Small employers seeking to offer robust major medical coverage to employees and their dependents face daunting price and transparency hurdles. Employers with 50 or fewer full-time equivalent employees, so-called “small...more
2/17/2025
/ Affordable Care Act ,
Association Health Plans ,
Employee Benefits ,
Employer Group Health Plans ,
Employer Liability Issues ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
Risk Management ,
Self-Insured Health Plans ,
Small Employers
Under the Affordable Care Act’s (ACA) employer shared responsibility provisions, applicable large employers (ALEs) must either offer minimum essential coverage that is “affordable” and that provides “minimum value” to their...more
On the issue of gender-affirming care, how would a Harris-Walz administration affect clients in your practice?
Bottom line: A Harris-Walz administration would likely provide health plans and health plan sponsors with...more
10/22/2024
/ Affordable Care Act ,
Donald Trump ,
Employee Benefits ,
Employer Group Health Plans ,
Employer Liability Issues ,
Employment Policies ,
Gender Equity ,
Health Insurance ,
Healthcare ,
Kamala Harris ,
LGBTQ ,
Political Campaigns ,
Political Candidates ,
Presidential Elections ,
Proposed Legislation ,
Proposed Regulation ,
Sex Discrimination ,
Telemedicine
In a recent article in Managed Healthcare Executive, Peter Wehrwein examines the trend of self-funding of group health benefits by smaller employers who used to depend mainly or entirely on fully insured programs....more
Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability, or any combination thereof, in a health program or activity, any part of which is...more
6/3/2024
/ Affordable Care Act ,
Civil Rights Act ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Federal Health Insurance Exchanges ,
Final Rules ,
Gender Identity ,
Health Care Providers ,
Non-Discrimination Rules ,
OCR ,
Public Health Insurance Marketplace ,
Section 1557
In a recent On the Subject (available here), we reported on the impact of the final rule (final rule) interpreting Section 1557 of the Affordable Care Act (ACA) on self-funded group health plans that contract with licensed...more
5/21/2024
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Covered Entities ,
Employee Benefits ,
Final Rules ,
Health and Welfare Plans ,
Health Insurance ,
Medicare ,
Medicare Advantage ,
Medicare Modernization Act ,
Medicare Part D ,
Section 1557 ,
Self-Funded Health Plans
On April 26, 2024, the US Department of Health and Human Services (HHS) issued a final rule (press release, fact sheet, FAQs) (final regulations) reinterpreting Section 1557 of the Affordable Care Act (ACA), which prohibits...more
5/9/2024
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Disability Discrimination ,
Final Rules ,
Gender Discrimination ,
Gender Identity ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Medicare Part B ,
New Regulations ,
Non-Discrimination Rules ,
Race Discrimination ,
Section 1557 ,
Sexual Orientation Discrimination
Employers and plan sponsors are facing growing – and often conflicting – pressures related to the coverage of gender-affirming care. Join McDermott lawyers Sarah G. Raaii and Alden J. Bianchi for a webinar to review recent...more
2/16/2024
/ Affordable Care Act ,
Best Practices ,
Continuing Legal Education ,
Denial of Insurance Coverage ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health Insurance ,
Health Plan Sponsors ,
Insurance Claims ,
Insurance Industry ,
Minors ,
Standard Setting Organizations ,
State Bans ,
Transgender ,
Webinars
Employer-sponsored health insurance covers almost 159 million non-elderly US workers and their dependents, and employees and jobseekers alike view group health coverage as the single most important non-cash job-related...more
11/28/2023
/ Affordable Care Act ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employees ,
Employer Group Health Plans ,
Employer Liability Issues ,
Fiduciary Duty ,
Health Insurance ,
Insurance Industry ,
Regulatory Agenda
We previously reported on proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). If adopted in final form, these regulations would vastly complicate compliance by group health plans and health...more
8/29/2023
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Employer Group Health Plans ,
Enforcement Actions ,
Health and Welfare Plans ,
Health Insurance ,
Healthcare Reform ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
U.S. Treasury
A recent article by the Kaiser Family Foundation (KFF) and National Public Radio (NPR) raised the prospect that patients may still see surprise medical bills despite the enactment of the No Surprises Act (NSA)....more
7/25/2023
/ Affordable Care Act ,
Billing ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Surprise Medical Bills ,
U.S. Treasury
In response to Braidwood Mgmt. Inc. v. Becerra, a recent case striking down part of the Affordable Care Act (ACA) preventive services mandate, the US Departments of Labor, Health and Human Services, and the Treasury...more
4/18/2023
/ Affordable Care Act ,
Appeals ,
Contraceptive Coverage Mandate ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Health Insurance ,
Motion To Stay ,
Preventive Health Care ,
Religious Exemption ,
U.S. Treasury
The Biden administration has announced its intention to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our series introduction for more information). Among other...more
The Biden administration has announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our prior article for more information). In response to the...more
3/22/2023
/ Affordable Care Act ,
Biden Administration ,
CARES Act ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Employee Benefits ,
HDHP ,
HSA ,
IRS ,
Medicare ,
Public Health Emergency ,
Relief Measures ,
Telehealth
The Biden administration has announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our prior article for more information). In response to the...more
Since the Biden administration announced its intention to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023, a topic of great debate has been the requirement and the...more
The US Departments of Health and Human Services, Labor and Treasury (the Departments) recently issued a proposed rule (the proposed rule) to eliminate a moral exemption to the Affordable Care Act (ACA) contraceptive mandate...more
2/9/2023
/ Affordable Care Act ,
Burwell v Hobby Lobby ,
Contraceptives ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dobbs v. Jackson Women’s Health Organization ,
Employer Group Health Plans ,
Proposed Rules ,
Religious Freedom Restoration Act (RFRA) ,
Reproductive Healthcare Issues ,
Roe v Wade ,
SCOTUS ,
U.S. Treasury
Section 204 of Title II of Division BB of the Consolidated Appropriations Act, 2021 amended the Internal Revenue Code, the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to add rules...more
On December 15, 2022, the Internal Revenue Service (IRS) finalized regulations regarding Information Reporting of Health Insurance Coverage and Other Issues Under Internal Revenue Code (Code) Sections 5000A, 6055 and 6056...more
12/22/2022
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Employer Liability Issues ,
Final Rules ,
Health Insurance ,
Information Reports ,
Internal Revenue Code (IRC) ,
IRS ,
Reporting Requirements ,
Self-Funded Health Plans ,
Shared Responsibility Rule ,
Tax Credits