Health & Welfare

CHIP Notice Revised

The Department of Labor ("DOL") has released a revised and updated model notice that employers can use to inform employees of the potential for state premium assistance subsidies for the purchase of group health coverage. The Children's Health Insurance Program ("CHIP") Reauthorization Act of 2009 requires employers who maintain group health plans to provide an annual notification of the ...

Single Document Can Serve as ERISA Plan Document and SPD

The Eighth Circuit Court of Appeals, in MBI Energy Services v. Hoch, has held that a self-insured medical plan is entitled to reimbursement because its summary plan description ("SPD") was also the plan document. With this ruling, the Eighth Circuit has joined the Fifth, Sixth, Ninth, and Tenth Circuit Courts in concluding that the Supreme Court's ruling in Cigna v. Amara does not prevent an SPD ...

Agencies Issue Guidance on Impact of Drug Manufacturer Coupons on ACA's Out-Of-Pocket Limits

DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing limits under the Affordable Care Act ("ACA"), including situations where there is no medically appropriate generic drug available.

IRS Releases ACA Affordability Rates for 2020

The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the employer shared responsibility mandate. Background. Under the ACA, contribution percentages are used to determine: (i) whether an Applicable Large Employer ("ALE") is subject to the ...

IRS Expands List of Preventive Care Benefits

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt contributions to a health savings account ("HSA"). In general, an individual is eligible to contribute (or have his or her employer contribute) to an HSA if he or she participates in ...

A Sigh of Relief For Employers Subject to Potential ACA Disparate Impact Discrimination Claims

In the aftermath of Title VI of the Civil Rights Act of 1964, litigants have pressed courts on what conduct meets the criteria for a disparate impact discrimination claim. Typically, a disparate impact discrimination claim contends that a facially neutral employment practice has a discriminatory effect on a protected class of people such as race, gender, or age. In contrast to traditional ...

Was The Court of Claims Correct for the Wrong Reason?

In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA") definition of a "covered entity" under Section 9010 of the ACA, subject to the annual fee on health insurance providers. Section 9010 of the ACA is not codified, but is interpreted by the IRS regulation at 26 ...

HHS Guidance on When One Health Plan May Share PHI of Individuals with Another Health Plan

HHS has issued FAQs that provide guidance on the circumstances under which HIPAA's Privacy Rule allows for one health plan to share protected health information ("PHI") about individuals who "have a relationship" with a second health plan. Background. HIPAA's Privacy Rule allows a covered entity ("CE"), including a health plan, to disclose PHI to another CE for either: (i) the health plan's own ...