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Employee Benefits Cost-Sharing

Proskauer - Employee Benefits & Executive...

Transparency in Coverage Rules: When Accurate Estimates for Low‑Utilization Items and Services Are Not Available

Last week, the Departments of Labor, Treasury and Health and Human Services (“the Departments”) issued an FAQ about the final Transparency in Coverage rules (“TiC Rules”). This FAQ addresses compliance with cost‑sharing...more

Ballard Spahr LLP

Prescription for Chaos: Copay Accumulator Programs Called Into Question

Ballard Spahr LLP on

Summary - Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more

Akerman LLP - HR Defense

Your Employee Benefit Plans May Need a Check Up: Nearing the End of the COVID-19 Public Health Emergency

Where did the time go? Just a brief 1,199 days after it began, the COVID-19 Public Health Emergency (PHE) is coming to an end. The PHE formally ends on May 11, 2023, short of any unexpected developments. And that means the...more

Groom Law Group, Chartered

ACA Preventive Service Requirements Partially Vacated

On March 30, 2023, the District Court for the Northern District of Texas issued an opinion and order in Braidwood Mgmt. Inc. v. Becerra that vacates the implementation and enforcement of certain preventive service provisions...more

Nelson Mullins Riley & Scarborough LLP

Telehealth Coverage Reinstated for HDHP/HSAs Effective April 1, 2022

The Consolidated Appropriations Act of 2022 (“2022 CAA”), which was recently signed into law, reinstates the exception that allows high deductible health plans (“HDHPs”) to waive all or a portion of participant cost-sharing...more

Proskauer - Employee Benefits & Executive...

There’s More! Tri-Agencies Provide Clarifying Guidance on Group Health Plan Coverage of Over-the-Counter At-Home COVID-19 Tests

A few short weeks ago we told you in a blog post that, with only four days’ notice, the Departments of Labor, Treasury, and HHS (the Departments) required that, starting January 15, 2022, group health plans cover FDA-approved...more

Venable LLP

Employer Group Health Plans Must Cover Over-the-Counter COVID Tests

Venable LLP on

On Monday, the government issued frequently asked questions (FAQs) requiring employer group health plans (Plans) and health insurance issuers to cover certain over-the-counter (OTC) COVID-19 tests at no cost to the...more

Polsinelli

Group Health Plan Coverage Requirements Expanded to Include Non-Prescribed Over-the-Counter COVID-19 Testing

Polsinelli on

Effective January 15, 2022, health plans are required to cover the cost of over-the-counter (“OTC”) COVID-19 test kits obtained without a health care provider’s prescription or clinical assessment. This new requirement was...more

Stinson LLP

Agencies Issue Guidance Requiring Coverage for Over-the-Counter COVID-19 Tests

Stinson LLP on

Beginning January 15, 2022, and through the duration of the public health emergency, insurers and group health plans must cover at-home COVID-19 diagnostic tests available over-the-counter (OTC) without imposing cost-sharing,...more

Proskauer - Employee Benefits & Executive...

You Can Go Home Again: Tri-Agencies Release New Group Health Plan Coverage Requirements for Over-the-Counter At-Home COVID-19...

Looking forward to the weekend? Many employers and plan administrators may also have been . . . up until yesterday, when the government issued new requirements that take effect on Saturday. ...more

Mitchell, Williams, Selig, Gates & Woodyard,...

"No Surprises Act" Compliance Tips For Group Health Plans and Health Insurance Issuers

On July 13th, group health plans and health insurance issuers subject to the Federal No Surprises Act (the “Act”) received the first phase of interim final rules promulgated under the Act (the “Rules”) and issued by the...more

Jackson Walker

Guidance Reminds Health Plans to Check Up on Preventive Care Compliance

Jackson Walker on

On July 19, 2021, the Internal Revenue Service, U.S. Department of Labor, and the U.S. Department of Health and Human Services (the “Tri-Agencies”) issued new frequently asked questions (FAQs) regarding the implementation of...more

Groom Law Group, Chartered

Surprise! Tri-Agencies Meet Deadline with First Set of Surprise Billing Rules, With More to Come

On July 1, 2021, the Office of Personnel Management, Department of the Treasury, Department of Health and Human Services (“HHS”), and Department of Labor (“DOL”) (collectively, the “Departments”), released the interim final...more

Bradley Arant Boult Cummings LLP

No More Surprises? New Rule on Surprise Medical Bills

The U.S. Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management have issued "Requirements Related to Surprise Billing; Part I," an interim final rule to implement the No...more

Carlton Fields

Midyear Premium Increases and Cafeteria Plan Rules

Carlton Fields on

Carlton Fields tax attorney Lowell Walters discusses issues that can arise when employers with group health plans increase the premiums paid by employees midyear, which we might see more of since certain grandfathered health...more

McAfee & Taft

More details on transparency rules that apply in 2022 and beyond

McAfee & Taft on

On December 6, 2020, we posted an article titled “RADICAL new transparency rules likely apply to your health plan in one year.” The regulations are a little more than 150 PDF pages long. The following is intended to provide a...more

Nelson Mullins Riley & Scarborough LLP

COVID-19’s Impact on Your Group Health Benefits – Are You Compliant?

Following a presentation to the Association of Corporate Counsel (ACC) in Georgia, Nelson Mullins attorneys Ann Murray and Matt Zischke shared additional insights into the evolving effects of the COVID-19 pandemic on group...more

McAfee & Taft

RADICAL new transparency rules likely to apply to your health plan in one year

McAfee & Taft on

New rules published last month likely require your employer health plan to phase-in certain disclosures over a three-year period beginning in one year: 1. January 1, 2022 (three files must be disclosed): For plan years...more

Seyfarth Shaw LLP

Final Rule regarding Transparency in Coverage for Health Care Services

Seyfarth Shaw LLP on

Seyfarth Comments: The final Transparency in Coverage Rule was published jointly by the Departments of Health and Human Services, Treasury, and Labor on November 12, 2020. The Rule aims to increase transparency in...more

Fisher Phillips

Group Health Plan Sponsors Receive Welcome Guidance On COVID-19 Testing Coverage Provisions

Fisher Phillips on

A second round of FAQs recently issued by the Labor Department, the IRS, and the Department of Health and Human Services provides plan sponsors and insurers with additional implementation guidance relating to health coverage...more

Seyfarth Shaw LLP

DOL Addresses Health Plan Coverage for Return-to-Work COVID Testing and Other Pressing Issues

Seyfarth Shaw LLP on

Seyfarth Synopsis: On June 23, 2020, the DOL issued additional FAQs relating to the COVID-19 testing mandate under the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act...more

Ballard Spahr LLP

FAQs on COVID-19 Address Benefit Issues

Ballard Spahr LLP on

The U.S. Departments of Labor, Health and Human Services, and the Treasury have jointly published a set of frequently asked questions that offer guidance on a number of benefits issues related to the expansion of coverage...more

Best Best & Krieger LLP

COVID-19 Pandemic May Force Some Cities to Reset Employee Benefits

As the harsh realities of the coronavirus pandemic, along with its widespread impact on all aspects of daily life, continue to shock and numb us all, many cities have already been identified as “high risk” from a financial...more

Bradley Arant Boult Cummings LLP

Coronavirus and Health Plans: Changes to Cost Sharing for COVID-19 Testing and Treatment - Employee Benefits Alert

The nation’s lawmakers, government agencies, and insurance carriers are taking measures to remove financial barriers to testing and treatment for the novel coronavirus disease (COVID-19). Employers sponsoring health plans...more

Bricker Graydon LLP

COVID-19 developments in employee medical insurance

Bricker Graydon LLP on

HDHP and HSA participants - The IRS has expanded prior guidance to allow health plans to pay first-dollar costs for testing and treatment of COVID-19 without jeopardizing the participant’s HSA eligibility. ...more

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