Health Insurance

News & Analysis as of

Health and Human Services, Labor and Treasury Departments Release New Summary of Benefits and Coverage Templates and Accompanying...

The Departments of Health and Human Services (“HHS”), Labor (“DOL”), and Treasury (the “Departments”) have jointly released final changes to the Summary of Benefits and Coverage (“SBC”) template, the Uniform Glossary, and...more

Employee Benefits Developments - May 2016

Agencies Issue New FAQs on the Affordable Care Act.The Departments of Labor, Health and Human Services, and the Treasury (the agencies) issued another set of frequently asked questions (FAQs) regarding the implementation of...more

Manatt on Medicaid: Monthly Expansion Recap - May 2016

Alaska - House Brings Medicaid Expansion Lawsuit to State Supreme Court - The Alaska House of Representatives has filed an appeal to the State Supreme Court seeking reinstatement of its lawsuit against Governor Bill...more

ACA Nondiscrimination Regulations Finalized

The U.S. Department of Health and Human Services (HHS) has issued final regulations under Section 1557 of the Affordable Care Act (ACA) which prohibit discrimination on the basis of race, color, national origin, sex, age, or...more

HHS Issues Final ACA Nondiscrimination in Health Programs and Activities Regulation

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

The Legalization of Medicinal Marijuana in PA – What Does it Mean for Employer Provided Insurance Coverage?

Pennsylvania’s Medical Marijuana Act (MMA) was signed into law on April 17, 2016 and officially took effect last week. One of the questions we’ve been asked since the passage of the Act is: how will employer provided...more

Manatt on Health Reform: Weekly Highlights - May 2016 #4

Uninsurance hit a record-breaking low of 9.1% in 2015; Vermont legislators pass a bill to increase drug formulary and price transparency; and California rolls out its State-funded Medi-Cal expansion to undocumented children....more

New ADA and GINA Wellness Regulation Changes Complicate Wellness Program Compliance Analysis and Risks

Wellness programs should all be reviewed considering the Americans with Disabilities Act (“ADA”) and the Genetic Information Nondiscrimination Act (“GINA”) regulatory changes because noncompliance with the new requirements do...more

Are You Still Reimbursing Premiums For Your Employee’s Individual Healthcare Insurance? Then You’d Better Read This!!

In the past, many employers (especially smaller companies) have offered to pay their employees’ premiums for individual healthcare insurance instead of sponsoring their own group health plans. With the advent of the...more

Health Update - May 2016

Actions to Advance Infant and Early Childhood Mental Health - Editor's Note: Children's earliest experiences—both positive and negative—impact their brain formation and in turn their social and emotional, physical,...more

Federal Court Strikes Down ACA Cost Sharing Reduction Payments

In Depth - A federal district court judge in Washington, DC ruled on May 12, 2016, that Congress did not appropriate funds for the Affordable Care Act’s (ACA) cost-sharing reduction (CSR) subsidies. See United States...more

Court Finds Faulty Funding Provisions in Affordable Care Act Affect Low-Income Affordability Provisions

On Thursday, May 12, 2016, a federal district court judge ruled against the Obama administration, finding that no appropriations have been made to fund payments under Section 1402 of the Affordable Care Act to reimburse...more

ERISA Preemption: Don't Tread on my Uniform System of Plan Administration

On March 1 the U.S. Supreme Court again reinforced the broad preemptive scope of the Employee Retirement Income Security Act of 1974, 29 U.S.C.A. §1001. In Gobeille v. Liberty Mutual Insurance Co., 136 S. Ct. 936, the court...more

Refresher Course on Affordable Care Act Individual and Employer Penalties For Not Having Health Insurance

Even though penalties for failure to comply with Affordable Care Act (ACA) coverage requirements have been in force since January 1, 2014 for employers with 100 or more full-time equivalent employees and January 1, 2015 for...more

Health Alert (Australia) May 23, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: South Australia - 19 May 2016 - Inquest into the deaths of Robert Campbell and Jeremy Todd...more

Affordable Care Act: Understanding Employer Notices From the Marketplaces

The Affordable Care Act (ACA) established Health Insurance Marketplaces (also called Exchanges) where individuals can shop and enroll in health coverage. Individuals who meet certain criteria are eligible for premium...more

Health Care Providers Can Fight Back Against Insurer Recoupment Demands Using ERISA

In the daily skirmishes between health care providers and payors, this scenario is not uncommon: A health care provider renders services to a patient and submits a reimbursement claim to the patient’s insurer. The insurer...more

The Supreme Court - May 2016 #2

The Supreme Court of the United States issued decisions in six cases today: Spokeo, Inc. v. Robins, No. 13-1339: The Fair Credit Reporting Act of 1970 (“FCRA”) imposes a number of requirements regarding the creation and...more

Manatt on Health Reform: Weekly Highlights - May 2016 #3

Maryland becomes the first State to mandate over-the-counter contraceptive coverage; Missouri plans to increase Medicaid asset limitations by 500% by 2021; and HHS' final rule extends protections against sex discrimination to...more

New Amendments Grant Failing ACA Co-Op Program Access to Private Capital and Limit Special Enrollment Eligibility

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) passed an interim final rule that amends regulations governing Consumer Operated and Oriented Plans (Co-ops) and tightens restrictions on special...more

Unclaimed Property Primer for Health and Property & Casualty Insurance

Background - Unclaimed Property: It’s not just about life insurance. The same contingency-fee unclaimed property auditors that targeted unclaimed life insurance proceeds are now turning their focus to other types of...more

Health Alert (Australia) - May 16, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Victoria 10 May 2016 - Allie v Allied Medical Group Pty Ltd (Human Rights) [2016] VCAT 728 Mr Allie...more

Illinois Supreme Court Issue Long-Awaited Decision on Vesting of Retiree Health Care Benefits in Matthews v. Chicago Transit...

On May 5th, nearly a full year after it heard oral arguments in the case, the Illinois Supreme Court issued its decision in Matthews v. Chicago Transit Authority, et al., addressing the interplay between a public sector...more

Employee Assistance Programs and State Insurance Regulation Structuring EAPs to Ensure Compliance

Employee Assistance Programs (or EAPs) have served employers and their employees for decades, providing a variety of benefits to address issues that might otherwise adversely affect the overall health and work of employees. A...more

House v. Burwell: Insurer Cost-Sharing Subsidies Unauthorized

A U.S. District Judge has ruled that HHS unlawfully has spent billions of dollars to reimburse insurers for cost-sharing reductions granted to individuals who bought health insurance through an ACA Exchange such as...more

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