The wait is over, and now the work begins for health plan sponsors.
Much-anticipated final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) were...more
9/19/2024
/ Benefit Plan Sponsors ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Health Insurance ,
HMOs ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Out of Network Provider ,
Outpatient Services ,
Substance Abuse
Employers will soon see the national debate about abortion popping up in some unexpected places: the HIPAA privacy policies and procedures and notices of privacy practices they use for their health benefit plans....more
5/6/2024
/ Abortion ,
Benefit Plan Sponsors ,
Compliance ,
Covered Entities ,
Dobbs v. Jackson Women’s Health Organization ,
Employer Group Health Plans ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Privacy Rule ,
Notice Requirements ,
Reproductive Healthcare Issues ,
Substance Abuse
Employers often target benefit offerings to specific groups of workers—think dependent care accounts or student loan repayment matching contributions—so maybe it was inevitable....more
Now you know.
It could not be any clearer to employers that compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) will be a—maybe the—top health and welfare benefit priority for federal...more
8/4/2023
/ Benefit Plan Sponsors ,
Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Health Insurance ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Rules ,
Regulatory Agenda ,
U.S. Treasury
Employers’ high deductible health plans (HDHPs) can continue to cover COVID-19 testing and treatment without violating the eligibility rules for health savings accounts (HSAs)—but only through 2024—under new Internal Revenue...more
What does the April 10, 2023, early end of the COVID-19 National Emergency declaration mean for employer health plans?
Well, nothing, actually....more
As employers plan for the impact of the anticipated May 11, 2023, end of the two federal COVID-19 emergency orders, they have some important new clarity on test and vaccine coverage and on how to unwind COVID-19–era extended...more
4/4/2023
/ Benefit Plan Sponsors ,
COBRA ,
Coronavirus/COVID-19 ,
Corporate Counsel ,
Department of Health and Human Services (HHS) ,
Health Savings Accounts ,
New Guidance ,
Public Health Emergency ,
Secretary of HHS ,
Vaccinations ,
Virus Testing
Employers have a reprieve from the challenging December 27, 2022, deadline for reporting 2020 and 2021 prescription drug cost information to the U.S. Department of Health and Human Services (HHS). ...more
Employers can’t say they weren’t warned.
For the second time in six months, frequently asked question (FAQ) guidance from federal regulators is calling attention to the requirement that employer-sponsored health...more
8/5/2022
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Contraceptive Coverage Mandate ,
Contraceptives ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
New Guidance ,
Preemption
On June 24, 2022, the Supreme Court of the United States issued its highly anticipated decision in Dobbs v. Jackson Women’s Health Organization, No. 19-1392. The Dobbs decision expressly overrules the two key precedents that...more
6/24/2022
/ Abortion ,
Affordable Care Act ,
Benefit Plan Sponsors ,
COBRA ,
Criminal Code ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Equal Employment Opportunity Commission (EEOC) ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Reimbursement ,
Mental Health ,
Mental Health Parity Rule ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Roe v Wade ,
SCOTUS ,
Telehealth
Employer health plans and health insurers will be required to cover over-the-counter (OTC) COVID-19 tests, even without a health care provider’s order or an individualized clinical assessment, and generally without cost...more
1/12/2022
/ Benefit Plan Sponsors ,
Biden Administration ,
Coronavirus/COVID-19 ,
Corporate Counsel ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Health Insurance ,
New Guidance ,
Popular ,
Virus Testing ,
Workplace Safety
Employers and their benefit administrators have more detail and a more convenient way to submit “top 50” lists and other data - but no more time to comply with - daunting prescription drug cost reporting requirements in the...more
12/16/2021
/ Benefit Plan Sponsors ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Drug Pricing ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Interim Final Rules (IFR) ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Rebates ,
Reporting Requirements ,
U.S. Treasury ,
Year-End Compliance Checklist
On December 2, 2021, President Joe Biden made comments announcing the White House’s plan for combating COVID-19 and the emerging new variant, Omicron. As part of the nine-step plan, President Biden announced an initiative...more
Plan participants can be hit with surprise medical bills when they receive care from out-of-network providers. Sometimes, this happens when participants do not know that the care they are receiving is from an out-of-network...more
7/22/2021
/ Benefit Plan Sponsors ,
Consolidated Appropriations Act (CAA) ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Employer Group Health Plans ,
Interim Final Rules (IFR) ,
New Guidance ,
Out of Network Provider ,
Self-Insured Health Plans ,
Surprise Medical Bills ,
U.S. Treasury
The American Rescue Plan Act of 2021 (ARPA), which became law on March 11, 2021, provides a 100 percent subsidy of premiums under the Consolidated Omnibus Budget Reconciliation Act (COBRA) beginning on April 1, 2021, through...more
3/18/2021
/ American Rescue Plan Act of 2021 ,
Benefit Plan Sponsors ,
Biden Administration ,
COBRA ,
Coronavirus/COVID-19 ,
Employee Benefits ,
Employer Group Health Plans ,
Families First Coronavirus Response Act (FFCRA) ,
Health Insurance ,
Medicare ,
Notice Requirements ,
Popular ,
Premium Subsidies ,
Relief Measures ,
Tax Credits
Beginning in 2022, employer-sponsored health plans will be required to pay providers certain emergency and out-of-network charges that would have otherwise been balance billed to participants.
That is the centerpiece of...more
A federal court ruling staying key parts of new Affordable Care Act (ACA) regulations in light of the landmark Supreme Court of the United States ruling on sexual orientation and gender identity will provide little certainty...more
Employers have more clarity on COVID-19 testing coverage requirements - including new details on at-home tests, return-to-work testing, and out-of-network pricing - under new guidance that the U.S. Department of Health and...more
Employers now have greater clarity on how the new federal requirements covering COVID-19 testing and diagnosis apply to their group health plans, under guidance issued by the U.S. Department of Labor, U.S. Department of...more
Employer plans will still be able to exclude the value of drug manufacturer coupons from annual out-of-pocket maximums, even when no generic equivalent is available, under new guidance from the Department of Labor, Department...more
8/28/2019
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Co-payments ,
Deductibles ,
Department of Health and Human Services (HHS) ,
Generic Drugs ,
Health Insurance ,
IRS ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
U.S. Treasury
Behavioral health claims administrators and plan sponsors alike may be looking more closely at their care guidelines—and how they are applied—after a federal court ruled in a California class action that a claims...more
Employers may soon find themselves reviewing and revising health plan master documents and summary plan descriptions (SPDs) and administrative service agreements with respect to an obscure claims administration practice known...more
The Department of Labor (DOL), the Department of the Treasury, and the Department of Health and Human Services (HHS) are making good on their promise to issue more guidance and to aggressively enforce the federal Mental...more
5/14/2018
/ 21st Century Cures Initiative ,
Affordable Care Act ,
Benefit Plan Sponsors ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Insurance ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
New Guidance
The deadline to respond is nearing for employers that received the first wave of Letter 226J mailings proposing to assess them with Employer Shared Responsibility Payments (ESRPs) for 2015 under Section 4980H of the Internal...more
Employers looking for strong scores on the Corporate Equality Index (CEI) in coming years may have to make some unexpected changes to their health benefit programs.
Benefit programs are one key component of CEI ratings,...more