Health & Welfare

OOP Limits and Marketplace Special Enrollment Period

The U.S. Department of Health and Human Services (HHS) has announced the inflation-adjusted maximum out-of-pocket (OOP) limits that will apply to non-grandfathered plans for plan years beginning in 2022.  The OOP limit includes the plan’s deductible and cost sharing for essential health benefits (EHBs) under the Affordable Care Act (ACA). HHS has also clarified the duration of the special open ...

Will Federal Rules on Mental Health Parity Work This Time?

Agencies Issue Guidance Regarding Consolidated Appropriations Act, 2021 (“CAA”) Amendments to Mental Health Parity and Addiction Equity Act (“MHPAEA”)

Stimulus Package Makes Major Changes with Respect to Employer Sponsored Benefit Plans

By Dannae Delano, Barry Salkin and Roberta Casper Watson

Agencies Issue Final Grandfathered Group Health Plan Regulations

The Department of Labor, Department of Health and Human Services, and the IRS (collectively, the “Agencies”) have issued final regulations providing greater flexibility to plan sponsors that wish to retain their group health plans’ “grandfathered” status under the Affordable Care Act (“ACA”).  The final regulations are substantially unchanged from the earlier proposed regulations.

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 ...

Agencies To Provide More Flexibility for Grandfathered Group Health Plans

The Department of Labor, Department of Health and Human Services (“HHS”), and the IRS (collectively, the “Agencies”) have issued proposed regulations that would provide greater flexibility for plan sponsors that wish to retain their group health plans’ “grandfathered” status under the Affordable Care Act (“ACA”).

Agencies Issue Further Guidance on COVID-19

The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions #43 (“FAQs”) regarding implementation of the Families First Coronavirus Response Act (the “FFCRA”), the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), and other health coverage issues related to COVID-19.

ACA Out-of-Pocket Limit and PCORI Fee Announced

HHS and IRS have announced inflation-adjusted out-of-pocket (“OOP”) limits that will apply to non-grandfathered health plans for plan years beginning in 2021, and the indexed PCORI fee. The OOP limit includes the plan’s deductible and cost-sharing amounts for benefits that are considered essential health benefits (“EHBs”) under the Affordable Care Act (“ACA”). 

Federal Agencies Extend Deadlines for COBRA and Health Plan Claims, Appeals, and Special Enrollments

In coordination, the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (collectively, the “Agencies”) have extended deadlines for multiple events important to health plan administration that will apply to ERISA-governed plans and governmental plans.  Third-party administrators and COBRA administrators will need to program for these extensions, and ...