First, Fisher appeals from the judgment of the United States District Court for the Southern District of New York (Woods, J.) granting judgment to Aetna Life Insurance Company on Count I of Fisher’s claim for breach of contract under the Employee Retirement Income Security Act of 1974 (“ERISA”) regarding her 2014 health insurance plan with Aetna. 2 POOLER, Circuit Judge: This case arises from three separate but related appeals of Jacqueline Fisher, which we heard in tandem. Austin, on the brief), New York, NY, for Defendant-Appellee. _ WILLIAM DUNNEGAN, Dunnegan & Scileppi LLC (Laura Scileppi, Richard Weiss, on the brief), New York, NY, for Plaintiff-Appellant. We hold that (1) the February 19 document governed the contract of insurance between the parties because Fisher was on inquiry notice as to its terms (2) Fisher is not entitled to a money judgment for her copay differential (3) the ACA does not provide that the annual limitation on cost sharing for selfonly coverage applies to all individuals regardless of whether the individual is covered under an individual “self-only” plan or is covered by a plan that is other than self-only for plans in effect prior to 2016 and (4) neither the ACA nor the February 19 document required Aetna to apply the brand-generic cost differential charge to Fisher’s out-of-pocket limit. § 18022(c)(1) (“ACA”), provides that Aetna must apply the individual out-of-pocket limit rather than the family out-of-pocket limit and that the brand-generic cost differential Fisher paid for her brand-name medication should count toward her out-of-pocket limit. Fisher contends that the insurance contract between the parties was governed by a document provided on Januinstead of Februthat she is entitled to a judgment based on Aetna’s miscalculation of her copay that even if the February 19 Document controls, the Patient Protection and Affordable Care Act, 42 U.S.C. Fisher also takes an interlocutory appeal from the non-final order of the United States District Court for the Southern District of New York (Woods, J.) granting judgment to Aetna. Korman, United States District Court for the Eastern District of New York, sitting by designation. Plaintiff-Appellant Jacqueline Fisher appeals from two judgments entered in the United States District Court for the Southern District of New York (Woods, J., and Sullivan, J.) granting defendant Aetna Life Insurance Company judgment on breach of contract claims under the Employee Retirement Income Security Act The caption is identical for the three docket numbers. 1 _ Before: CALABRESI, POOLER, Circuit Judges, and KORMAN, 2 District Judge. AETNA LIFE INSURANCE COMPANY, Defendant-Appellee. Aetna Life Insurance Company UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT _ August Term, 2021 (Argued: OctoDecided: April 22, 2022) Docket Nos. Finally, the court held that the ACA nor the February document required Defendant to apply the brand-generic cost differential costs to Plaintiff’s out-of-pocket limit.Ģ0-3148, 20-3804, 21-1 Jacqueline Fisher v. The court also found that the ACA does not provide that the annual limitation on cost-sharing applies to all individuals regardless of whether the individual is covered under an individual “self-only” plan or is covered by a plan that is other than self-only for plans effective before 2016. Further, Plaintiff is not entitled to a money judgment for her copay because Defendant agreed to pay Plaintiff the copay differential. The court held that the February document governed the relationship between the parties because Plaintiff was on notice as to its terms. The Second Circuit affirmed the district court’s judgments. Plaintiff filed a breach of contract claim under ERISA, and the district court granted Defendant judgment on the breach of contract claims under ERISA. Section 18022(c)(1) (“ACA”), mandates that the insurance company must apply the individual out-of-pocket limit rather than the family out-of-pocket limit and that the generic-brand cost differential Plaintiff paid for her name-brand medication should count toward her out-of-pocket limit. Plaintiff argued that the insurance contract between the parties was governed by a document provided on January 9, 2014, instead of Februthat she is entitled to a judgment based on the insurance company’s miscalculation of her copay and that even if the February 19 document controls, the Patient Protection and Affordable Care Act, 42 U.S.C.
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