Class Action Accusing Wellmark of Failing to Adequately Cover Comprehensive Lactation Services Survives Dismissal

Class Action Accusing Wellmark of Failing to Adequately Cover Comprehensive Lactation Services Survives Dismissal

On September 6, 2017, U.S. District Judge Rebecca Goodgame Ebinger denied, in part, Wellmark’s Motion to Dismiss in York v. Wellmark, Inc., No. 4:16-cv-00627-RGE-CFB (U.S.D.C. S.D. Iowa), an action charging the leading health insurance company in Iowa and South Dakota with violations of ERISA, the insurance contracts and the Affordable Care Act (ACA) for their failure to provide coverage for Comprehensive Lactation Benefits as a mandated preventive health service.

In finding that, “Plaintiffs state a plausible claim that Wellmark violated the ACA by improperly imposing cost sharing on Plaintiffs,” Judge Ebinger held that Wellmark’s argument that, “it was within its rights to impose cost sharing…because Wellmark’s general-provider network in fact contains lactation counseling providers” was an issue of fact, not law, thus improper to resolve at the motion to dismiss stage.  See, Order at pgs. 10-11 (denying dismissal of the claim for breach of fiduciary duty, Count I in this Action, for the ERISA Plaintiff).  Judge Ebinger also declined to dismiss the breach of contract claim under state law for the non-ERISA Plaintiff. The Order did grant, but with leave to amend, the dismissal of the claim for ERISA co-fiduciary liability (for the ERISA Plaintiff), but dismissed, with prejudice, the claim for sex discrimination under the ACA (Count III in this Action) and claim for unjust enrichment (Count V in this Action).