"Federal regulations only required McQuillin to wait 45 days for Hartford Life to issue a 'benefit determination' after he challenged its initial denial, and he had filed his lawsuit on day 46, Senior Circuit Judge John Walker Jr wrote for the 2nd Circuit. Hartford Life's attorneys ... argued that it met the 45-day deadline by 'overturning' its previous denial, and telling McQuillin it would reconsider his claim, 12 days after he filed his internal appeal; and that McQuillin was therefore barred from filing suit until the company finished its review." [ McQuillin v. Hartford Life and Accident Ins. Co. , No. 21-1514 (2d Cir. Jun. 7, 2022)]   MORE >>

"A district court has concluded that an exclusion for gender reassignment surgery under a government employer's health plan violated Title VII's prohibition against sex discrimination. The court also concluded that the participant's gender dysphoria was not a disability covered by Title I of the Americans with Disabilities Act (ADA)[.]" [( Lange v. Houston Cty., Ga. , No. 19-0392 (M.D. Ga. June 2, 2022))]   MORE >>

"The U.S. Federal Trade Commission [FTC] is looking into how big pharmacy benefit managers like CVS Caremark affect pricing and patients' access to prescription drugs at a time when costs of some medicines, even older ones like insulin, have skyrocketed ... As part of the probe, the FTC is sending demands for information to CVS Health Corp's Caremark, Humana Inc, Cigna Corp's Express Scripts and UnitedHealth Group's OptumRx, among others."   MORE >>

"As mental health concerns have risen over the past decade -- and reached new heights during the pandemic -- there's a push for primary care doctors to provide mental health care.... But the way many insurance plans cover mental health doesn't necessarily support integrating it with physical care.... In some cases, the main insurance plan may deny a claim, saying it's related to mental health, while the behavioral health company also denies it, saying it's physical."   MORE >>

"The proposed law would require employers in California to give eligible employees up to five days of bereavement leave after the death of a spouse, child, parent, sibling, grandparent, grandchild, domestic partner or parent-in-law. Other family relationships are not included. The bill covers all public employers and private companies that employ five or more individuals in California."   MORE >>

"HHS Transparency Rule likely to require amendment to TPA confidentiality agreement provision ... Fee disclosure requirement for group health plan service providers ... Insurers and group health plans required to provide free COVID tests."   MORE >>

"The mechanisms of the proposed rule ... will have consequences for job-based coverage, that will erode insurance options for employees and their families while increasing costs for employers. Fixing one problem in ACA markets should not detrimentally impact markets where a majority of Americans receive their coverage."   MORE >>