Cost-Sharing Employer Group Health Plans

News & Analysis as of

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 6 of 24): Reporting Group Health Plan Opt-Out...

Under a common strategy for controlling group health care plan costs, employers sometimes adopt arrangements under which an employee is offered cash as an incentive to waive coverage. These arrangements are colloquially...more

Obama Administration Finalizes Regulations on ACA Coverage of Preventive Services, Including Contraceptive Services

The Obama Administration published final regulations on July 14, 2015 that implement Affordable Care Act requirements regarding coverage without cost sharing of certain preventive services, including contraceptive services....more

Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums

As employers and plans prepare for 2016 open enrollment, they must be sure to address in their benefit design and with their third party vendors the new embedded out-of-pocket maximum limitations on individuals that were...more

New ruling limits out-of-pocket expenses at individual level in 2016

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

Agencies Clarify Cost-Sharing Limits Under the Affordable Care Act

The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) have issued a set of Frequently Asked Questions (FAQs) clarifying the limitations on cost sharing under...more

New HHS Regulations “Clarify” that Health Plans Covering Families Must Have “Embedded” Individual Cost-Sharing Limits

On February 27, 2015, the Department of Health and Human Services (HHS) released its final HHS Notice of Benefit and Payment Parameters for 2016. The lengthy regulation covers a wide range of topics affecting group health...more

Washington Healthcare Update

This Week: Upcoming Hearing: HHS Sec. Burwell Appearing Before E&C Committee on FY2016 Budget... CMS Issues 2016 Payment and Policy Updates for Medicare Health and Drug Plans... CMS Releases Improved Rating System for Nursing...more

Staying the Course: HHS Finalizes the Essential Health Benefits Regulations for 2014

The U.S. Department of Health and Human Services (HHS) Essential Health Benefits Final Rule and actuarial value regulations offer few surprises and much needed certainty to enable group health plans and health insurance...more

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