A new secret shopper study published in JAMA Health Forum on October 16, 2026 puts hard numbers on issues related to mental health network adequacy and provider directories. The study, Mental Health Ghost Networks in Commercial Insurance Plans, tested the directories of the largest commercial carrier in each of five states and found that
The en banc Eleventh Circuit in Bolton v. Inland Fresh Seafood Corporation of America, Inc. overruled Mason v. Continental Group, Inc. “to the extent [Mason and its progeny] hold that ERISA itself requires exhaustion of statutory claims (including those alleging a breach of fiduciary duty).” The term “exhaustion” simply means that, before suing, a
A newly filed class action against Cigna Health and Life Insurance Company puts a spotlight on a common but often overlooked feature of administrative services only (ASO) agreements: “shared savings” fees that pay the third-party administrator (TPA) a percentage of the amount it “saves” the plan on out-of-network claims. The complaint, Kreutzmann v. Cigna Health
On September 17, 2026, the Second Circuit handed down a significant decision for self-insured group health plans, holding that the No Surprises Act (“NSA”) does not create a private right of action for out-of-network providers to enforce payment awards obtained through the independent dispute resolution (“IDR”) process. The ruling in East Coast Advanced Plastic Surgery
On September 8, 2026, the Department of Labor’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03 (FAB 2026-03 or the Bulletin), announcing a focused enforcement policy for the Mental Health Parity and Addiction Equity Act (MHPAEA). At the same time, EBSA also released a corresponding compliance tool intended to provide additional guidance
Every few years, promoters resurface with new “double dip” health plan products promising employees more take‑home pay and employers big employment‑tax savings. The pitch is familiar: employees pay large pre‑tax “premiums” through a cafeteria plan, then receive substantial, “tax‑free” payments back through payroll that are just shy of the pre‑tax contributions. Because the contribution was
As described in earlier Thompson Hine blog posts (here, here, here, and here), Trump accounts continue to take shape as a new employer-sponsored benefit. On August 11, 2026, the Treasury Department and IRS published proposed regulations (REG-101355-26) that answer many of the open questions we flagged previously, most significantly, how
On August 11, 2026, the Treasury Department and Internal Revenue Service published proposed regulations that, for the first time, provide comprehensive regulatory guidance on how to perform nondiscrimination testing for dependent care assistance programs (DCAPs) under Section 129 of the Internal Revenue Code. While the proposed regulations were prompted by the need to implement the
Employer-sponsored group health plans are facing a growing wave of ERISA class action lawsuits, and the claims are getting bolder, including claims of “financial dominance”. In our previous post on this topic, we analyzed Barbich et al. v. Northwestern University et al., No. 1:25-cv-06849 (N.D. Ill.), which introduced a novel “financial dominance” theory
On April 23, 2026, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced settlements with four health entities following investigations into ransomware breaches that exposed unsecured electronic protected health information (“ePHI”). While ransomware enforcement actions are not new, one of the four settlements stands out as a landmark: for