The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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