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Health Care Update - June 2014 #4

In This Issue: - Hobby Lobby decision further complicates ACA implementation - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State...more

New Obamacare Benefit Mandate Takes Aim at Breast Cancer

Under the Affordable Care Act, insurers and employers that sponsor non-grandfathered medical plans must cover and pay the full cost of specified preventive services in accordance with recommendations issued by the U.S....more

Final Regulations on Orientation Periods Released

On June 20, the Federal regulatory agencies in charge of health care reform guidance (the Departments of Labor, Treasury, and Health and Human Services) released final regulations (“Final Regulations”) clarifying the...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 28: The Logic, Calculus, and Limits of “Skinny” Plans

It was just over a year ago that the Wall Street Journal published an article entitled, “Employers Eye Bare-Bones Health Plans Under New Law,” which highlighted a compliance strategy to minimize employer exposure for...more

The Federal Court for the Southern District of New York Rules that Employers with Self-Insured Health Plans Need Not Offer Medical...

The issue of same-sex spousal rights is now largely resolved for qualified retirement plans. However, substantial questions about same-sex spouse health benefits remain unanswered. In Roe v. Empire Blue Cross Blue Shield,...more

IRS Issues Guidance Effectively Prohibiting Employers From Reimbursing Employees For Individual Health Insurance Premiums

The IRS’ reasoning is that such reimbursement arrangements, often referred to as “employer payment plans” are “group health plans.” All group health plans must meet the Affordable Care Act’s “market reform” requirements, such...more

Health care reform reporting requirements: Final rules

The Patient Protection and Affordable Care Act (PPACA) contains requirements for both individuals and employers related to health care coverage. In order to assure compliance with certain of these requirements, PPACA requires...more

Labor Pains: The $2 Million Part-Time Employee

One of your employees (we’ll call him “Don”) cannot enroll in your health insurance plan because you classify him as “part-time” (one who works less than 30 hours a week). This forces Don to get health insurance through a...more

The Devil is in the Details: Advising Your Clients on the Affordable Care Act

The Affordable Care Act (ACA) represents a fundamental shift in healthcare delivery and insurance. The law is complex and many of its provisions are delayed due to implementation difficulties. However, virtually all...more

Changes & Opportunities in 2014 for Small Employers under ACA

The Affordable Care Act (ACA) brings about significant healthcare reform changes, as well as opportunities for small employers in 2014. Many of the reforms affect all employers who sponsor group health plans; however, the...more

So, Are You Really Compliant With HIPAA?

As covered entities under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), healthcare providers are intimately familiar with the strict privacy and security requirements imposed on them by HIPAA and...more

Third Circuit Issues Opinion On Arbitrability Of Direct And Assigned, Or Derivative, Claims

The Third Circuit recently vacated a lower court’s decision granting a motion to compel arbitration of (1) direct claims by certain cardiac services health providers against CIGNA and...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 33: The Impact of Value-Based–Plan Designs and Reference...

Whether a group health plan provides minimum value is central to the application of the Affordable Care Act’s employer shared responsibility rules. The particulars of the role of minimum value in determining assessable...more

U.S. Supreme Court Case Could Alter Retiree Health Benefit Landscape

The U.S. Supreme Court has agreed to review a 2013 Sixth Circuit decision that could alter the way collective bargaining agreement provisions covering retiree health benefits are interpreted. In Taketts v. M&G Polymers, the...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 34: When Can Carriers Impose Minimum Participation and Minimum...

Commencing with plan and policy years beginning on or after January 1, 2014, the Affordable Care Act amends the Public Health Service Act (“PHS Act”) to make three important changes to the rules governing health insurance...more

Trustee Alert – Final Mental Health Parity Rules

The Mental Health Parity rules require group health plans that offer mental health and substance use disorder benefits to cover those benefits on terms that are no more restrictive than those applied to comparable medical and...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 43: Coordinating the 3-Month Delay under Employer Shared...

So much attention has been paid to the issuance of the final employer shared responsibility regulations that some might have missed the news that final regulations were recently issued under another of the Affordable Care...more

New U.S. Guidance On Expatriate Health Plans

As discussed in a prior post, the U.S. Internal Revenue Service (“IRS”) is currently in the process of finalizing its regulations implementing the Affordable Care Act’s (“ACA”) “Employer Mandate.” The Employer Mandate, which...more

CMS Seeks Comments on Establishment of CMPs Related to MSP Reporting

CMS recently solicited comments for the development of methodologies and criteria to be used in evaluating whether or not to impose civil money penalties (CMPs) on arrangements of certain group health plans (GHPs) and...more

Stand-Alone Health Reimbursement Arrangements May Not Be Dead After All

Many employers offer employees Health Reimbursement Arrangements (“HRAs”) to assist employees meet their health care related expenses. Often such employer funded arrangements are not “integrated” with an insured health plan,...more

Group Health Plans: Year-End Action Items and Upcoming Changes

Group health plan sponsors turn their attention to completing 2013 tasks, implementing upcoming 2014 changes, preparing for the ACA Shared Responsibility requirement in 2015, and documenting recent extensive plan changes....more

Final Regulations for the Mental Health Parity and Addiction Equity Act of 2008

On November 8, 2013, the Departments of Treasury, Labor, and Health and Human Services (collectively, the "Departments") jointly issued final regulations under the Mental Health Parity and Addiction Equity Act of 2008 (the...more

Employee Benefits Developments November 2013

RULINGS, OPINIONS, ETC. - Religious Employers and the Women’s Contraceptive Mandate Background - This past July, the U.S. Departments of Labor, Health and Human Services, and the Treasury released final...more

Update on “Play or Pay”

The employer shared responsibility provisions of the Affordable Care Act (ACA), often referred to as “play or pay,” require large employers to offer affordable medical coverage to full-time employees or face penalties. For...more

Sixth Circuit Rejects Challenge to ACA Based on Religious Beliefs

The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventative health services. In a case seeking an injunction to bar enforcement of ACA’s so-called “contraception mandate” on the ground...more

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