Out-of-Pocket Expenses

News & Analysis as of

HHS Sets New Requirements to Limit Surprise Medical Bills from Out-of-Network Providers

The U.S. Department of Health and Human Services (“HHS”) recently released a final rule titled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] that sets...more

Affordable Care Act Compliance Update for 2016

Affordable Care Act (ACA) reforms have become effective incrementally over the last six years. In 2016, most of the ACA changes are applicable. Employers that sponsor group health plans should ensure that they are in...more

Circuit Court Affirms Bankruptcy Order Requiring Creditor to Reimburse Trustee for Maintaining Collateral

In the case of Domistyle, Inc., 14-41463 (5th Cir. Dec. 29, 2015), the United States Court of Appeal for the Fifth Circuit affirmed an order of the bankruptcy court requiring a secured creditor to reimburse the trustee for...more

White & Case ECB News – Issue 2, 2015: 60 seconds around the globe – ECB News Issue 2, 2015

China - Changes to Employee contribution rates for work related injury insurance and maternity insurance - As of 1 October 2015, employer contribution rates for injury-at-work insurance and maternity insurance have...more

Employee Training: Payment Obligations and Strategies for Employers

Many employees receive training related to their jobs, or to positions to which they might be promoted. Employers sometimes require employees to undergo training and provide the training in-house. In other situations,...more

Maine Workers’ Compensation Alert: Board Revises Fee Schedule and Changes Reimbursement Rules

The Maine Workers’ Compensation Board has published a new Medical Fee Rule and made revisions to rules regarding reimbursement and expense payments, effective October 1, 2015. The following are some key changes...more

Amazon.com Hit With Independent Contractor Misclassification Class Action Lawsuit By Delivery Drivers

Amazon is the latest tech company to be sued in a proposed class action by drivers delivering its products – in this case, goods to be delivered within two hours of being ordered through Amazon’s “Prime Now” app. The drivers...more

Where to Draw the Line: HR’s Role in Disciplinary Decisions

In the recent case of Ramphal v. Department of Transport (DoT) the tricky question of where HR should draw the line in a disciplinary matter between guiding the decision-maker on the right decision, and making that decision...more

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

Blog: Joining the Debate, Hillary Clinton Releases Plan to Curb Drug Prices

In the wake of the uproar about drug pricing, Hillary Clinton unveiled on Tuesday, a plan to address the rising cost of prescription drugs. The plan will focus on ending “excessive” profits, lowering out-of-pocket costs,...more

Healthcare Costs for the Average Family Have Risen Dramatically

According to consulting and actuarial firm Milliman’s “2015 Milliman Medical Index,” which measures the cost of healthcare for a typical American family of four receiving coverage from an employer-sponsored preferred provider...more

Client Alert: AB 533 Defeated

Johan Swanepoel © 123RF.com Controversial AB 533 did not obtain the necessary votes for approval and failed to pass. Assembly Health Committee Chair Rob Bonta proposed AB 533 in an attempt to purportedly address the problems...more

The Scoop on MOOP: McGuireWoods Healthcare Reform Guide: Installment No. 53

This is the 53rd in a series of WorkCite articles concerning the Patient Protection and Affordable Care Act and its companion statute, the Health Care and Education Reconciliation Act of 2010 (referred to collectively as the...more

IREG Update - August 2015 #2

Hot Topic: New York Emergency Medical Services and Surprise Bills Law - Earlier this year, New York’s Emergency Medical Services and Surprise Bills Law went into effect (the full text of the bill is available on the...more

Washington Healthcare Update

This Week: 21st Century Cures Legislation Passes House in Bipartisan Vote... CMS Releases Proposed CY 2016 Home Health Prospective Pay Rule... CMS Releases Final CY 2016 Hospital Outpatient Prospective Payment System (OPPS)...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

Uber Drivers as “Independent Contractors” – Maybe Not!

Employers face a variety of challenges when relying on “independent contractors.” Typically these disputes involve wages and/or hours worked or alleged entitlement to benefits. A recent case against Uber, however, brought a...more

Alert: Health Plan Update on Out-of-Pocket Limitations

The Affordable Care Act (the “ACA”) established limitations on the annual out-of-pocket costs that a health plan may impose on a participant. The U.S. Department of Health and Human Services, Department of Labor and the...more

Documenting Your Gifts to Charity: Don’t Jeopardize Your Charitable Deduction

April 15th is fast approaching. This is the time of year when many of our clients ask us how to properly document charitable contributions. In several recent cases, donors have been denied all or a portion of their...more

Understanding Expense Reimbursement Rules Is Critical As Claims Are Likely to Rise

Employers commonly reimburse expenses incurred by employees in the course of their employment, but many employers do not fully understand their obligations with respect to the reimbursement of business expenses. In light of...more

Employer Required to Reimburse Employees for Personal Cell Phone Use Despite Unlimited Minutes Plans

Cell phones are ubiquitous. At some companies, employees use their personal phones to make business calls. Does an employer need to “pay” for that use of the phone, even if the employee did not incur any extra expenses for...more

The California Court of Appeal Finds That an Employee Expense is an Employee Expense is an Employee Expense

On Tuesday, August 12, 2014, the California Court of Appeal (Second Appellate District) published a decision that could impact many employers in California. The threshold question at issue in the case was whether an employer...more

We Have to Pay for What? A California Court of Appeal Issues Expansive Expense Reimbursement Ruling

A California Court of Appeal recently issued a short decision in Cochran v. Schwan’s Home Services, Inc., B247160 (Aug. 12, 2014) that took an expansive view of an employer’s obligation to reimburse employees for business...more

Reminder: ACA’s Out-of-Pocket Limits Differ from HSA-Qualified HDHPs Starting in 2015

In April, the IRS released the 2015 inflation adjustments for Health Savings Accounts (HSA) and HSA-qualified high deductible health plans (HDHPs). A month earlier, HHS released details on the “premium adjustment percentage,”...more

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