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Patient Protection and Affordable Care Act (PPACA) › Third Party Administrators

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
Polsinelli

Department of Labor Sues UnitedHealth TPA Over Claim Denials

Polsinelli on

The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more

Foley & Lardner LLP

Employer Checklist for New Health Plan Price Transparency Rules and CAA

Foley & Lardner LLP on

The effective date is fast approaching for certain provisions of the Consolidated Appropriations Act of 2021 (“CAA”) and related regulations, and the Transparency in Coverage Rule. You can access previous articles written...more

Morgan Lewis

Health and Welfare Plan Year-End Reminders

Morgan Lewis on

Permissible Flexibility under Code Section 125 Pursuant to IRS Notice 2021-15 Notice 2021-15 offered plan sponsors the flexibility to adopt any of the following options despite the longstanding rules under Section 125 of the...more

King & Spalding

Strategies for Addressing Reference-Based Plans

King & Spalding on

The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more

Littler

“Medical Necessity” Isn’t Well-Defined Unless It Is Well-Defined

Littler on

A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more

Eversheds Sutherland (US) LLP

Transparency in coverage rule - Potential implications for self-insured health plans

Eversheds Sutherland (US) LLP on

On November 15, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Agencies”) issued a proposed "Transparency in Coverage" rule that would require most...more

Snell & Wilmer

2019 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare

Snell & Wilmer on

As 2019 comes to an end, we are pleased to present our traditional End of Year Plan Sponsor “To Do” Lists. This year, we present our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 covers year-end health...more

Jackson Walker

ERISA Alert: An Update on Health and Welfare and Retirement Plans

Jackson Walker on

Health and Welfare Plan Update - It is 9:00 p.m., do you know where your health plan data is? As IT systems continue to expand, and data is accessed, moved and stored in many new and different ways, the Office for Civil...more

Seyfarth Shaw LLP

Eighth Circuit Grants Slight Reprieve To Mother Of Transgender Son In ACA Discrimination Suit

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Eighth Circuit upheld dismissal of Title VII claims challenging an employee benefit plan’s blanket transgender exclusion because the exclusion impacted the employee’s transgender son, not the employee....more

McDermott Will & Emery

HHS Issues Final ACA Nondiscrimination in Health Programs and Activities Regulation

McDermott Will & Emery on

In Depth - On Friday, May 13, 2016, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) finalized regulations that provide explicit protections from discrimination on the basis of gender...more

Seyfarth Shaw LLP

Suing Not Too Wisely

Seyfarth Shaw LLP on

Seyfarth Synopsis: A district court in Minnesota recently found an employee could not challenge a plan’s blanket transgender exclusion under Title VII, when the employee was not transgender but her son was. The Court went on...more

Balch & Bingham LLP

Simple ACA Rules for Simple (But Not Small) Employers

Balch & Bingham LLP on

If you had at least 50 but less than 100 full-time employees (on an aggregated basis, including full-time equivalents) in an average month in 2014, then you are an ACA “Applicable Large Employer” with ALE reporting...more

Mintz - Health Care Viewpoints

Government Finalizes Religious Accommodation, But What About Health Plans, TPAs and PBMs?

Mintz - Health Care Viewpoints on

In a set of rules published last week, the government finalized a July 2010 interim final rule (“IFR”) related to coverage of certain preventive services and an August 2014 IFR regarding the definition of an eligible...more

McNees Wallace & Nurick LLC

Feds Define Which “Closely Held Corporations” Are Eligible to Opt Out of Contraception Mandate Under ACA

McNees Wallace & Nurick LLC on

One year ago, the U.S. Supreme Court ruled in the case of Burwell v. Hobby Lobby Stores, Inc. et al, that for-profit closely held corporations must be permitted to opt out of the Affordable Care Act’s contraception mandate on...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Montana Governor Signs Act to Expand Medicaid

Manatt, Phelps & Phillips, LLP on

On April 29, 2015, Montana Governor Steve Bullock signed Senate Bill 405, referred to as the Montana Health and Economic Livelihood Partnership Act (HELP Act), which expands Medicaid to cover an estimated 70,000 new adults....more

Mintz - Health Care Viewpoints

Government Issues New Rules for Religious Employers, But Health Plans, TPAs, and PBMs are still on the Hook to Provide...

Mintz - Health Care Viewpoints on

The Affordable Care Act (“ACA”) requires that non-grandfathered health plans make preventive care and screenings available to their members at no cost (i.e. no deductibles, coinsurance, or co-payments). The Department of...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

How a Plan Sponsor Can Avoid Being a Deer Caught in the Headlights

Ary Rosenbaum - The Rosenbaum Law Firm P.C. on

The term “deer in the headlights” explains the mental state of a person who shows behavioral signs that remind us of a deer subjected to a car’s headlights where the deer is in such panic that they show no motor reaction to...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Religious Freedom, Contraceptive Services, and The ACA: The Dilemma of the Self-Certification Provision

Ogletree, Deakins, Nash, Smoak & Stewart,... on

On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act...more

Ballard Spahr LLP

HHS and IRS Release Updates on the SHOP Marketplace, Fees, Taxes, and Payment Parameters

Ballard Spahr LLP on

Before departing for the 2013 Thanksgiving holiday, the Obama administration released several new regulatory announcements and guidance relating to the implementation of the Affordable Care Act (ACA). The new guidance delays...more

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