The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Employers that sponsor a self-insured health plans must submit their Patient-Centered Outcomes Research Institute (PCORI) fees to the Internal Revenue Service by July 31, 2024. Plan sponsors need to calculate their PCORI fee...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
Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more
Well, it was good while it lasted. On September 27th, the Departments issued new FAQs regarding implementation of provisions of The Transparency in Coverage Final Rules (TiC Final Rules). ...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
How much would you get back in your budget if you could save up to 10% on your medical and Rx benefits costs? Employee benefits are the second largest budget item in employee compensation, with medical benefits consuming the...more
On June 16, 2022 Groom will be hosting a webinar on the impact of state abortion restrictions on employers, insurers, and self-insured plans. Over the past year, numerous states have enacted new abortion restrictions, and we...more
States have always been the primary regulators of their local health care markets and have increasingly used All Payer Claims Databases (APCDs) as one tool to help them make data-driven policy decisions. Like much state...more
For those employers that sponsor a self-insured health plan, it’s important to be aware that the deadline for your 2021 PCORI filing is August 2, 2021. This deadline applies for plan years ending on December 31, 2020 (or any...more
As some states make headlines for so-called “anti-trans” laws, the Washington state legislature rejected a bill designed to limit youth participation in sports based on their gender as assigned on a birth certificate and...more
How Can Mental Health and Substance Use Disorder (SUD) Parity Laws Help Battle the Overdose Epidemic? Learn the Answers—and Catch Up on the Most Recent State and Federal Developments—at a New Webinar from the AMA and Manatt. ...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
We have had a number of questions from clients about their ability to maintain group medical and other employer-provided benefits for employees affected by temporary layoffs and working hours reductions related to COVID-19....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
Last Filing for Calendar Year Plans! The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (the...more
In what can only be described as a complete and total win for self-insured health plan sponsors, the Southern District of New York recently upheld a plan’s prohibition on assignments of benefits. While a number of cases...more
An employer that employs 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year is subject to the Family Medical Leave Act (“FMLA”). Therefore, often...more
On June 21, 2018, the Department of Labor (the “DOL”) issued new regulations giving official status to a previously proposed new form of Association Health Plans (“AHPs”). A qualified AHP, while covering the employees of...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
San Francisco (January 11, 2018) – The final day of the 2018 JP Morgan Healthcare Conference gave us food for thought about the topic of healthcare navigation, as well as updates on the home health sector. Post-acute has...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
The U.S. House of Representatives passed the Self-Insurance Protection Act (H.R. 1304), on April 5, 2017, in an effort to preclude federal regulation of stop-loss insurance. This Act would not alter regulation of the current...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