News & Analysis as of

Self-Insured Health Plans

Bricker Graydon LLP

Does Your Health Plan Meet the New Kentucky Prescription Drug Rules?

Bricker Graydon LLP on

Effective January 1, 2025, Kentucky has new law regulating pharmacy benefit managers (“PBMs”). Earlier this year, the Governor of Kentucky signed SB 188 into law, making Kentucky the latest state to pass legislation...more

Pullman & Comley - Labor, Employment and...

Reminder: July 31 Is the PCORI Fee Remittance Deadline for Self-Insured Health Plans

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

Woodruff Sawyer

Reminder: PCORI Fees Due By July 31, 2024

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2024 deadline for paying fees that fund the Patient-Centered Outcomes...more

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

Hall Benefits Law on

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

Verrill

Cross-Plan Offsetting in Group Health Plans—The DOL Makes its Position Clear

Verrill on

Under Section 404 of ERISA, plan fiduciaries must act for the exclusive benefit of plan participants and beneficiaries and use plan assets only to provide benefits and defray reasonable expenses of administering the plan. In...more

Laner Muchin, Ltd.

Lawsuit Against Johnson & Johnson For Mismanagement of Drug Prices Likely a Sign of Things To Come For Many Self-Insured Health...

Laner Muchin, Ltd. on

A novel proposed class action lawsuit was filed against Johnson & Johnson (J&J) earlier this month by a current employee for mismanagement of prescription drug prices. The lawsuit alleges, among other things, that J&J...more

Hall Benefits Law

The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors

Hall Benefits Law on

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

Jackson Lewis P.C.

Self-Insured Health Plans: Adjusted PCORI Fee Announced for 2024

Jackson Lewis P.C. on

As discussed in a previous blog, the Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through...more

Bricker Graydon LLP

Departments Roll Back Enforcement Discretion in New Guidance on Transparency in Coverage Rules.

Bricker Graydon LLP on

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

Warner Norcross + Judd

Group Health Plan PCORI Fees Due by July 31

Warner Norcross + Judd on

As a reminder, the deadline for submitting Patient-Centered Outcomes Research Institute (PCORI) fees is July 31. Employers that sponsor self-insured group health plans should report and pay PCORI fees using the most recently...more

Bricker Graydon LLP

PCORI Fee Deadline is Almost Here

Bricker Graydon LLP on

If you sponsor a self-insured group health plan (including an HRA), make sure you set a calendar alert for July 31 to pay the annual PCORI fee (Patient-Centered Outcomes Research Institute fee) for the 2022 plan year. The...more

Woodruff Sawyer

Compliance Alert: Reminder PCORI Fees Due By July 31, 2023

Woodruff Sawyer on

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

Woodruff Sawyer

Self-Funded Health Plans: Breaking the Myths to Find Cost Savings

Woodruff Sawyer on

Employees generally know healthcare is expensive, but they often don’t know just how expensive until they’re on COBRA and are shocked at the cost. Companies pay around $23,000 per year for family and $8,000 per year for...more

Woodruff Sawyer

Claims Cost Transparency: Using Data to Optimize Medical Benefits Costs

Woodruff Sawyer on

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

Proskauer - Employee Benefits & Executive...

District Court Holds Third-Party Administrator Violated ACA’s Anti-Discrimination Rules by Administering Self-Insured Plan’s...

On the heels of several recent court decisions concerning gender-affirming care, a federal district court in Washington concluded that the denial of benefits for gender-affirming care by a third-party administrator (“TPA”)...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - December 2022

The December Monthly Minute highlights the IRS’ decision to make permanent the ACA individual-reporting extension and EBSA’s restoration of $1.4B as a result of its FY22 enforcement actions....more

Laner Muchin, Ltd.

Reminder: Deadline for Prescription Drug and Certain Medical Claim Reporting is December 27, 2022

Laner Muchin, Ltd. on

The 2021 Consolidated Appropriations Act (CAA) established new transparency requirements for group health plans to report specific information about prescription drugs and health care spending to the Centers of Medicaid and...more

Husch Blackwell LLP

Final Rules Issued on Private Plans Under Colorado's Paid Family and Medical Leave Insurance Act

Husch Blackwell LLP on

On November 1, 2022, the Family and Medical Leave Insurance Division (the Division) of the Colorado Department of Labor and Employment adopted final rules that employers must follow to offer private plans under Colorado’s...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Colorado Employers - Get Ready for a Wave of New Laws

The Colorado General Assembly was busy drafting and passing numerous employment laws during its 2022 legislative session, creating a wave of change for employers in the Centennial State. Colorado Expands Termination Notice...more

Jackson Lewis P.C.

Self-Insured Health Plans: August 1st PCORI Fee Due Date is Rapidly Approaching

Jackson Lewis P.C. on

The Patient-Centered Outcomes Research Institute (“PCORI”) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through annual fees — provided for in...more

Amundsen Davis LLC

Employee Benefit Plan Considerations Post-Roe

Amundsen Davis LLC on

The U.S. Supreme Court's decision last month to overturn Roe v. Wade presents new challenges for employee benefit plans. By overturning the case establishing a constitutional right to abortion, the Court's decision in Dobbs...more

Fox Rothschild LLP

The Supreme Court’s Dobbs Ruling Creates a Variety of Significant Legal Issues

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The Supreme Court of the United States held in Dobbs v. Jackson Women’s Health Organization, that the Constitution does not confer a right to abortion, overruling long-standing precedent in Roe v. Wade and Planned Parenthood...more

Groom Law Group, Chartered

[Webinar] State Abortion Restrictions and the Impact on Employers, Insurers, and Self-Insured Plans - June 16th, 2:00 pm - 3:00 pm...

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

Woodruff Sawyer

Compliance Alert: Reminder PCORI Fees Due By July 31, 2022

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2022 deadline for paying fees that fund the Patient-Centered Outcomes...more

Manatt, Phelps & Phillips, LLP

[Webinar] Advancing a National Health Data Agenda: Realizing the Promise of All Payer Claims Databases - March 2nd, 1:00 pm - 2:00...

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

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