News & Analysis as of

Employer Group Health Plans Self-Funded Health Plans

Venable LLP

Final Rules on MHPAEA and the NQTL Comparative Analysis

Venable LLP on

The government recently issued final rules on the Mental Health Parity and Addiction Equity Act (MHPAEA). The rules implement requirements for plans to conduct a comparative analysis of their nonquantitative treatment...more

Bricker Graydon LLP

Summer's Hot Debate: Does a Self-Funded Group Health Plan Cover Gender-Affirming Care?

Bricker Graydon LLP on

As the temperatures continue to rise, regulations and litigation related to employer-sponsored group health plans have followed suit. As these new rules continue to evolve, we are often asked whether a self-insured group...more

McDermott Will & Emery

Group Medical Captives, Level Funding and US Healthcare Policy

McDermott Will & Emery on

In a recent article in Managed Healthcare Executive, Peter Wehrwein examines the trend of self-funding of group health benefits by smaller employers who used to depend mainly or entirely on fully insured programs....more

Verrill

Can a Self-Funded Group Health Plan Exclude Coverage for Gender-Affirming Care?

Verrill on

We are sometimes asked whether a self-funded group health plan is required to cover gender-affirming medical services. As this post explains in detail, it is generally impracticable for a self-funded ERISA-covered plan to...more

McDermott Will & Emery

Gender-Affirming Benefits: Best Practices for Group Health Plans

McDermott Will & Emery on

Federal legislative and regulatory activity related to employer-sponsored group health plans shows no signs of slowing, particularly with the issuance of interpretive guidance regarding the transparency and surprise-billing...more

Venable LLP

July Filing Deadlines for Employee Benefit Plans - July 2023

Venable LLP on

By July 31, employers that sponsor self-funded medical plans must report and pay their PCORI fee. By July 31, employers that sponsor calendar-year employee benefit plans that are subject to ERISA must file a Form 5500 (unless...more

Smith Gambrell Russell

New Group Health Plan Annual Attestation Requirement

Smith Gambrell Russell on

Group health plans are now required to submit an annual attestation confirming that the agreements the plan enters into with its service providers do not contain “gag clauses,” which are limitations regarding the plan’s...more

Woodruff Sawyer

Compliance Alert: CAA, 2023 Eliminates MHPAEA Exemption for Self-Funded Non-Federal Governmental Health Plans

Woodruff Sawyer on

On December 29, 2022, the President signed the Consolidated Appropriations Act, 2023 (“CAA, 2023”), into law. The CAA, 2023, which is largely a bipartisan spending bill, sunsets provisions of the Public Health Service Act...more

McAfee & Taft

Overturning of Roe v. Wade creates challenging legal issues for self-funded health plan sponsors

McAfee & Taft on

On Friday, June 24, 2022, the U.S. Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, and overruled Roe v. Wade and Planned Parenthood of Southeastern Pa. v. Casey.  In doing so, the Court held...more

Sherman & Howard L.L.C.

Navigating Employer-Provided Benefits in the Wake of Dobbs

On June 24, 2022, the U.S. Supreme Court issued its opinion in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and Planned Parenthood v. Casey (which collectively held that the U.S. Constitution...more

Perkins Coie

Contractual Considerations for Self-Funded Group Health Plan Sponsors in 2022

Perkins Coie on

In our January 2022 update, we discussed new federal requirements that group health plans should pay close attention to in 2022. The sponsor of a self-funded plan will need to work closely with its legal counsel, benefits...more

Holland & Hart - The Benefits Dial

Talk About Bruno . . . Health Plan Premium Surcharges & Vaccination Status

Last week, the US Supreme Court blocked the OSHA standard requiring private employers with 100 employees or more to vaccinate-or-test for COVID-19 from taking effect (more info here). With the fate of that standard likely...more

Fox Rothschild LLP

A Guide For Employers To The American Rescue Plan Act

Fox Rothschild LLP on

The American Rescue Plan Act of 2021 is an enormous and intricate piece of legislation that has direct consequence for employers. Signed into law by President Joe Biden on March 11, 2021, ARPA mandates several important...more

BakerHostetler

Self-Funded Employer Health Plans are Changing: What to Watch

BakerHostetler on

The healthcare industry is rapidly changing, and self-funded employer sponsored health plans have more options to consider when creating solutions for their employees. In today’s episode, Jennifer Mills and Susan Hughes...more

Holland & Hart - The Benefits Dial

It’s HIP(AA) to be square… making sure you are HIPAA compliant

The Health Insurance Portability and Accountability Act (“HIPAA”) was created for one specific reason – evolution of technology. Today, health care providers are using online clinical applications and electronic health...more

Winstead PC

Good News on Health Coverage Reporting for 2018 Coverage

Winstead PC on

Normally, the deadline for reporting health care coverage by a self-insured medical plan or an insured plan follow rapidly after year end. In an early holiday gift, the Internal Revenue Service (the “Service”) provided an...more

Epstein Becker & Green

New Jersey’s Surprise Medical Bill Law: Part 1: Regulatory Issuances by New Jersey Agencies

Epstein Becker & Green on

Earlier this year, New Jersey Governor Phil Murphy signed into law the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“Law”), creating a statutory framework attempting to protect...more

Mintz - Employment Viewpoints

Association Health Plans: Self-Funded vs. Fully-Insured

Recently proposed Department of Labor (Department) regulations governing Association Health Plans (AHPs) would, if made final, permit small employers to be regulated under more favorable, large group rules. The proposed...more

Foley & Lardner LLP

Thank You IRS - Extensions for This Year’s ACA Tax Reporting

Foley & Lardner LLP on

The “Bottom Line” - Employers will have until March 2, 2018 to furnish Form 1095-C (“Employer-Provided Health Insurance Offer and Coverage”) to employees.,,...more

Nilan Johnson Lewis PA

Association Health Plans: What Are They & What’s Changing?

Nilan Johnson Lewis PA on

What are Association Health Plans? Association Health Plans allow small employers or self-employed individuals to group together to form a larger pool for offering health insurance. An Association Health Plan model can...more

Mintz - Employment Viewpoints

Association Health Plans—Can The Trump Administration Expand Access Without Congress?

In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of...more

Proskauer - Employee Benefits & Executive...

Court Throws Monkey Wrench Into Wellness Programs

The U.S. District Court for the District of Columbia has ordered the EEOC to reconsider its final regulations on the extent to which an employer may offer incentives to participate in a wellness program without violating the...more

Mintz - Employment Viewpoints

The Rise of the Group Health Insurance Captive

With its “employer mandate”—i.e., the requirement that applicable large employers make an offer of group health coverage to substantially all full-time employees or face the prospect of a penalty—the Affordable Care Act (ACA)...more

BCLP

IRS Addresses ACA Reporting Requirements Self-Funded Plans, HRAs

BCLP on

As promised in Notice 2015-68, the IRS has proposed clarifications to the regulations under IRC Section 6055 relating to information reporting rules for minimal essential coverage providers. These rules affect employers...more

Dorsey & Whitney LLP

Quirky Question #270: A Win for Wellness Plans

Dorsey & Whitney LLP on

Question: Our company offers employees a self-funded and self-insured health plan. We’d now like to implement a wellness program. Can we require employees to complete a health risk assessment which requests personal medical...more

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