News & Analysis as of

Employee Benefits Compliance Health Insurance

McDermott Will & Schulte

Key updates on the US health benefits and reimbursement landscape

The world of health benefits is constantly evolving. Recent policy shifts and legislative developments are expected to impact the economic landscape and have significant implications for employer plan sponsors, insurers,...more

Foley & Lardner LLP

Thorny Laws That ICHRA Vendors Should Consider, Part Three: FinTech Edition

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We continue our series on the legal and regulatory challenges facing individual coverage health reimbursement arrangements (ICHRAs); this time, we are focusing on the fintech-related requirements that may apply to ICHRA...more

Bass, Berry & Sims PLC

Reminder – Annual Deadline (July 31) to Report and Pay PCORI Fee is Approaching (UPDATED)

The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (PCORI fee) is due by Thursday, July 31, 2025....more

Hall Benefits Law

PBM Contracts Could Expose Plan Sponsors to Fiduciary Liability

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A plan sponsor’s fiduciary duty to be transparent in Pharmacy Benefit Manager contracts safeguards plan participants’ interests and mitigates the risk of litigation, regulatory penalties, and reputational harm, say Hall...more

Epstein Becker & Green

What Health Care Lawyers and Professionals Need to Know About Emerging Employee Benefit Issues

“ERISA, you’ll need a lawyer for that.” Our practice group’s tagline is meant to be a shorthand for the alphabet soup of laws that apply to employee benefits, including the Employee Retirement Income Security Act (ERISA)....more

Epstein Becker & Green

Hot Topics in Employee Benefits: A Primer for In-House Lawyers

“ERISA, you’ll need a lawyer for that.” Our practice group’s tagline is meant to be a shorthand for the alphabet soup of laws that apply to employee benefits, including the Employee Retirement Income Security Act (ERISA)....more

Verrill

The GLP-1 Coverage Conundrum: Managing Costs for Group Health Plans

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Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity, and Wegovy, into their group health plans, as they must balance the cost to the group health...more

Arnall Golden Gregory LLP

Challenges in Enforcing Mental Health Parity: EBSA’s Struggle to Ensure Compliance

A recent audit conducted by the U.S. Department of Labor’s Office of Inspector General (“OIG”) has uncovered significant challenges encountered by the Employee Benefits Security Administration (“EBSA”) in ensuring compliance...more

Saul Ewing LLP

Trump on Transparency: Making America Healthy Again Through Executive Order 14221; How Plan Sponsors Can Respond

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One mandate under the PPACA required health care providers, non-grandfathered health insurance issuers and self-insured group health plans to provide consumers with access to information about the cost of services before they...more

Snell & Wilmer

Mental Health Parity Compliance: What Steps Should an Employer Take Next?

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The Mental Health Parity and Addiction Equity Act (“MHPAEA”) and its implementing rules require group health plans to ensure that financial requirements (e.g., co-pays, deductibles, and coinsurance), quantitative treatment...more

Jackson Lewis P.C.

The Guidance Has Arrived! More Information from the IRS on ACA Forms 1095-B and 1095-C

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Takeaways- Employers may post a notice on their website instead of automatically furnishing Forms 1095-B and 1095-C to all full-time employees. The first due date for such a notice is March 3 for 2024 forms, and the notice...more

Warner Norcross + Judd

IRS Releases ACA Reporting Relief Guidance

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At the end of last year, we told you about new legislation that provides employers with a little Affordable Care Act (ACA) reporting relief. Specifically, under the Paperwork Burden Reduction Act, applicable large employers...more

Amundsen Davis LLC

IRS Issues Guidance on Alternative Distribution Method for Form 1095-C

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As part of the Paperwork Burden Reduction Act, signed into law on December 23, 2024, Internal Revenue Code (IRC) sections 6055(c) and 6056(c) were amended to allow the use of the alternative method for distributing Forms...more

McDermott Will & Schulte

How PPM Health Plans Can Solve the MEWA Problem

While a physician practice management (PPM) structure allows for compliance with corporate practice of medicine laws and ease of administration, it often creates inadvertent health plan issues that should be navigated...more

Foley & Lardner LLP

Is Your Nonprofit Slashing Benefits to Offset Federal Funding Cuts?

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On February 6, 2025, the Trump administration (the Administration) issued an executive order (the Review Order) directing the heads of Federal executive departments and agencies (Agencies) to review all funding the Agencies...more

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

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With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

Mitratech Holdings, Inc

ACA Reporting Deadlines for 2025: What You Need to Know

Understanding reporting rules for the Affordable Care Act (ACA) is more than a best practice. It’s a legal imperative. If your reports aren’t timely and accurate, you face penalties....more

Bass, Berry & Sims PLC

2025 Changes to ACA Employer Information Reporting Obligations and the Employer Shared Responsibility Penalties

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In December 2024, Congress and President Biden passed two laws—the Paperwork Burden Reduction Act (PBRA) and the Employer Reporting Improvement Act (ERIA)—that made important changes to employers’ responsibilities regarding...more

Faegre Drinker Biddle & Reath LLP

Affordable Care Act Penalty and Reporting Relief

The Employer Reporting Improvement Act and the Paperwork Burden Reduction Act (PBA), each signed into law in December 2024, provide the following penalty and reporting relief for plan sponsors required to provide minimum...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Congress Declines to Extend HDHP First-Dollar Telehealth Coverage Relief

After Congress declined to extend certain relief allowing first-dollar coverage of telehealth services by high-deductible health plans (HDHPs), health plan sponsors may need to make immediate changes to preserve employees’...more

Warner Norcross + Judd

Holy Smokes: Is Your Tobacco Surcharge Program Compliant?

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A “tobacco surcharge” is part of many employers’ wellness programs, where the employer charges tobacco users higher health insurance premiums than non-tobacco users. A typical tobacco surcharge program will ask an employee if...more

Saul Ewing LLP

Organizing Your Company’s Health and Welfare Plans Part 1: Creating a Framework

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Following the flurry of regulatory guidance and informal comments from officials at the Employee Benefits Security Administration, and other agencies of the Federal government, health and welfare plans should be a primary...more

Morgan Lewis - ML Benefits

Welcome Healthcare Reporting Simplification Enacted

On December 23, 2024, President Biden signed into law two bills that will simplify employer reporting compliance under the Affordable Care Act (ACA). The new laws streamline the rules for employers furnishing ACA reporting...more

Bradley Arant Boult Cummings LLP

Significant ACA Improvements for 2025: What Employers Need to Know

The Affordable Care Act reporting requirements are undergoing significant changes in 2025, thanks to the recently enacted Employer Reporting Improvement Act and Paperwork Burden Reduction Act. These changes simplify the...more

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