News & Analysis as of

Health Insurance Employer Group Health Plans Out-of-Pocket Expenses

Sheppard Mullin Richter & Hampton LLP

Trump Administration Finalizes The Transparency in Coverage Rule

On October 29, 2020, the Department of Health and Human Services (“HHS”), the Department of Labor, and the Department of the Treasury (collectively, the “Departments”) released the Transparency in Coverage Final Rules (the...more

King & Spalding

Strategies for Addressing Reference-Based Plans

King & Spalding on

The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more

Foley & Lardner LLP

Is an Employer’s Health Plan Required to Count the Value of Drug Manufacturer Coupons Towards an Employee’s Out-of-Pocket Maximum?

Foley & Lardner LLP on

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

Snell & Wilmer

Preventive Care Can Now Be Covered for Specified Chronic Conditions Before HDHP Deductible

Snell & Wilmer on

On July 17, 2019 the IRS released Notice 2019-45 resolving a preventive care problem that has been plaguing many high deductible health plans (“HDHPs.”). The Affordable Care Act’s free preventive care mandate appears to be...more

Burr & Forman

IRS Expands Preventive Care Benefits Under High Deductible Health Plans

Burr & Forman on

On July 17, 2019, the Internal Revenue Service (the “IRS”) released Notice 2019-45 which expands the list of permissible preventive care benefits for high deductible health plan (“HDHP”) purposes. Among other requirements, an...more

Fisher Phillips

Reference-Based Pricing: Another Self-Insured Option for Employers

Fisher Phillips on

As health care costs increase, employers have been exploring new types of health coverage options, one of which is reference-based pricing (RBP). This method typically does not involve a traditional insurance carrier or...more

McGuireWoods LLP

Healthcare Costs for the Average Family Have Risen Dramatically

McGuireWoods LLP on

According to consulting and actuarial firm Milliman’s “2015 Milliman Medical Index,” which measures the cost of healthcare for a typical American family of four receiving coverage from an employer-sponsored preferred provider...more

McAfee & Taft

New ruling limits out-of-pocket expenses at individual level in 2016

McAfee & Taft on

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

Pullman & Comley, LLC

Alert: Health Plan Update on Out-of-Pocket Limitations

Pullman & Comley, LLC on

The Affordable Care Act (the “ACA”) established limitations on the annual out-of-pocket costs that a health plan may impose on a participant. The U.S. Department of Health and Human Services, Department of Labor and the...more

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