...The Consolidated Appropriations Act, 2021, Public Law 116-260 (CAA) sets forth new compensation disclosure requirements that apply to brokers and consultants with respect to both fully-insured and self-insured group health...more
Health plan wellness programs may generally include a health plan premium incentive discount for those who have received the COVID-19 vaccine(s) or, alternatively, a premium surcharge for those who are not vaccinated....more
On September 30, 2021, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury (collectively, the Departments) along with the Office of Management and Budget released “Requirements Related to Surprise...more
Over the last several years, both the federal government and a number of state legislatures have sought to find a solution to the billing by out-of-network providers, referred to as “Out of Network Billing” (OON Billing) and...more
Recent court trends suggest that preemption under the Employee Retirement Income Security Act (ERISA) may not apply to certain state laws that regulate pharmacy benefit managers (PBMs), including state laws governing Maximum...more
6/16/2021
/ Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Prescription Drug Coverage ,
Prescription Drugs ,
Rutledge v Pharmaceutical Care Management Association ,
SCOTUS
Embedded in the Consolidated Appropriations Act, 2021 (the “CAA”) is a new obligation for group health plan sponsors and insurers that provide health insurance to document that their group health plan or insurance policy...more
Readers will recall that in the early months of the COVID-19 pandemic, the EEOC published a plethora of responses and updates to frequently asked COVID-19 questions. As the months went by, the pace of EEOC updates slowed, and...more
6/1/2021
/ Americans with Disabilities Act (ADA) ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Disability ,
Employer Mandates ,
Equal Employment Opportunity Commission (EEOC) ,
GINA ,
Incentives ,
New Guidance ,
Pregnancy Discrimination ,
Reasonable Accommodation ,
Religious Exemption ,
Title VII ,
Vaccinations
Takeaway Message. The Department of Labor (“DOL”) has recently issued model notices and forms that can be used to comply with the new subsidized COBRA requirements created by the American Rescue Plan Act of 2021 (“ARPA” or...more
The American Rescue Plan Act of 2021 (the “ARPA”), which President Biden is expected to sign this week, includes a handful of provisions affecting employee benefit plans and publicly-traded companies’ tax deductions for...more
Last year, the Internal Revenue Service (IRS) and the Department of Labor (DOL) issued two notices that extended certain benefit plan deadlines for both employees/plan participants and for plan administrators as a result of...more
California health insurers and health care service plans that provide hospital, medical, or surgical coverage and that are issued, amended, or renewed on or after January 1, 2021 will be required to cover all medically...more
The United States Supreme Court recently ruled that certain federal employment protections against sex discrimination extend to employer discrimination based on sexual orientation or gender identity. In light of this ruling,...more
7/15/2020
/ Altitude Express Inc v Zarda ,
Bostock v Clayton County Georgia ,
Civil Rights Act ,
EEOC v RG & GR Harris Funeral Homes ,
Employee Benefits ,
Employer Liability Issues ,
Gender Identity ,
Hiring & Firing ,
LGBTQ ,
SCOTUS ,
Sex Discrimination ,
Sexual Orientation ,
Sexual Orientation Discrimination ,
Title VII ,
Transgender
COBRA compliance requires extra attention right now. There has been a wave of litigation surrounding COBRA election notices. Regulatory agencies have extended certain COBRA deadlines due to the COVID-19 pandemic. And the...more
The IRS issued two notices on May 12, 2020, Notice 2020-29 and Notice 2020-33. These Notices provide a number of options that employers could choose to offer their employees with respect to their 2020 cafeteria plan benefits...more
The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), which was signed by the President on March 27, 2020, includes several provisions affecting employer benefit plans.
Expansion of Withdrawal and Loan...more
On March 27, 2020, President Trump signed the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) into law. The CARES Act contains several provisions affecting healthcare benefits and the expansion of...more
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which was signed by the President on March 27, 2020, includes several provisions affecting group health plans, as discussed below.
Health Plan Rules and...more
3/31/2020
/ CARES Act ,
Clinical Laboratory Testing ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Federal Funding ,
Financial Stimulus ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Medical Supplies ,
Medicare ,
Prescription Drugs ,
Public Health Emergency ,
Telehealth
Takeaway Message: The IRS has recently concluded that the Affordable Care Act’s (the “ACA”) employer mandate is an ongoing tax liability which cannot be extinguished with the passage of time. In other words, the IRS has no...more
In April 2019, the Department of Health and Human Services (HHS) released guidance indicating that a health plan must include the value of financial assistance received from a drug manufacturer (often referred to as a...more
Background. These days, almost all employer-sponsored group health plans require an employee (and any dependents) covered under the plan (each are referred to as a “member”) to pay “out-of-pocket” for covered expenses in the...more
9/10/2019
/ Benefit Plan Sponsors ,
Co-payments ,
Coupons ,
Deductibles ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Out-of-Pocket Expenses ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs
The Mental Health Parity and Addiction Equity Act (MHPAEA) prohibits health insurance policies and group health plans that cover mental health and substance use disorder (MH/SUD) benefits from imposing limitations on MH/SUD...more
7/9/2019
/ Addiction Equity Act ,
Benefit Plan Sponsors ,
Department of Labor (DOL) ,
EBSA ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
Self-Funded Health Plans ,
Substance Abuse
Effective January 1, 2020, employers may put aside pre-tax funds into a health reimbursement arrangement (“HRA”) that can be used by an employee to pay for premiums and other out-of-pocket costs related to the purchase of an...more
Takeaway Message: A recent IRS notice provides a future path for employers to avoid ACA employer mandate penalties by reimbursing employees for a portion of the cost of individual insurance coverage through an...more
1/15/2019
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Employer Group Health Plans ,
Employer Mandates ,
Full-Time Employees ,
HRA ,
IRS ,
Proposed Regulation ,
Safe Harbors ,
Tax Credits ,
Wage and Hour
Takeaway Message: Except in limited circumstances, current regulatory guidance prohibits an employer from maintaining a health reimbursement arrangement (HRA) that reimburses the cost of premiums for individual health...more
The “Bottom Line” -
Employers will have until March 2, 2018 to furnish Form 1095-C (“Employer-Provided Health Insurance Offer and Coverage”) to employees.,,...more