HHS, DOL, and Treasury Give Employer-Sponsored Health Plans Another Warning on Providing Contraceptive Coverage

For the second time in six months, frequently asked question (FAQ) guidance from federal regulators is calling attention to the requirement that employer-sponsored health plans provide coverage for women, without any cost sharing, for the full range of contraceptive methods approved by the U.S. Food and Drug Administration (FDA).

Employer-Provided COVID-19 Testing: An Employee Benefits Q&A

Although the fate of the Occupational Safety and Health Administration’s (OSHA) rules remains in limbo, many employers are moving ahead with efforts to comply with the OSHA emergency temporary standard (ETS) that requires employers with 100 or more employees to ensure that all are fully vaccinated or subject to COVID-19 testing at least weekly.

Health Plan Surcharge for Unvaccinated Employees: New Guidance Provides a Roadmap

Employers that are considering imposing health plan premium surcharges to encourage their employees to get vaccinated have clearer guidance on how to do so without running afoul of the nondiscrimination rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Both vaccination surcharges and incentives are permitted by HIPAA, provided that a plan complies with the requirements for “activity-only” wellness programs under the HIPAA regulations. Importantly, that means limiting the amount of the health plan surcharge or incentive generally to 30 percent of the total cost of coverage under the health plan, and providing a reasonable alternative way to avoid the surcharge if it is medically inadvisable for an individual to get the COVID-19 vaccine.

 

Initial No Surprises Act Regulations Provide Some Clarity for Employer Plans

Plan participants can be hit with surprise medical bills when they receive care from out-of-network providers. Sometimes, this happens when participants do not know that the care they are receiving is from an out-of-network provider, like when they have surgery at an in-network facility only to find that the facility-appointed anesthesiologist, for example, is out-of-network.  Now, employers have a bit more clarity about how those surprise medical bills are supposed to be paid, beginning January 1, 2022, under new “No Surprises Act” regulations.

Agencies Issue FAQs on Required Comparative Analysis of Nonquantitative Treatment Limitations

The Consolidated Appropriations Act (CAA), 2021 had far-reaching effects on employee benefit plans. One of the more onerous changes introduced by the CAA relates to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA requires that group health plans offering mental health and substance use disorder benefits (MH/SUD benefits) provide those benefits on no less generous terms than medical and surgical benefits.

COVID-19 Vaccine Incentives Without the HIPAA Headache

On February 26, 2021, the U.S. Department of Labor, along with the U.S. Department of Health and Human Services and the U.S. Department of the Treasury, issued answers to new frequently asked questions (FAQs) interpreting certain provisions of the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This article reviews the portion of the FAQs that directly apply to employer vaccination incentive programs. Previous guidance addressed coverage requirements for COVID-19 vaccines and diagnostic testing.

Incentivizing (COVID-19) Vaccinations: What Employers Need to Know

As COVID-19 vaccines become available to greater swaths of the population, many employers are considering ways to incentivize employees to get vaccinated. Incentives can take many forms, including extra pay, paid time off, gift cards, or tangible gifts. Employers that offer incentives to employees to get vaccinated may be creating group health plans under the Employee Retirement Income Security Act of 1974 (ERISA).

EEOC Issues Long-Awaited Proposed Wellness Program Rules

The U.S. Equal Employment Opportunity Commission (EEOC) recently issued its revamped proposed rules governing employer-sponsored wellness programs. These proposed rules have been a long time coming, with the EEOC’s prior rules on the topic having been invalidated by a court and then partially revoked. In this current proposal, the EEOC has issued two separate sets of regulations: one under the Americans with Disabilities Act (ADA) and one under the Genetic Information Nondiscrimination Act of 2008 (GINA).

DOL Finally Relaxes Its Electronic Delivery Rule—But Only for Retirement Plans

On May 21, 2020, the U.S. Department of Labor (DOL) announced publication of its long-awaited guidance on electronic participant  disclosures. The good news is that the DOL has taken a step in the right direction in easing some of the difficulties that were present in the prior electronic communications safe harbor. The bad news is that the new guidance applies only to retirement plans.