Health & Welfare

Agencies Issue Regulations Restricting Surprise Billing

The Biden administration, through HHS, DOL, IRS and the Office of Personnel Management (collectively, the “Agencies”), issued an interim final rule that aims to restrict excessive out-of-pocket costs from “surprise billing” and balance billing. Beginning in 2022, the interim final rule bans surprise out-of-network and balance billing for individuals enrolled in employer-sponsored or marketplace ...

Court Rejects Health TPA’s Cross-Plan Offsetting Practice

The U.S. District Court for the District of New Jersey, in Lutz Surgical Partners PLLC v. Aetna, Inc., has ruled that a group health plan administrator (“TPA”) cannot offset overpayments made to a provider by one health plan it administers by reducing the amount paid to that provider by a different health plan.

IRS Confirms Options for Unused Qualified Transportation Benefits Due to COVID-19

Facts. The IRS released Information Letter 2020-0024 in response to an inquiry it received from a qualified transportation plan participant with unused transit benefits due to COIVD-19. In particular, the participant explained that due to the COVID-19 pandemic he was now driving to work rather than taking public transportation, and he asked whether his unused benefits could be rolled over to ...

2021 Medicare Parts A & B Premiums and Deductibles

The Centers for Medicare & Medicaid Services (“CMS”) has announced the deductibles, premiums and coinsurance amounts for Medicare Part A and Part B for 2021. Medicare Part A covers inpatient hospital and hospice care, while Part B covers outpatient services such as doctors’ visits.

Agencies Issue Final Regulations Regarding Health Care Transparency

By Barry L. Salkin, Roberta Casper Watson, and Dannae Delano

Agencies Issue Guidance on Coronavirus Diagnostic Testing and Immunizations

Section 6001 of the Families First Coronavirus Response Act (FFCRA) required group health plans and health insurance issuers to provide coverage for certain items and services including in vitro diagnostic testing products for the detection of the virus that causes COVID-19, or for the diagnosis of COVID-19 when those items or services are offered on or after March 18, 2020, and during the public ...

IRS Releases 2021 Welfare Benefit Plan Limits: Health FSA and HSA Limits Increase

The IRS has released Revenue Procedures 2020-45 and 2020-32, which set forth the 2021 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination testing. 

Courts Decides ACA’s Individual Out-Of-Pocket Limits Do Not Apply Retroactively

The U.S. District Court for the Southern District of New York, in Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family out-of-pocket cost-sharing limit rather than the individual limit. In reaching this outcome, the court concluded that HHS regulations interpreting the ACA’s cost-sharing provisions were not retroactively ...

Courts of Appeal Split on Circumstances Where it is Appropriate to Override the Arbitrary and Capricious Standard of Review

The U.S. Court of Appeals for the Eighth Circuit has ruled, in McIntyre v. Reliance Standard Life, that a claims decision will be judged under the arbitrary and capricious standard despite the fact that the claims administrator had a conflict of interest and that there were irregularities in the claims procedure.

IRS Again Extends Deadline for ALEs to Furnish ACA Reporting Forms to Employees

The IRS has issued Notice 2020-76, which provides an automatic deadline extension for Applicable Large Employers’ (“ALE”) reporting obligations to employees under the Affordable Care Act’s (“ACA”) Employer Mandate for the 2020 tax year.