Health Plans Post-Bostock: Mixed Signals on Sex Discrimination?

Most employer-sponsored health plans will be exempt from the primary Affordable Care Act (ACA) provision governing race, color, age, sex, disability, and national origin discrimination under new final rules issued by the U.S. Department of Health and Human Services (HHS). Only plans (or other covered programs and activities) that receive financial assistance from HHS or that are sponsored by entities principally engaged in providing healthcare will have to comply with ACA Section 1557.

What’s Changed, What Hasn’t: A Review of HIPAA Rules in a COVID-19 Context

With employers planning for employees to return to work following COVID-19–related closures, there are sure to be questions about sharing employee medical information as it relates to COVID-19 (symptoms, test results, status) within the workplace and with public authorities. Now may be a good time to review what has changed about federal privacy rules in light of the COVID-19 pandemic—and what hasn’t.

IRS to Waive HSA Rule for Coronavirus Coverage

High-deductible health plans may now cover testing and treatment for 2019 novel coronavirus (COVID-19) on a first-dollar basis without risking making participants ineligible to participate in health savings accounts (HSAs). The Internal Revenue Service (IRS) released a notice providing temporary relief for high-deductible health plans covering COVID-19-related health care services and supplies before the minimum deductible is met.

2020 Drug Coupon Rule Dropped Due to Implementation Concerns

Employer plans will still be able to exclude the value of drug manufacturer coupons from annual out-of-pocket maximums, even when no generic equivalent is available, under new guidance from the Department of Labor, Department of Health and Human Services (HHS), and Department of Treasury. These exclusions, or copay accumulators, are built into many employer plans.

Key Takeaways From an ERISA Fiduciary Breach Ruling on Behavioral Standards of Care After a 10-Day Trial

Behavioral health claims administrators and plan sponsors alike may be looking more closely at their care guidelines—and how they are applied—after a federal court ruled in a California class action that a claims administrator had breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA) by applying standards of care that were more restrictive than generally accepted standards and by improperly prioritizing cost savings.

Eighth Circuit Casts Doubt on Cross-Plan Offsetting for ERISA Health Plans

Employers may soon find themselves reviewing and revising health plan master documents and summary plan descriptions (SPDs) and administrative service agreements with respect to an obscure claims administration practice known as “cross-plan offsetting”—following a recent federal appeals court ruling.

New Mental Health Parity Guidance and Enforcement Efforts May Warrant a Deep Dive Into Plan Administration

The Department of Labor (DOL), the Department of the Treasury, and the Department of Health and Human Services (HHS) are making good on their promise to issue more guidance and to aggressively enforce the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) by recently issuing a slew of new guidance, enforcement statistics, and promises of continued aggressive enforcement.

’Tis the Season to Answer Employer Shared Responsibility Payment Letters From the IRS

The deadline to respond is nearing for employers that received the first wave of Letter 226J mailings proposing to assess them with Employer Shared Responsibility Payments (ESRPs) for 2015 under Section 4980H of the Internal Revenue Code of 1986, as added by Section 1511 of the Patient Protection and Affordable Care Act (ACA).

The Ball Dropped on New Year’s Eve for Some ACA Section 1557 Nondiscrimination Rules

Some employers may want to reconsider their approach to gender transition benefits after a federal court enjoined the U.S. Department of Health and Human Services (HHS) from enforcing its 2016 nondiscrimination regulations under Section 1557 of the Affordable Care Act (ACA), which were generally set to take effect on January 1, 2017, to the extent those regulations prohibit discrimination on the basis of “gender identity” and “termination of pregnancy.”

At Last, A Little Good FSA News

Ironically, one of the first things that employees probably heard about the health care reform law back in 2010 had a decidedly anti-reform sound to it: It would halve the legal limits on health flexible spending account (FSA) contributions to $2,500 in 2013. By contrast, one of the last things that employees…..

Reporting and Filing for the PCORI Fee

As you may know the Affordable Care Act imposed a new fee on issuers of individual and group health insurance policies and plan sponsors of self-funded plans. As previously noted in our blog, on December 5, 2012, the Internal Revenue Service (IRS) issued final regulations requiring health insurance issuers and…..

New Final “Breach” Rules under HIPAA

On January 25, 2013, the final rules designed to bring Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and breach notification rules up to date were published in the Federal Register. The breach notification rules issued by the U.S. Department of Health and Human Services (HHS) will…..

No Harm, No Foul, No More—New HIPAA “Breach” Standards Seek to Provide Consistency, Objectivity

Beginning this fall, employer health plans—or their business associates—will have to make more comprehensive and methodical risk assessments following the discovery of an impermissible use or disclosure of unsecured “protected health information” under revised Health Insurance Portability and Accountability Act of 1996 (HIPAA) breach notification rules recently issued by the U.S. Department of Health and Human Services (HHS).

For Employers, Pay-or-Play Proposals Could Be Worse, Much Worse

Could employee benefits regulatory activity under the Patient Protection and Affordable Care Act (Act) be taking a turn toward common sense? Based on the new proposed rules on the “pay-or-play” provision under the Act—only those on the federal payroll still say “shared responsibility”—the answer may be a qualified “yes.” (The “pay-or-play”…..

New PPACA Benefit Summary Rules Clarified

If their open enrollment periods start before September 23, 2012, health insurers and employers that sponsor health plans will not have to provide new summaries of benefits and coverage, or “SBCs,” to new enrollees and existing health plan participants later this year, under new final regulations implementing the 2010 health care reform law.