The IRS has issued Notices 2024-71 and 2024-75 (the “Notices”) to expand the definition of “preventive care” for high deductible health plans (“HDHPs”). Law. In general, individuals are eligible to...
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ACA
2026 ACA Out-of-Pocket Limits
The Centers for Medicare & Medicaid Services (“CMS”) has announced the proposed maximum out-of-pocket (“OOP”) limits that will apply to non-grandfathered plans for plan years beginning in 2026. ...
IRS Releases ACA Affordability Rates for 2025
The Internal Revenue Service has issued Revenue Procedure 2024-35 to implement the 2025 index adjustments for certain Affordable Care Act (“ACA”) applicable contribution percentages used to...
Appeals Court Issues Split Ruling on ACA’s Preventive Services Requirements
In Braidwood Management, Inc. v. Becerra, the U.S. Court of Appeals for the Fifth Circuit has issued a “mixed bag” of rulings with regards to the preventive services requirements of the Affordable...
DOL Revokes Association Health Plan Regulations
The Department of Labor (“DOL”) has revoked its Association Health Plan (“AHP”) regulations and expects to replace them with stricter standards that provide additional employee protections....
IRS Announces Decreased 2025 Employer Shared Responsibility Penalties
In Revenue Procedure 2024-14, the IRS has announced the 2025 penalty rates for violations of the employer shared responsibility provisions of the Affordable Care Act (“ACA”). Background. Under the...
Agencies Update Non-English Language Requirements
The Departments of Labor and Health and Human Services, and the IRS (“the Agencies”) have issued Frequently Asked Questions About Affordable Care Act (“ACA”) and Consolidated Appropriations Act,...
Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits
Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits - Dannae Delano, panelist, Strafford live CLE webinar, January 4. 2024 - Click here for...
DOL Proposes Rescission of Association Health Plan Rules
The Department of Labor (“DOL”) has proposed that the Association Health Plan (“AHP”) regulations be revoked and replaced with stricter standards that provide additional employee protections....
Eleventh Circuit Adopts Strict Standard for FMLA Claims
The Eleventh Circuit Court of Appeals, in Lapham v. Walgreen Co., has ruled that the “but for” legal standard applies to Family and Medical Leave Act (“FMLA”) retaliation claims. Law. The FMLA...
DOL Proposes to Rescind 2018 Association Health Plan Rule
DOL Proposes to Rescind 2018 Association Health Plan Rule - Roberta Casper Watson, PLANSPONSOR, December 22, 2023 (PDF)
2025 ACA Out-of-Pocket Limits
The U.S. Department of Health and Human Services (“HHS”) has announced the proposed maximum out-of-pocket (“OOP”) limits that will apply to non-grandfathered plans for plan years beginning in...
Participant May Sue Plan for Facial Feminization Surgery Coverage
The United States District Court for the Eastern District of Pennsylvania, in Doe v. Independence Blue Cross, declined to dismiss a participant’s lawsuit claiming that a group health plan covered...
IRS Announces PCORI Fee
IRS has released Notice 2023-70, which provides the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“ PCORI” ) fee for plan years ending before October 1, 2024....
IRS Releases ACA Affordability Rates for 2024
The Internal Revenue Service has issued Revenue Procedure 2023-29 to implement the 2024 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
UnitedHealth Group Insurance TPA, UMR Sued by DOL
UnitedHealth Group Insurance TPA, UMR Sued by DOL - Andrew Oringer, PLANSPONSOR, August 2, 2023 (PDF)
CMS Recommends Extension of Special Enrollment for Individuals Losing Medicaid and CHIP
By Roberta Watson, Dannae Delano and Barry Salkin Employers frequently provide group health plan coverage for their employees through pre-tax contributions to a cafeteria plan. Elections under a...
Departments Issue Guidance on No Surprises Act and Limitations on Cost Sharing Under the Affordable Care Act
By Dannae Delano, Roberta Watson and Barry Salkin In FAQ Part 60, the Departments of Health and Human Service, Treasury, and Labor (the “Departments”) addressed limitations on cost sharing under the...
Departments Propose Regulations on Short-Term Limited Duration Insurance and Indemnity Insurance Excepted Benefits
By Dannae Delano, Roberta Casper Watson and Barry Salkin On July 7, the Departments of Health and Human Services, Labor, and Treasury (the “Departments”) issued proposed regulations modifying the...
Plan May Exclude Certain Specified Emergency Services
The U.S. Court of Appeals for the Eighth Circuit has ruled, in Shafer v. Zimmerman Transfer, that a group health plan does not have to pay for emergency services specifically excluded by the plan...
IRS Issues HDHP Guidance for End of COVID Emergency Period
In response to the ending of the COVID-19 public health emergency and national emergency, the IRS has issued Notice 2023-37, which modifies its prior guidance on benefits relating to the testing and...
TPA Subject to Nondiscrimination Rules
The Federal District Court for the Western District of Washington has ruled, in C.P. vs. Blue Cross Blue Shield of Illinois, that an insurer acting as a third party administrator (“TPA”) is covered...
IRS Requires Most Employee Benefit Plans to File Forms Electronically
The IRS has issued final regulations that will require almost all employee benefit plan filings to be made electronically. Background. Generally, Applicable Large Employers are required to file...
Rule Proposes Removing Moral Exemption to Contraception Mandate
Rule Proposes Removing Moral Exemption to Contraception Mandate - Marcia Wagner, SHRM, January 30, 2023 (PDF)
2024 ACA Out-of-Pocket Limits
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...
Federal Agencies Issue Group Health Plan Guidance
By Roberta Watson, Barry Salkin and Dannae Delano On December 23, 2022, new guidance applicable to group health plans was issued by federal agencies, as described more fully below. The Center for...
IRS Finalizes Delayed Effective Dates for ACA Filing Requirements
In past years, the IRS has extended the deadlines for employer and group health plan Affordable Care Act (“ACA”) reporting. In lieu of the deadline extensions, the IRS has now issued final...
Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators
Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators - Roberta Casper Watson, panelist, Strafford live CLE webinar, January 4, 2023, 1:00 - 2:30 PM (EST) - Click here for...
IRS Announces Expansion of Change in Status Rules for Cafeteria Plans
One of the basic rules under which cafeteria plans operate is that elections are irrevocable except in certain limited circumstances. Further, even when those limited circumstances apply, the change...
New IRS Regulations Resolve “Family Glitch” Issue
The IRS has issued final regulations amending the Affordable Care Act (“ACA”) rules regarding eligibility for the law’s premium tax credit (“PTC”). The new rules provide that the “affordability” of...
Federal Court Finds Key Part of ACA’s Preventive Service Mandate Unconstitutional
A Texas federal district court, in Braidwood Management, Inc. v. Becerra, has held that the Affordable Care Act’s (“ACA’s”) requirement that most group health plans and health insurers cover certain...
Labor Opinions are Fair Game for Litigation After Circuit Ruling
Labor Opinions Are Fair Game for Litigation After Circuit Ruling - Roberta Watson, Bloomberg Law, August 19, 2022 (PDF)
Inflation Reduction Act’s Impact on Group Health Plans
On August 16, 2022, President Biden signed into law the Inflation Reduction Act (“IRA”). The new legislation contains several provisions impacting group health plans. Below is a description of...
HHS Again Proposes Nondiscrimination Regulations under Section 1557 of the Affordable Care Act
By Dannae Delano, Roberta Casper Watson and Barry Salkin Section 1557 of the Affordable Care Act (“ACA”) prohibits discrimination on the basis of race, color, national origin, sex, age or disability...
IRS Releases ACA Affordability Rates for 2023
The Internal Revenue Service has issued Revenue Procedure 2022-34 to implement the 2023 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
Agencies Issue Guidance on Contraception Coverage Requirements
The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies” ) have issued Frequently Asked Questions 54 (“FAQs”) regarding the contraception coverage requirements...
IRS Announces Decreases in ACA Affordability Threshold and Increases in ACA Employer Shared Responsibility Penalties for 2022 Plan Years
The IRS has recently updated its Questions and Answers on Employer Shared Responsibility Provisions under the Affordable Care Act to reflect 2022 indexing adjustments for the ACA’s affordability...