News & Analysis as of

Employer Group Health Plans Third Party Administrators

Polsinelli

Department of Labor Settles with TPA to End Cross-Plan Offsetting Practice

Polsinelli on

The U.S. Department of Labor (“DOL”) recently entered into a settlement agreement with a New York-based insurer and third-party administrator (“Company”) of employer group health plans governed by the Employee Retirement...more

Stevens & Lee

Gag Clause Prohibitions in ERISA, the Internal Revenue Code and the Public Health Service Act

Stevens & Lee on

If you work for or represent group health plans or issuers of group health plans, it is important that you take a look at the contracts they have with health care providers before the end of 2023. The Internal Revenue Code...more

Jackson Lewis P.C.

A Current Roadmap for Complying with Mental Health Parity Requirement

Jackson Lewis P.C. on

Most employers know that if a group health plan provides mental health or substance use disorder (MH/SUD) benefits in any of six specified classifications, the plan must provide MH/SUD benefits in all specified...more

Warner Norcross + Judd

Preparing for Health Plan Anti-Gag Clause Attestation

Although the end of the year seems far away, employers should start preparing for the anti-gag clause attestations for their group health plans that are due December 31. Namely, employers need to determine who is completing...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

Kaufman & Canoles

ESOPs & Employee Benefits Q2 2022 Client Update

Kaufman & Canoles on

Happy Summer from the K&C ESOPs & Employee Benefits practice group. We’ve compiled a short list of employee benefits updates from the second quarter of 2022....more

Snell & Wilmer

An Interesting Intersection: No Surprises Act Claims and the New Fee Disclosure Requirements for Group Health Plans

Snell & Wilmer on

As reported in our January 7, 2022 SW Benefits Blog “The DOL Asks and Answers Questions About the New Welfare Plan Fee Disclosure Rules,” group health plans must now comply with the ERISA Section 408(b)(2) disclosure...more

Foley & Lardner LLP

Employer Checklist for New Health Plan Price Transparency Rules and CAA

Foley & Lardner LLP on

The effective date is fast approaching for certain provisions of the Consolidated Appropriations Act of 2021 (“CAA”) and related regulations, and the Transparency in Coverage Rule. You can access previous articles written...more

Morgan Lewis

Health and Welfare Plan Year-End Reminders

Morgan Lewis on

Permissible Flexibility under Code Section 125 Pursuant to IRS Notice 2021-15 Notice 2021-15 offered plan sponsors the flexibility to adopt any of the following options despite the longstanding rules under Section 125 of the...more

Verrill

Identifying Plan Assets in ERISA Health & Welfare Plans

Verrill on

Last month, we advised readers of this blog to consider efforts to formalize the fiduciary governance of their health and welfare benefit plans. In that post, we described some of the reasons that employers have historically...more

Roetzel & Andress

Employee Benefits Update: Recent Legislation And Regulations Impose New Obligations On Plan Administrators And Plan Sponsors

Roetzel & Andress on

Congress’s passage of the Consolidated Appropriations Act (“CAA”) imposes a series of new recordkeeping and disclosure obligations on plan sponsors, as well as extending and expanding upon COVID-19 related relief. Less than...more

Nossaman LLP

New Disclosure Requirements for Those that Contract with ERISA Group Health Plans

Nossaman LLP on

Included within the 5539 pages of statutory changes in the Consolidated Appropriations Act, 2021 (the COVID-19 relief bill signed into law at the end of December 2020) are important new “transparency” laws that affect third...more

Morgan Lewis - ML Benefits

Mental Health Parity Transparence: Consolidated Appropriations Act, 2021

As we addressed in our recent LawFlash covering the Consolidated Appropriations Act, 2021 (Act), the Act includes several requirements to enhance group health plan transparency. One provision we wanted to further highlight...more

McAfee & Taft

RADICAL new transparency rules likely to apply to your health plan in one year

McAfee & Taft on

New rules published last month likely require your employer health plan to phase-in certain disclosures over a three-year period beginning in one year: 1. January 1, 2022 (three files must be disclosed): For plan years...more

Cozen O'Connor

IRS Announces High Deductible Health Plans Can Cover COVID-19 Expenses Without Applying a Deductible

Cozen O'Connor on

Employers across the country are currently considering what actions to put in place in light of the potential spread of COVID-19 (the coronavirus). Many employers offer their employees high-deductible health plans that can...more

Polsinelli

IRS Issues Guidance on COVID-19 Coverage for High Deductible Health Plans

Polsinelli on

In response to the Coronavirus (“COVID-19”), the Internal Revenue Service advised that a health plan that otherwise satisfies the requirements to be a High Deductible Health Plan (“HDHP”) under section 223(c)(2)(A) will not...more

Morgan Lewis - ML Benefits

IRS Modifies HDHP Rules in Response to Coronavirus Concerns

The IRS issued guidance on March 11 that clears the way for employers to offer employees covered by a high-deductible health plan (HDHP) testing and treatment for the 2019 Novel Coronavirus (COVID-19) with no deductible or at...more

King & Spalding

Strategies for Addressing Reference-Based Plans

King & Spalding on

The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more

Eversheds Sutherland (US) LLP

Transparency in coverage rule - Potential implications for self-insured health plans

On November 15, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Agencies”) issued a proposed "Transparency in Coverage" rule that would require most...more

Jackson Walker

ERISA Alert: An Update on Health and Welfare and Retirement Plans

Jackson Walker on

Health and Welfare Plan Update - It is 9:00 p.m., do you know where your health plan data is? As IT systems continue to expand, and data is accessed, moved and stored in many new and different ways, the Office for Civil...more

Seyfarth Shaw LLP

Fraud In Your Healthcare Plan? It’s Probably There

Seyfarth Shaw LLP on

Seyfarth Synopsis: Employer subsidized healthcare is one of the largest cost centers for small and large businesses.  This post provides a primer on what to do if you suspect that your healthcare costs are rising because your...more

Seyfarth Shaw LLP

Eighth Circuit Grants Slight Reprieve To Mother Of Transgender Son In ACA Discrimination Suit

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Eighth Circuit upheld dismissal of Title VII claims challenging an employee benefit plan’s blanket transgender exclusion because the exclusion impacted the employee’s transgender son, not the employee....more

McDermott Will & Emery

HHS Issues Final ACA Nondiscrimination in Health Programs and Activities Regulation

McDermott Will & Emery on

In Depth - On Friday, May 13, 2016, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) finalized regulations that provide explicit protections from discrimination on the basis of gender...more

Seyfarth Shaw LLP

Suing Not Too Wisely

Seyfarth Shaw LLP on

Seyfarth Synopsis: A district court in Minnesota recently found an employee could not challenge a plan’s blanket transgender exclusion under Title VII, when the employee was not transgender but her son was. The Court went on...more

Stinson - Benefits Notes Blog

What You Say in Your SPD About Claims Processing Makes a Difference

Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others...more

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