McDermott Will & Schulte
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What plan sponsors must know about gag clauses in contracts
By McDermott Will & Schulte on Dec 9, 2025
Posted In Employee Benefits
The “gag clause prohibition” rules prevent group health plans and insurers from entering contracts that restrict their ability to access or share provider-specific cost and quality-of-care information with participants, plan sponsors, or other authorized parties. These clauses are most commonly found lurking in agreements with third-party administrators and pharmacy benefit managers, where they can include...
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AI in employer-sponsored group health plans: Legal, ethical, and fiduciary considerations
By Jacob Mattinson, Sarah Raaii, Haley Dow and McDermott Will & Schulte on Sep 16, 2025
Posted In Digital Health, Employee Benefits, Employment, Health and Welfare Plans
Artificial intelligence (AI) has increasingly been integrated into the tools used by and for employer-sponsored group health plans, prompting a multitude of concerns. In this article, we discuss key issues that require immediate attention from both plan sponsors and plan administrators. Find out the legal, ethical, and fiduciary considerations employer-sponsored group health plans should keep...
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OBBBA’s impact on employee benefit plans, programs, and arrangements
By Jacob Mattinson, Sarah Raaii and McDermott Will & Schulte on Jul 29, 2025
Posted In Employee Benefits, Health and Welfare Plans
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. The OBBBA includes several employee benefits-related provisions impacting employer-sponsored plans and fringe benefits, including changes to health savings account eligibility, telehealth coverage, dependent care flexible spending accounts (FSAs), employer-provided childcare credits, student loan repayment programs, and more. Learn more...
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Enforcement of Mental Health Parity Regulations Suspended: Takeaways for Plan Sponsors and Health Insurance Issuers
By Jacob Mattinson, Sarah Raaii and McDermott Will & Schulte on May 22, 2025
Posted In Employee Benefits, Mental Health Parity and Addiction Equity Act
Enforcement of the 2024 final regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA) has been suspended due to litigation by The ERISA Industry Committee. In response, the US Departments of Labor, Health and Human Services, and Treasury announced that they will not enforce the new rule until the case is resolved, plus...
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PBMs Score a Win in Federal Court Against State Regulation
By Sarah Raaii and McDermott Will & Schulte on Apr 25, 2025
Posted In Employee Benefits, Health and Welfare Plans
A recent federal court decision in McKee Foods Corp. v. BFP Inc. declared that Tennessee’s “any willing pharmacy” requirement was preempted by the federal Employee Retirement Income Security Act of 1974. This decision impacts self-funded group health plans, potentially allowing them to comply with a single set of rules nationwide rather than navigating conflicting state...
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Examining Group Health Coverage Alternatives for Small Employers
By Sarah Raaii, Teal Trujillo, Erin Turley and McDermott Will & Schulte on Feb 27, 2025
Posted In Employee Benefits, Health and Welfare Plans
Small employers have long struggled to offer comprehensive major medical coverage to their workers and families, mainly due to underwriting hurdles. Groups with fewer than 50 employees are often confined to state small group market plans, which can be costly. Even slightly larger groups, underwritten based on their own claims history, still face a significant...
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2025 Employee Benefits & Workplace Predictions
By McDermott Will & Schulte on Jan 30, 2025
Posted In Benefit Controversies, Employee Benefits, Health and Welfare Plans
Managing healthcare costs often feels like an endless struggle for benefits professionals, employers, and employees. Nevertheless, benefits professionals persist in their efforts to control escalating healthcare expenses. In this article, Alden Bianchi and industry members share their predictions about the healthcare landscape, zeroing in on primary care, weight loss drug coverage, the Affordable Care Act,...
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Supreme Court’s Transgender Case May Affect Travel Benefits
By Sarah Raaii and McDermott Will & Schulte on Jan 28, 2025
Posted In Employee Benefits, Health and Welfare Plans
The US Supreme Court is currently reviewing a case (US v. Skrmetti) concerning Tennessee’s ban on gender-affirming care for youth. If the Court upholds the ban, some employers might consider offering travel benefits to help employees access healthcare services that are prohibited by state law. This could also apply to other plan-covered services that are...
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Gender-Affirming Benefits: Best Practices for Group Health Plans
By Sarah Raaii, Scott Kenkel and McDermott Will & Schulte on Jan 14, 2025
Posted In Employee Benefits, Health and Welfare Plans
Gender-affirming care has become a central topic in US political discussions, significantly affecting employer-sponsored group health plans. Depending on whether they purchase insurance or self-fund their health benefits, group health plan sponsors face different challenges in covering gender-affirming care. In this PlanSponsor article, Alden Bianchi, Sarah Raaii, and Scott Kenkel explore these challenges and share...
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Complying With the ‘Relevant Data’ Requirement Under the Final 2024 Mental Health Parity and Addiction Equity Act: A Proposal for a Workable Alternative
By McDermott Will & Schulte on Dec 19, 2024
Posted In Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires group health plans and health insurance issuers to ensure that financial requirements (such as copays and deductibles), quantitative treatment limitations (such as visit limits), and nonquantitative treatment limitations (such as prior authorization and concurrent review) applicable to mental health or substance use disorder (MH/SUD)...
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