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Employer Group Health Plans Self-Funded Health Plans Health Insurance

Warner Norcross + Judd

Group Health Plan PCORI Fees Due by July 31 - UPDATED JULY 2025

As a reminder, the deadline for submitting Patient-Centered Outcomes Research Institute (PCORI) fees is July 31. Employers who sponsor self-insured group health plans should report and pay PCORI fees using the most recently...more

Venable LLP

Final Rules on MHPAEA and the NQTL Comparative Analysis

Venable LLP on

The government recently issued final rules on the Mental Health Parity and Addiction Equity Act (MHPAEA). The rules implement requirements for plans to conduct a comparative analysis of their nonquantitative treatment...more

Bricker Graydon LLP

Summer's Hot Debate: Does a Self-Funded Group Health Plan Cover Gender-Affirming Care?

Bricker Graydon LLP on

As the temperatures continue to rise, regulations and litigation related to employer-sponsored group health plans have followed suit. As these new rules continue to evolve, we are often asked whether a self-insured group...more

McDermott Will & Schulte

Group Medical Captives, Level Funding and US Healthcare Policy

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

Verrill

Can a Self-Funded Group Health Plan Exclude Coverage for Gender-Affirming Care?

Verrill on

We are sometimes asked whether a self-funded group health plan is required to cover gender-affirming medical services. As this post explains in detail, it is generally impracticable for a self-funded ERISA-covered plan to...more

McDermott Will & Schulte

Gender-Affirming Benefits: Best Practices for Group Health Plans

Federal legislative and regulatory activity related to employer-sponsored group health plans shows no signs of slowing, particularly with the issuance of interpretive guidance regarding the transparency and surprise-billing...more

Venable LLP

July Filing Deadlines for Employee Benefit Plans - July 2023

Venable LLP on

By July 31, employers that sponsor self-funded medical plans must report and pay their PCORI fee. By July 31, employers that sponsor calendar-year employee benefit plans that are subject to ERISA must file a Form 5500 (unless...more

BakerHostetler

Self-Funded Employer Health Plans are Changing: What to Watch

BakerHostetler on

The healthcare industry is rapidly changing, and self-funded employer sponsored health plans have more options to consider when creating solutions for their employees. In today’s episode, Jennifer Mills and Susan Hughes...more

Winstead PC

Good News on Health Coverage Reporting for 2018 Coverage

Winstead PC on

Normally, the deadline for reporting health care coverage by a self-insured medical plan or an insured plan follow rapidly after year end. In an early holiday gift, the Internal Revenue Service (the “Service”) provided an...more

Epstein Becker & Green

New Jersey’s Surprise Medical Bill Law: Part 1: Regulatory Issuances by New Jersey Agencies

Epstein Becker & Green on

Earlier this year, New Jersey Governor Phil Murphy signed into law the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“Law”), creating a statutory framework attempting to protect...more

Foley & Lardner LLP

Thank You IRS - Extensions for This Year’s ACA Tax Reporting

Foley & Lardner LLP on

The “Bottom Line” - Employers will have until March 2, 2018 to furnish Form 1095-C (“Employer-Provided Health Insurance Offer and Coverage”) to employees.,,...more

Mintz - Employment Viewpoints

Association Health Plans—Can The Trump Administration Expand Access Without Congress?

In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of...more

Mintz - Employment Viewpoints

The Rise of the Group Health Insurance Captive

With its “employer mandate”—i.e., the requirement that applicable large employers make an offer of group health coverage to substantially all full-time employees or face the prospect of a penalty—the Affordable Care Act (ACA)...more

Mintz - Employment, Labor & Benefits...

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 15 of 24): Coding Form 1095-C, Part II for...

As we noted in a previous post, the recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event...more

Mintz - Employment, Labor & Benefits...

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 10 of 24): IRS Issues Final Form 2015...

The IRS recently issued final instructions for Forms 1094-B and 1095-B and Forms 1094-C and 1095-C . The 2015 Instructions for Forms 1094-B and 1095-B implement a suggestion we made in a previous post relating to the...more

Mintz - Employment, Labor & Benefits...

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 2 of 24): Yikes! The Costs of Failing to Comply...

The Affordable Care Act (ACA) imposes information reporting rules on providers of minimum essential coverage, e.g., insurance carriers and self-funded plans, and on applicable large employers, i.e., those employers that are...more

Mintz - Employment, Labor & Benefits...

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 1 of 24)

Alden Bianchi, Chair of the our Employee Benefits & Executive Compensation Practice, will provide a weekly installment on the complex reporting obligations outlined by the Affordable Care Act for health insurance carriers and...more

McAfee & Taft

New ruling limits out-of-pocket expenses at individual level in 2016

McAfee & Taft on

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

Pullman & Comley, LLC

Alert: Health Plan Update on Out-of-Pocket Limitations

Pullman & Comley, LLC on

The Affordable Care Act (the “ACA”) established limitations on the annual out-of-pocket costs that a health plan may impose on a participant. The U.S. Department of Health and Human Services, Department of Labor and the...more

McAfee & Taft

The ACA’s Toyota tax

McAfee & Taft on

For several years now, employers have spent a great deal of time focusing on the Affordable Care Act’s (ACA) play-or-pay mandate. Numerous articles have been written and numerous educational seminars have been given...more

Dickinson Wright

Iowa Supreme Court Affirms Ruling for Health Insurer in Antitrust Dispute

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In late February, the Iowa Supreme Court affirmed a lower court ruling in Mueller v. Wellmark, ending a seven year battle over whether the health insurer’s agreement with employers operating “self-funded” insurance plans to...more

Mintz - Employment, Labor & Benefits...

Beware of Stop-Loss Coverage Gaps When Choosing a Self-Funded Major Medical Plan

The Affordable Care Act requires applicable large employers to make broad-based offers of group health insurance coverage to substantially all their full-time employees or face potential tax penalties. (The term “applicable...more

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