drugs | JD Supra
Seyfarth Synopsis: As expected, the lawsuits have commenced following the enactment of the Arkansas legislation prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. Michigan has filed its own lawsuit against PBMs. Further, a similar bill targeting PBMs is winding its way through the Illinois legislature.
Cutting Out The Middle Man
Seyfarth Synopsis: Arkansas has become the first state in the nation to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBMs) from owning or operating actual pharmacies within the state. We take a look at what that may mean for employers sponsoring health plans with pharmacy benefits in the state. PBMs have become a unifying scapegoat in the escalating concern about the cost of prescription drug coverage in the country.
Cutting Out the Middle Man | JD Supra
Seyfarth Synopsis: Arkansas has become the first state in the national to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. We take a look at what that may mean for employers sponsoring health plans with pharmacy benefits in the state. PBMs have become a unifying scapegoat in the escalating concern about the cost of prescription drug coverage in the country.
EXPERT INSIGHTS-FINAL RULES RELATED TO THE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT MAY DRIVE YOU WILD
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Final Rules Related To The Mental Health Parity And Addiction Equity Act May Drive You Wild
SS Seyfarth Shaw LLP More With more than 900 lawyers across 18 offices, Seyfarth Shaw LLP provides advisory, litigation, and transactional legal services to clients worldwide. Our high-caliber legal representation and advanced delivery capabilities allow us to take on our clients’ unique challenges and opportunities-no matter the scale or complexity.
Final Rules Related to the Mental Health Parity and Addiction Equity Act May Drive You Wild | JD Supra
Seyfarth Synopsis: On September 9, 2024, the Departments of the Treasury, Labor, and Health and Human Services (the “Departments”) released highly anticipated Final Rules under the Mental Health Parity and Addiction Equity Act (MHPAEA). Instead of providing the guidance hoped for by stakeholders, the new rules may leave employers wondering if they should continue to offer mental health (MH) and substance use disorder (SUD) benefits.
Does Section 1557 Apply To Employer Group Health Plans? (And - Why That Question May Not Even Matter)
SS Seyfarth Shaw LLP More With more than 900 lawyers across 18 offices, Seyfarth Shaw LLP provides advisory, litigation, and transactional legal services to clients worldwide. Our high-caliber legal representation and advanced delivery capabilities allow us to take on our clients’ unique challenges and opportunities-no matter the scale or complexity.
Does Section 1557 Apply to Employer Group Health Plans? (And — Why That Question May Not Even Matter) | JD Supra
May 21, 2024 To embed, copy and paste the code into your website or blog: Seyfarth Synopsis: Following years of back and forth, new final rules were published by the Department of Health and Human Services (HHS) on May 6, 2024 reinstituting the Department’s interpretation that the prohibition on discrimination by health programs and activities “on the basis of sex” includes treatments for gender-affirming care. In this post, we explore the rule’s impact on self-funded group health plans.
Agencies Defer Final Action On Junk Insurance, While Suggesting Caution Against One Last
Seyfarth Synopsis: The agencies have finalized a portion of their proposed rules impacting so-called "junk insurance" regarding short-term limited-duration insurance, but deferred finalizing the more significant changes that would have impacted most fixed indemnity policies. In early April 2024, the Treasury Department, Department of Labor, and Health and Human Services (the "agencies") issued final rules regarding short-term limited-duration insurance (STLDI).
Agencies Defer Final Action on Junk Insurance, While Suggesting Caution Against One Last “Binge” | JD Supra
Seyfarth Synopsis: The agencies have finalized a portion of their proposed rules impacting so-called “junk insurance” regarding short-term limited-duration insurance, but deferred finalizing the more significant changes that would have impacted most fixed indemnity policies. In early April 2024, the Treasury Department, Department of Labor, and Health and Human Services (the “agencies”) issued final rules regarding short-term limited-duration insurance (STLDI).
Employers Consider Post-Dobbs Playbook In Dealing With Alabama Ruling On IVF Treatments
Seyfarth Synopsis: Last week, the Alabama Supreme Court ruled that cryogenically frozen embryos are children and are protected from destruction under state law. This is the latest in a series of post-Dobbs judicial rulings and state laws that have upended access to reproductive healthcare. In the wake of the ruling, employers are considering creative options to aid employees in Alabama whose family planning goals have been disrupted.
Drugmaker Sued For…Overpaying For Drugs? Lawsuit Ushers In Expected Wave Of Welfare Fiduciary Litigation
Seyfarth Synopsis: As foreshadowed in our earlier post, the first complaint was filed in what is expected to be a wave of litigation alleging breach of fiduciary duty in selecting and monitoring welfare plan vendors. While the facts of this particular case may make it somewhat distinguishable from the circumstances involved in most employer-sponsored plans, it does provide early insight into how future litigation may proceed.
Employers Consider Post-Dobbs Playbook in Dealing with Alabama Ruling on IVF Treatments
By Diane V. Dygert and Benjamin J. Conley Seyfarth Synopsis: Last week, the Alabama Supreme Court ruled that cryogenically frozen embryos are children and are protected from destruction under state law. This is the latest in a series of post-Dobbs judicial rulings and state laws that have upended access to reproductive healthcare. In the wake of the ruling, employers are considering creative options to aid employees in Alabama whose family planning goals have been disrupted. What Was the Case About?
Employers Consider Post-Dobbs Playbook in Dealing with Alabama Ruling on IVF Treatments | JD Supra
Seyfarth Synopsis: Last week, the Alabama Supreme Court ruled that cryogenically frozen embryos are children and are protected from destruction under state law. This is the latest in a series of post-Dobbs judicial rulings and state laws that have upended access to reproductive healthcare. In the wake of the ruling, employers are considering creative options to aid employees in Alabama whose family planning goals have been disrupted. What Was the Case About?
Drugmaker Sued for…Overpaying for Drugs? Lawsuit Ushers in Expected Wave of Welfare Fiduciary Litigation | JD Supra
Seyfarth Synopsis: As foreshadowed in our earlier post, the first complaint was filed in what is expected to be a wave of litigation alleging breach of fiduciary duty in selecting and monitoring welfare plan vendors. While the facts of this particular case may make it somewhat distinguishable from the circumstances involved in most employer-sponsored plans, it does provide early insight into how future litigation may proceed.
Drugmaker Sued for…Overpaying for Drugs? Lawsuit Ushers in Expected Wave of Welfare Fiduciary Litigation
By Benjamin J. Conley and Sam M. Schwartz-Fenwick Seyfarth Synopsis: As foreshadowed in our earlier post, the first complaint was filed in what is expected to be a wave of litigation alleging breach of fiduciary duty in selecting and monitoring welfare plan vendors. While the facts of this particular case may make it somewhat distinguishable from the circumstances involved in most employer-sponsored plans, it does provide early insight into how future litigation may proceed.
Drugmaker Sued for…Overpaying for Drugs? Lawsuit Ushers in Expected Wave of Welfare Fiduciary Litigation
By Benjamin J. Conley and Sam M. Schwartz-Fenwick Seyfarth Synopsis: As foreshadowed in our earlier post, the first complaint was filed in what is expected to be a wave of litigation alleging breach of fiduciary duty in selecting and monitoring welfare plan vendors. While the facts of this particular case may make it somewhat distinguishable from the circumstances involved in most employer-sponsored plans, it does provide early insight into how future litigation may proceed.
Drugmaker sued for … overpaying for drugs? Lawsuit ushers in expected wave of welfare fiduciary litigation
(March 12, 2024) - Seyfarth Shaw attorneys Benjamin Conley and Sam Schwartz-Fenwick discuss how a recent lawsuit against Johnson & Johnson for breach of fiduciary duty in selecting its prescription drug benefits vendor can help fiduciaries of employer-sponsored plans design vendor selection processes to avoid similar lawsuits.
Eleventh Circuit Holds FMLA Retaliation Requires “But-for” Showing
By Benjamin J. Conley and Joshua A. Rodine Seyfarth Synopsis: The United States Court of Appeals for the Eleventh Circuit affirmed a district court’s decision that “but-for” is the proper causation standard for FMLA retaliation claims addressed within the burden-shifting framework. The Eleventh Circuit’s decision acknowledges that it potentially creates a Circuit split over the threshold a plaintiff must meet to unlawful retaliation in a case based on circumstantial evidence.
Eleventh Circuit Holds FMLA Retaliation Requires “But-for” Showing
Seyfarth Synopsis: The United States Court of Appeals for the Eleventh Circuit affirmed a district court’s decision that “but-for” is the proper causation standard for FMLA retaliation claims addressed within the burden-shifting framework. The Eleventh Circuit’s decision acknowledges that it potentially creates a Circuit split over the threshold a plaintiff must meet to unlawful retaliation in a case based on circumstantial evidence.
Coffee Talk With Benefits Episode 16: Junk Insurance (Podcast)
Coffee Talk With Benefits · Episode 16: Junk Insurance Earlier this year, the Biden-Harris Administration took a firm stance against 'junk insurance' by introducing regulations aimed at impacting short-term limited duration insurance policies, independent non-coordinated coverage, and level funded plan arrangements.
Mental Health Compliance Report Issued to Congress Spoiler Alert – Plans All Fail | JD Supra
Seyfarth Synopsis:The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans and insurers to cover treatments for mental health and substance use disorders in a manner that is equitable to the plans' coverage of medical and surgical treatments. Exactly how that is accomplished and how compliance is proven have been the subject of prescriptive yet ambiguous guidance for several years.
Mental Health Request for Public Comment Spoiler Alert – The Departments Need Help | JD Supra
Seyfarth Synopsis:The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans and insurers to cover treatments for mental health and substance use disorders in a manner that is equitable to the plans' coverage of medical and surgical treatments. Exactly how that is accomplished and how compliance is proven have been the subject of prescriptive yet ambiguous guidance for several years.
Mental Health Parody: In A Cruel Prank, Agencies Respond to Employer Pleas for Guidance with More Stringent Regulations | JD Supra
Seyfarth Synopsis: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans and insurers to cover treatments for mental health and substance use disorders in a manner that is equitable to the plans' coverage of medical and surgical treatments. Exactly how that is accomplished and how compliance is proven have been the subject of prescriptive yet ambiguous guidance for several years.
Mental Health Parody: In A Cruel Prank, Agencies Respond To Employer Pleas For Guidance With More Stringent Regulations
Seyfarth Synopsis: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans and insurers to cover treatments for mental health and substance use disorders in a manner that is equitable to the plans' coverage of medical and surgical treatments. Exactly how that is accomplished and how compliance is proven have been the subject of prescriptive yet ambiguous guidance for several years.
My Insurance Doesn't Cover That? Agency Guidance On
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".
My Insurance Doesn’t Cover That? Agency Guidance on “Junk Insurance” | JD Supra
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”.
OMG! OMB Reviewing Long-Awaited Mental Health Parity Regulations – Public Release Imminent - Employee Benefits & Compensation - United States
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.
EXPERT INSIGHTS-WHO DO I NEED TO SUE TO GET A DECENT CUP OF COFFEE? JITTERY FIDUCIARIES CONSIDER OPTIONS AS HEALTH PLAN LITIGATION FROTHS UP
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OMG! OMB Reviewing Long-Awaited Mental Health Parity Regulations – Public Release Imminent | JD Supra
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.
Who Do I Need To Sue To Get A Decent Cup Of Coffee? Jittery Fiduciaries Consider Options As Health Plan Litigation Froths Up
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.
Who Do I Need to Sue to Get a Decent Cup of Coffee? Jittery Fiduciaries Consider Options as Health Plan Litigation Froths Up | JD Supra
July 13, 2023 To embed, copy and paste the code into your website or blog: 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.
Who Do I Need to Sue to Get a Decent Cup of Coffee? Jittery Fiduciaries Consider Options as Health Plan Litigation Froths Up
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.
Coffee Talk With Benefits Episode 14: Benefit Attorneys in the Wild
Click here to listen to the audio 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 Dygert, Caroline Pieper, Alisha Sullivan, Ben Conley, Jen Kraft, Sam Schwartz-Fenwick, and Ada Dolph covering a range of interesting topics.
FICA Tax Avoidance Wellness Program Viewed Unfavorably By 87,000 New IRS Agents
Seyfarth Synopsis: Just like a bad penny, schemes promising employers ways to reduce their FICA tax burden, and maybe their employees' income tax burden at the same time, keep popping up with a slightly different burnish on the coin. The risks of such an approach have concerned tax practitioners and now the IRS has directly and definitively weighed in on the side of confirming there is no free lunch here.
FICA Tax Avoidance Wellness Program Viewed Unfavorably by 87,000 New IRS Agents | JD Supra
Seyfarth Synopsis: Just like a bad penny, schemes promising employers ways to reduce their FICA tax burden, and maybe their employees’ income tax burden at the same time, keep popping up with a slightly different burnish on the coin. The risks of such an approach have concerned tax practitioners and now the IRS has directly and definitively weighed in on the side of confirming there is no free lunch here.
FICA Tax Avoidance Wellness Program Viewed Unfavorably by 87,000 New IRS Agents
Seyfarth Synopsis: Just like a bad penny, schemes promising employers ways to reduce their FICA tax burden, and maybe their employees’ income tax burden at the same time, keep popping up with a slightly different burnish on the coin. The risks of such an approach have concerned tax practitioners and now the IRS has directly and definitively weighed in on the side of confirming there is no free lunch here.
Final Rules Fix Family Glitch | JD Supra
Seyfarth Synopsis: Recently, on October 11, 2022, the Internal Revenue Service (IRS) issued final regulations which finalized changes to affordability of employer coverage for the family members of employees under Internal Revenue Code (Code) §36B. While these final regulations are seen as “family-friendly” (in their expansion of the availability of the premium tax credit), they likely will have little impact on employers.
Are We There Yet? Emergency Declarations and COVID Relief Are Extended Into 2023 | JD Supra
October 19, 2022 To embed, copy and paste the code into your website or blog: Seyfarth Synopsis: HHS has announced that the COVID-19 Public Health Emergency (PHE) has been extended another 90 days, and will run until January 11, 2023. In response to the COVID-19 pandemic, two separate emergency declarations have been in effect: (1) the COVID-19 PHE and (2) the COVID-19 National Emergency.
Agency FAQs Reveal Employers Continue to Struggle with No Surprises Act & Transparency in Coverage Implementation | JD Supra
September 7, 2022 To embed, copy and paste the code into your website or blog: Seyfarth Synopsis: With staggered effective dates continuing over the course of the next several years, the No Surprises Act (NSA) and Transparency in Coverage requirements impose a number of additional compliance obligations on group health plan sponsors. The DOL, HHS and the Treasury recently issued joint guidance in the form of Frequently Asked Questions (FAQs) attempting to clarify a number of these obligations.
Episode 3: Employee Benefit Impact Of Restrictions On Abortion, Contraceptive And Prenatal Services (Podcast)
Coffee Talk With Benefits · Episode 3: Employee Benefit Impact of Restrictions on Abortion, Contraceptive and Prenatal Services Should the recently leaked SCOTUS draft opinion overturning Roe v. Wade become law this summer, trigger laws across the Country will go into effect, illegalizing abortion in a significant number of states. Other states are exploring implementing new restrictions on abortion, contraceptive and prenatal services.
Businesses Seek To Provide Abortion Travel Benefits In Light Of Potential Supreme Court Decision
*Updated on 5/13/22* Seyfarth Synopsis: In light of recent state-level trends, businesses have begun exploring avenues to assist employees in states with restrictive abortion laws with travel to nearby states to receive abortion services. In implementing these programs, employers should consider the various ERISA and tax code-related provisions that may impact design.
Businesses Seek to Provide Abortion Travel Benefits in Light of Potential Supreme Court Decision | JD Supra
May 13, 2022 To embed, copy and paste the code into your website or blog: Seyfarth Synopsis: In light of recent state-level trends, businesses have begun exploring avenues to assist employees in states with restrictive abortion laws with travel to nearby states to receive abortion services. In implementing these programs, employers should consider the various ERISA and tax code-related provisions that may impact design.
Businesses Seek to Provide Abortion Travel Benefits in Light of Potential Supreme Court Decision
Seyfarth Synopsis: In light of recent state-level trends, businesses have begun exploring avenues to assist employees in states with restrictive abortion laws with travel to nearby states to receive abortion services. In implementing these programs, employers should consider the various ERISA and tax code-related provisions that may impact design.
Businesses Seek To Provide Abortion Travel Benefits In Light Of Potential Supreme Court Decision
Seyfarth Synopsis: In light of recent state-level trends, businesses have begun exploring avenues to assist employees in states with restrictive abortion laws with travel to nearby states to receive abortion services. In implementing these programs, employers should consider the various ERISA and tax code-related provisions that may impact design.
No More Surprises, But Much Uncertainty Over Non-Network Bills
United States: No More Surprises, But Much Uncertainty Over Non-Network Bills 02 March 2022 by Diane V. Dygert and Benjamin Conley Seyfarth Shaw LLP Your LinkedIn Connections with the authors To print this article, all you need is to be registered or login on Mondaq.com.
No More Surprises, But Much Uncertainty Over Non-Network Bills | JD Supra
Seyfarth Synopsis: Last summer and fall, the Departments of Treasury, Labor, and Health and Human Services issued Interim Final Rules (IFRs) [here] and [here], implementing the sweeping changes that applied to out-of-network health care providers and health plans under the No Surprises Act. While much of the IFR content was welcome relief for health plans and participants, not all providers were content with the new rules, leading to the filing of several lawsuits.
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