In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization and subsequent state abortion bans, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services issued a...more
By July 31, employers that sponsor self-funded medical plans must report and pay their PCORI fee. By July 31, employers that sponsor calendar-year employee benefit plans that are subject to ERISA must file a Form 5500 (unless...more
As the temperatures continue to rise, regulations and litigation related to employer-sponsored group health plans have followed suit. As these new rules continue to evolve, we are often asked whether a self-insured group...more
In a recent article in Managed Healthcare Executive, Peter Wehrwein examines the trend of self-funding of group health benefits by smaller employers who used to depend mainly or entirely on fully insured programs....more
We are sometimes asked whether a self-funded group health plan is required to cover gender-affirming medical services. As this post explains in detail, it is generally impracticable for a self-funded ERISA-covered plan to...more
Estate planning is about much more than reducing taxes; it’s about ensuring your loved ones are provided for after you’re gone and that your assets are passed on according to your wishes. However, few events can upend your...more
In a recent On the Subject (available here), we reported on the impact of the final rule (final rule) interpreting Section 1557 of the Affordable Care Act (ACA) on self-funded group health plans that contract with licensed...more
The DRI Life, Health, and Disability Committee is once again sponsoring a program aimed at providing a basic understanding of the concepts applicable to life, health, and disability litigation. The program, which receives...more
Federal legislative and regulatory activity related to employer-sponsored group health plans shows no signs of slowing, particularly with the issuance of interpretive guidance regarding the transparency and surprise-billing...more
As reported in a prior blog post, the Federal Trade Commission (“FTC”) filed suit in federal district court in September alleging that U.S. Anesthesia Partners, Inc. (“USAP”), and the private equity firm Welsh, Carson,...more
Many employees—and some employers—don’t realize how much companies pay for fully funded health insurance premiums. According to the KFF 2022 Employer Health Benefits Survey, premiums cost an average of $7,911 for single...more
If you sponsor a group health plan, make sure you set a calendar alert before the winter holidays to submit the annual gag clause prohibition compliance attestation. Under the Consolidated Appropriations Act of 2021 (CAA),...more
In this session, McDermott Will & Emery Partner Patrick Healy moderated a panel that examined the expansion of value-based care in the employer market. We summarize the panel’s insights on how stakeholders can successfully...more
Employees generally know healthcare is expensive, but they often don’t know just how expensive until they’re on COBRA and are shocked at the cost. Companies pay around $23,000 per year for family and $8,000 per year for...more
Group health plans are now required to submit an annual attestation confirming that the agreements the plan enters into with its service providers do not contain “gag clauses,” which are limitations regarding the plan’s...more
On December 29, 2022, the President signed the Consolidated Appropriations Act, 2023 (“CAA, 2023”), into law. The CAA, 2023, which is largely a bipartisan spending bill, sunsets provisions of the Public Health Service Act...more
We recently reported on an FAQ issued December 23, 2022 (FAQ About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 56) by the US Departments of Labor, Health and Human Services and the...more
On December 15, 2022, the Internal Revenue Service (IRS) finalized regulations regarding Information Reporting of Health Insurance Coverage and Other Issues Under Internal Revenue Code (Code) Sections 5000A, 6055 and 6056...more
We are pleased to present our annual End of Year Plan Sponsor “To Do” Lists. This year, we present our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 covers year-end health and welfare plan issues....more
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
On Friday, June 24, 2022, the U.S. Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, and overruled Roe v. Wade and Planned Parenthood of Southeastern Pa. v. Casey. In doing so, the Court held...more
On June 24, 2022, the U.S. Supreme Court issued its opinion in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and Planned Parenthood v. Casey (which collectively held that the U.S. Constitution...more
In our January 2022 update, we discussed new federal requirements that group health plans should pay close attention to in 2022. The sponsor of a self-funded plan will need to work closely with its legal counsel, benefits...more