News & Analysis as of

Patient Protection and Affordable Care Act (PPACA) › Self-Insured Health Plans

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
Woodruff Sawyer

Reminder: PCORI Fees Due By July 31, 2024

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2024 deadline for paying fees that fund the Patient-Centered Outcomes...more

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

Hall Benefits Law on

A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

Jackson Lewis P.C.

Self-Insured Health Plans: Adjusted PCORI Fee Announced for 2024

Jackson Lewis P.C. on

As discussed in a previous blog, the Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through...more

Bricker Graydon LLP

PCORI Fee Deadline is Almost Here

Bricker Graydon LLP on

If you sponsor a self-insured group health plan (including an HRA), make sure you set a calendar alert for July 31 to pay the annual PCORI fee (Patient-Centered Outcomes Research Institute fee) for the 2022 plan year. The...more

Woodruff Sawyer

Compliance Alert: Reminder PCORI Fees Due By July 31, 2023

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2023 deadline for paying fees that fund the Patient-Centered Outcomes...more

Proskauer - Employee Benefits & Executive...

District Court Holds Third-Party Administrator Violated ACA’s Anti-Discrimination Rules by Administering Self-Insured Plan’s...

Proskauer - Employee Benefits & Executive... on

On the heels of several recent court decisions concerning gender-affirming care, a federal district court in Washington concluded that the denial of benefits for gender-affirming care by a third-party administrator (“TPA”)...more

Jackson Lewis P.C.

Self-Insured Health Plans: August 1st PCORI Fee Due Date is Rapidly Approaching

Jackson Lewis P.C. on

The Patient-Centered Outcomes Research Institute (“PCORI”) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through annual fees — provided for in...more

Woodruff Sawyer

Compliance Alert: Reminder PCORI Fees Due By July 31, 2022

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2022 deadline for paying fees that fund the Patient-Centered Outcomes...more

Snell & Wilmer

For the Long Haul: SCOTUS Ruling Means ACA Coverage and Reporting Rules Here to Stay

Snell & Wilmer on

Despite myriad legal challenges, the Affordable Care Act (“ACA”) remains the law of the land. We previously reported on the Supreme Court’s latest validation of the law in our SW Benefits Update, “Three Strikes You’re Out –...more

Genova Burns LLC

The Biden Administration’s Health Insurance Priorities

Genova Burns LLC on

The Biden Administration wasted no time in implementing some of the new President’s campaign promises relating to health insurance and the Affordable Care Act (“ACA”). First, on February 10 the Department of Justice filed a...more

Troutman Pepper

COVID-19 Employee Benefits: FAQs for Employers Focus on Health and Welfare Benefit Plans

Troutman Pepper on

It is hard to find a sector of the American workforce that has not been affected by the COVID-19 emergency. Employees are being asked to work from home if they are able, businesses are being forced to close, and employers are...more

Holland & Hart - The Benefits Dial

You’ve Got Another PCORI Fee Coming!: Congress revives the PCORI fee and filing obligations

Holland & Hart - The Benefits Dial on

In the wee hours of December 2019, Congress revived the PCORI fee and filing obligations of employer sponsors of self-insured group health plans. In accordance with the requirements of the Affordable Care Act, employer...more

Snell & Wilmer

Congress Giveth and They Taketh Away — Recent Health Plan Changes

Snell & Wilmer on

In enacting the Further Consolidated Appropriations Act, 2020, (the “Act”), Congress, among other changes, enacted the following key changes affecting employer group health plans...more

Burr & Forman

PCORI Fee Resurrected

Burr & Forman on

In the summer of 2019, I wrote a short blog on the death of the PCORI fee — Ding, Dong, the PCORI Fee is Dead!. When enacted as part of the Affordable Care Act, the fee was set to expire with plan/policy years ending after...more

Eversheds Sutherland (US) LLP

Transparency in coverage rule - Potential implications for self-insured health plans

Eversheds Sutherland (US) LLP on

On November 15, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Agencies”) issued a proposed "Transparency in Coverage" rule that would require most...more

Jones Day

Direct Contracting 101: Collaborations Between Employers and Health Care Providers

Jones Day on

As employers continue to encounter escalating health care costs, many are exploring the "direct contracting" option, which allows for direct service and pricing negotiations with health care providers. While the direct...more

Mintz - Employment Viewpoints

Association Health Plans: Self-Funded vs. Fully-Insured

Mintz - Employment Viewpoints on

Recently proposed Department of Labor (Department) regulations governing Association Health Plans (AHPs) would, if made final, permit small employers to be regulated under more favorable, large group rules. The proposed...more

Nilan Johnson Lewis PA

Association Health Plans: What Are They & What’s Changing?

Nilan Johnson Lewis PA on

What are Association Health Plans? Association Health Plans allow small employers or self-employed individuals to group together to form a larger pool for offering health insurance. An Association Health Plan model can...more

Davis Wright Tremaine LLP

Update #8: American Health Care Act Passed by House May Revive Annual and Lifetime Limits in Self-Insured Employer Plans

Davis Wright Tremaine LLP on

On May 4, the House Republicans narrowly passed the American Health Care Act (AHCA). Except for effective dates, the provisions impacting employers were generally unchanged. One major change to the original bill is that...more

Sullivan & Worcester

Employment and Benefits Advisory: 2017 Reminders and Developments

Sullivan & Worcester on

New Relief for Small Employer Health Reimbursement Arrangements - As mentioned in prior advisories, the Departments of Labor, Health and Human Services and Treasury have taken the position that employers cannot reimburse...more

Bass, Berry & Sims PLC

Reminder: November 15 Transitional Reinsurance Program Filing Deadline is Fast Approaching

Bass, Berry & Sims PLC on

To help stabilize the individual insurance market, Section 1341 of the Affordable Care Act introduced the Transitional Reinsurance Program (TRP), which includes the collection of a TRP fee from “contributing entities” for...more

McDermott Will & Emery

Affordable Care Act Compliance: IRS Releases Draft 2016 Employer Reporting Forms and Instructions

McDermott Will & Emery on

The Internal Revenue Service recently issued revised draft Forms 1094-C and 1095-C and related instructions for use for the 2016 reporting year. ...more

BCLP

Deadline Reminder for Employers and Providers: Electronically File Information Returns with IRS by June 30

BCLP on

Self-insured employers, applicable large employers and health coverage providers are reminded that the June 30 deadline to electronically file information returns with the IRS is approaching. The deadline to provide...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - March 2016

Manatt, Phelps & Phillips, LLP on

HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more

BCLP

Health Coverage Providers: Deadlines for Health Coverage Providers to Report Minimum Essential Coverage are Approaching

BCLP on

Who Must Report? If you are a health insurance issuer, self-insured employer, or other entity that providedminimum essential coverage (MEC) during calendar year 2015, including a state government providing Medicaid or...more

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