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.

Short, Fast and to the Point – Proposed PPACA Benefit Summary Rules Set Tight Standards

Starting in March 2012, employers would have to provide much more succinct summaries of their health plan benefits (no more than four double-sided pages), much more quickly (often within seven days) and in a much more standardized form than they do now under proposed regulations issued this week by the three agencies responsible for implementing the benefit summary requirements of the 2010 health care reform law.

Forever Young: New “Adult Children” Guidance under Health Care Reform Covers Enrollment, Surcharges

Employer-sponsored health plans will not be able to tack on special “adult children” surcharges and will have to offer an enrollment period of at least 30 days to adult children who may previously have lost coverage or been ineligible for coverage before turning 26, under interim final rules issued on May 10, 2010, interpreting one

COBRA Subsidy Extended and Modified

Newly-enacted legislation extends and expands the 65 percent federal COBRA subsidy under the American Recovery and Reinvestment Act (ARRA) in cases of involuntary termination of employment. A stopgap measure signed into law on March 2 by President Barack Obama extends the end of the eligibility period from February 28 to March 31, 2010, and makes

Does Your Health Plan Violate the New Mental Health Parity Rules?

New regulations are giving employers their first glimpse of the mental health and substance abuse benefit changes that may be needed by 2011 to ensure that their health plans do not violate the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“New Mental Health Parity Act”). Published in the

Do Your Health and Wellness Plans Violate GINA?

 Many employers with wellness program that use health risk assessments will have to modify their assessments to avoid running afoul of the Genetic Information Nondiscrimination Act of 2008 (GINA), under final interim regulations set to appear in the Federal Register on October 7, 2009. Just in time for open enrollment, the Internal Revenue Service (IRS),