Employer Group Health Plans

News & Analysis as of

IRS Pulls Determination Letter Program, Puts Premium on Plan Assessments by Sponsors

Effective January 1, 2017, the IRS has announced that, due to limited resources, it is eliminating the existing 5-year determination letter application staggered filing cycles for individually designed plans. Off-cycle...more

Are Wellness Programs Worth It?

Please see Chart below....more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 2 of 24): Yikes! The Costs of Failing to Comply...

The Affordable Care Act (ACA) imposes information reporting rules on providers of minimum essential coverage, e.g., insurance carriers and self-funded plans, and on applicable large employers, i.e., those employers that are...more

Benefits Litigation Update – July 2015

Welcome to the new, rejuvenated version of the Benefits Litigation Update, which we bring you jointly with the law firm of Epstein Becker Green. Our goal is to provide a concise and, we hope, insightful glimpse into recent...more

SEC Issues Proposed Incentive Compensation Clawback Rule

In another round of rulemaking related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, the SEC proposed a rule that would require certain executive officers to pay back incentive compensation tied to...more

Obergefell v. Hodges – Same-Sex Marriage Now Legal in all 50 States

Same-sex Marriage Now Legal in All 50 States - In 2013, the Supreme Court, in United States v. Windsor, struck down Section 3 of the Defense of Marriage Act (“DOMA”) which defined marriage, for Federal purposes, as...more

Health and Welfare Benefits for Same-Sex Spouses after Obergefell: A New Mandate for Employers?

After last month’s decision by the U.S. Supreme Court in Obergefell v. Hodges, employee benefit plan sponsors may wonder whether Obergefell affirmatively imposes an obligation for employers to provide health, life,...more

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

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

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 1 of 24)

Alden Bianchi, Chair of the our Employee Benefits & Executive Compensation Practice, will provide a weekly installment on the complex reporting obligations outlined by the Affordable Care Act for health insurance carriers and...more

Trade Act Reinstates Expired Health Coverage Tax Credit (HCTC)

On July 6, 2015, President Obama signed the Trade Preferences Extension Act of 2015. Among other things, the Trade Act retroactively reinstated the Health Coverage Tax Credit (HCTC), which had previously expired on January...more

Proceed With Caution: Does HIPAA Apply to Your Business?

Even if your business is not in the health care industry, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as updated by the Health Information Technology for Economic and Clinical Health Act (HITECH...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

Agencies Issue Final Regulations on the Summary of Benefits and Coverage (SBC) Requirements

As promised in the FAQ issued on March 30, 2015, the U.S. Departments of the Treasury, Labor and Health and Human Services (the Departments) have issued final regulations regarding the summary of benefits and coverage (SBC)...more

Supreme Court Denies Significant Challenge to Affordable Care Act: Employers Should Continue to Follow the Act as Currently...

On June 25, 2015, the U.S. Supreme Court held in King v. Burwell that individual taxpayers who enroll in health plans through the federal government's health insurance exchange can be eligible for federal tax credits under...more

IRS Notice 2015-43 Addresses Expatriate Health Coverage

New guidance from the Internal Revenue Service (IRS) leaves in place the limited Affordable Care Act (ACA) exemptions set out in the Expatriate Health Coverage Clarification Act of 2014 (EHCCA). IRS Notice 2015-43 (Notice)...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

How to Comply With the Affordable Care Act's Employer Mandate

The Affordable Care Act (“ACA”) is the most far-reaching piece of employee benefits legislation passed in the last 40 years. With over 20,000 pages of regulations and other guidance, the ACA is profoundly affecting our...more

Business As Usual: Supreme Court Upholds ACA Subsidies

The United States Supreme Court recently held in King v. Burwell that the Affordable Care Act (ACA) permits individuals to receive health insurance premium subsidies through federally-facilitated exchanges (in addition to...more

U.S. Supreme Court Upholds Premium Subsidies on Federally Run Health Insurance Exchanges

On June 25, 2015, in a 6-3 majority opinion, the U.S. Supreme Court confirmed the availability of premium subsidies for health coverage purchased on Affordable Care Act (ACA) health insurance exchanges, regardless of whether...more

Health Care Update - June 2015 #4

In This Issue: - Pathway for Bipartisanship following King v. Burwell - Federal Regulatory Initiatives - Congressional Initiatives - Other Health Care News - Upcoming Congressional...more

Employee Benefits Implications of Supreme Court Decision on Same-Sex Marriage

On June 26, 2015, in Obergefell v. Hodges, the Supreme Court of the United States determined that it is unconstitutional for a state to ban same-sex couples from exercising the fundamental right to marry. As a result of this...more

The Same-Sex Marriage Ruling: Key Employee Benefits Take-Aways

Last Friday, the Supreme Court of the United States issued its highly-anticipated decision in the case of Obergefell v. Hodges, ruling that all 50 states must license marriages between two people of the same sex and must...more

What the Supreme Court’s Same-Sex Marriage Ruling Means for Employers

On Friday, the Supreme Court of the United States issued its long-awaited opinion in the Obergefell case, striking down bans on same-sex marriage as unconstitutional and legalizing same-sex marriage in every state. We posted...more

Supreme Court Rejects Latest Challenge to Affordable Care Act: What Are Employers' Obligations Going Forward?

On June 25, 2015, the Supreme Court of the United States upheld one of the main pillars of the Affordable Care Act (ACA): the tax credits that allow millions of Americans to afford health care insurance on the public...more

US Supreme Court Issues Landmark Decision Upholding Current ACA Structure

Now is the time for employers to focus on next steps. Yesterday, the US Supreme Court, in a 6–3 decision, held that the Internal Revenue Service (IRS) regulations issued in 2012 under the Affordable Care Act (ACA)...more

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