Summary The Fifth Circuit Court of Appeals recently upheld regulations defining the qualifying payment amount (QPA). The QPA is a key factor in determining how much individuals and health plans must pay out-of-network providers in certain situations, where the individual does not have a choice to receive services in-network. The Upshot The Bottom Line The [&hellip… Continue Reading »
Summary The IRS recently issued Notices 2024-71 and 2024-75, which expand the list of “preventive care” benefits permitted to be provided by a high deductible health plan (HDHP) without a deductible and the list of benefits considered “medical care expenses” under group health plans. The Upshot The Bottom Line Employers that offer health benefits, and particularly those that [&hellip… Continue Reading »
Summary The Departments of the Treasury, Labor, and Health and Human Services have published final regulations under the Mental Health Parity and Addiction Equity Act that prohibit group health plans and health insurers from imposing nonquantitative treatment limitations that place greater restrictions on benefits for mental health and substance use disorders than for medical and [&hellip… Continue Reading »
A new and unprecedented wave of class action complaints is targeting a common feature of many employer-sponsored benefit plans: tobacco-user surcharges. These surcharges are often part of a wellness program that charges higher medical plan premiums to participants who fail to certify that they do not use tobacco products. As we reported earlier this year, employers who [&hellip… Continue Reading »
Summary The U.S. Department of Labor (DOL) updated its 2021 cybersecurity guidance to clarify that it applies to all employee benefit plans. The DOL guidance confirms that plan fiduciaries, including health and welfare plan fiduciaries, have an obligation to evaluate the cybersecurity procedures of plan record-keepers and other service providers. The Bottom Line While the updates to [&hellip… Continue Reading »
Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that have not started to prepare for these new requirements should begin to take measures now. Section 1557. Final regulations under the [&hellip… Continue Reading »
Summary The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules. The Upshot The Bottom Line As a result of the ruling, health plans may pay more in out-of-network claims. Health plan sponsors should pay attention to the fees that vendors charge [&hellip… Continue Reading »
Over the course of the past few months, the Office of Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC), both of which are divisions of the U.S. Department of Health and Human Services (HHS), have issued a series of new regulations and guidance related to the Health Insurance [&hellip… Continue Reading »
Summary The U.S. Department of Health and Human Services (HHS) has issued final regulations on the nondiscrimination rules set forth in Section 1557 of the Affordable Care Act. The new rules apply to certain group health plans, as well as many health care providers. The Upshot The Bottom Line Plan sponsors need to evaluate whether the new [&hellip… Continue Reading »
Summary The Departments of Labor, Health and Human Services, and the Treasury have issued guidance on how health plans and insurers may attest to their compliance with the anti-gag rules of the Consolidated Appropriations Act, 2021 (CAA). The Upshot The Bottom Line By December 31, 2023, health plans and insurers must submit an attestation of [&hellip… Continue Reading »
Since the inception of the annual reporting requirements under the Affordable Care Act for Forms 1094 and 1095, the IRS has been annually extending the deadline for employers to distribute those reports to individuals. In line with prior guidance, the IRS has now issued final regulations that provide for a permanent, automatic 30-day reporting deadline [&hellip… Continue Reading »
Summary The Department of Health and Human Services (HHS) has issued proposed regulations under the nondiscrimination provisions of Section 1557 of the Affordable Care Act (ACA). The proposed rules restore and augment a number of the nondiscrimination requirements in regulations that were published in 2016, but later stripped away in rules published in 2020. The [&hellip… Continue Reading »
The recently enacted Consolidated Appropriations Act, 2022 (CAA 2022) is best known for preventing a government shutdown and providing aid to Ukraine, but its more than 2,600 pages also contain language that revives a telehealth services provision that many health plan sponsors will welcome. The provision allows participants to receive benefits under a High Deductible Health Plan [&hellip… Continue Reading »
The stimulus package that President Trump signed includes several provisions of significance to employee benefit plans, including measures that respond to the effects of the COVID-19 pandemic on health and dependent care flexible spending arrangements (FSAs). FSAs typically allow employees to make contributions on a pre-tax basis through a cafeteria plan and use those contributions to pay [&hellip… Continue Reading »
The IRS has released Notice 2020-50, which provides guidance to employers that have amended their retirement plans to take advantage of provisions under the CARES Act that provide access to special plan distributions, known as Coronavirus-Related Distributions (CRDs), and expanded plan loans. Coronavirus-Related Distributions The CARES Act permits employers to amend their eligible retirement plans to [&hellip… Continue Reading »
The Internal Revenue Service (IRS) issued Notice 2020-46 providing guidance to employers whose employees forgo sick, vacation, or personal leave to aid victims of COVID-19. Generally, when an employee donates sick, vacation, or personal leave to which he or she otherwise is entitled, the donation is treated as an assignment of income – the employee is treated [&hellip… Continue Reading »
The IRS released Notice 2020-42, which provides temporary relief during calendar year 2020 from the physical presence requirements for participant elections in retirement plans. Under the new guidance, there is relief during calendar year 2020 from the physical presence requirement for any participant election witnessed by a notary public through an electronic system that uses remote [&hellip… Continue Reading »
The Pension Benefit Guaranty Corporation (PBGC) – the federal agency created by the Employee Retirement Income Security Act of 1974 (ERISA) to insure certain defined benefit pension plans offered by private-sector employers – has announced that it will extend deadlines for upcoming premium payments and certain other required plan filings under Title IV of ERISA to July [&hellip… Continue Reading »
