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Changes to the HIPAA Privacy Rules – A Primer for Self-Insured Group Health Plans

The Office for Civil Rights (“OCR”) of the US Department of Health and Human Services recently released a final rule (“Final Rule”) to update the HIPAA Privacy Rules for reproductive health care information. The Final Rule...more

Regulators Issue Further Guidance on Mandatory Coverage of Over-the-Counter COVID-19 Tests

As we previously discussed, federal regulators released FAQs on January 10, 2022 (“January FAQs”), requiring health plans to cover over-the-counter (OTC) COVID-19 tests for all participants during the pandemic, without...more

Health Plans Must Cover Over-the-Counter COVID-19 Tests for All Participants

Federal regulators recently released FAQs providing that health plans are now required to cover over-the-counter (OTC) COVID-19 tests for all participants through the remaining duration of the pandemic, without requiring an...more

Mental Health Parity - New Requirements for Plan Sponsors

On August 12, 2021, the U.S. Department of Labor announced a $15.6 million settlement related to violations of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). In the news release announcing the...more

Surprise! Biden Administration Releases Surprise Billing Guidance

The Departments of Health and Human Services, Treasury, and Labor jointly released a package of guidance relating to the surprise billing reforms included in the Consolidated Appropriations Act, 2021 (“CAA”). The guidance...more

ACA Survives Latest Supreme Court Challenge

The Supreme Court released its opinion today in a highly anticipated third challenge to President Obama’s signature health care law, the Patient Protection and Affordable Care Act (“ACA”). The 7-2 majority opinion,...more

Health Savings Account Contributions Increase and ACA Maximums Decrease for 2022

Today, the Internal Revenue Service announced increases to the health savings account contribution limits for 2022. HSA contributions increased from $3,600 to $3,650 for 2022 self-only coverage, and from $7,200 to $7,300 for...more

COBRA Subsidy - Part II

The American Rescue Plan Act of 2021 (“ARPA”) includes a provision amending the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to provide COBRA premium assistance to eligible individuals. The ARPA COBRA...more

IRS Extends Transitional Relief for 2020 ACA Reporting

The Internal Revenue Service (IRS) released Notice 2020-76 on October 2, 2020, announcing a delay in the deadline for distribution of Forms 1095-B and Forms 1095-C to participants by employers, health insurers and other...more

CARES Act Clarifies Telehealth Coverage for High Deductible Health Plans

Earlier this week the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) passed the Senate and today has passed the House. President Trump has indicated that he will immediately sign the CARES Act. The Act...more

COVID-19 Relief Act Mandates Testing Coverage without Cost Sharing

This afternoon the Senate passed the Families First Coronavirus Response Act, H.R. 6201 (the “Act”) sending it to President Trump’s desk. The President has already indicated that he will sign it. The Act remains unchanged...more

House Updates Coronavirus Legislation Requiring COVID-19 Coverage

Updated from a Previous Post - Early Saturday morning, the House of Representatives passed the Families First Coronavirus Response Act, H.R. 6201 (the “Bill”). As currently drafted the Bill provides a number of COVID-19...more

IRS Provides Coronavirus Deductible and Coinsurance Exception for HDHPs

Today, the IRS issued Notice 2020-15 that allows a high deductible health plan (HDHP) to provide first dollar coverage for both testing and treatment of the coronavirus. This means that claims for testing and treatment may...more

Employer Mandate Penalties Last Forever

The Internal Revenue Service (IRS)’s Office of Chief Counsel recently issued a memorandum (the “CCM”) announcing that the Employer Shared Responsibility Payment (“Employer Penalty”) under Code Section 4980H is effectively not...more

ACA Taxes to be Repealed, PCORI Extended

Yesterday, language to eliminate the Cadillac and other ACA taxes was included in must pass spending legislation. The Consolidated Spending Bill is set to be voted on by the House and Senate and signed by the President by...more

Impact of New Department of Labor HRA Regulations on Retiree Only HRAs

On June 13, 2019, the Department of Labor (the “DOL”), along with the Departments of Treasury and Health and Human Services, released final regulations expanding the use of health reimbursement arrangements (HRAs). Since...more

DOL Enforcement Relief Clears Pathway for Association Health Plans

On May 13, 2019, the Department of Labor released additional guidance addressing questions about the enforcement relief announced earlier by the Department pending its appeal of the district court’s ruling that invalidated...more

DOL Appeals Association Health Plan Ruling

On April 26, 2019, the Department of Labor filed a notice of appeal in the case that invalidated key provisions of its Association Health Plan (AHP) regulations. Released last summer, the AHP regulations loosened the...more

Court Ruling Chills Association Health Plans

On March 28, 2019, in State of New York v. United States Department of Labor, a federal district court in the District of Columbia set aside key portions of the Department of Labor’s final rule (the “Final Rule”) which paves...more

SDNY Hands Self Insured Health Plans a Total Win

In what can only be described as a complete and total win for self-insured health plan sponsors, the Southern District of New York recently upheld a plan’s prohibition on assignments of benefits. While a number of cases...more

Group Health Plan Section 111 Reporting is Back

Self-insured plan sponsors thought they had seen the last of Group Health Plan Section 111 Reporting in 2009, but like a character in a movie …… it’s baaaccckkk. ...more

Proposed Regulations Exponentially Expand the Use of HRAs

Health Reimbursement Accounts (HRAs) are employer funded, account-based health plans which, by design, reimburse up to a fixed dollar amount of medical expenses. The Affordable Care Act (ACA) has severely limited their use...more

Health Plans must Explain Reasonable and Customary

As most plan sponsors know, demand letters and lawsuits from out-of-network providers have been on the rise the past few years. This rise in out-of-network provider demands and lawsuits is a product of the sharp rise in...more

More Guidance in Favor of Association Health Plans

In June, the Department of Labor issued a final rule that allowed the expansion of Association Health Plans (AHPs). The final rule revised the definition of who can qualify as an “employer” under ERISA and loosened the...more

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