News & Analysis as of

Employer Liability Issues Patient Protection and Affordable Care Act (PPACA) Employer Group Health Plans

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

McDermott Will & Emery

Special Report: Examining Group Health Coverage Alternatives for Small Employers

McDermott Will & Emery on

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

Fisher Phillips

Rising ERISA Class-Action Lawsuits Over Tobacco Surcharges in Health Plans: What Employers Need to Know + 6 Steps to Stay...

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A wave of ERISA class-action lawsuits is challenging tobacco surcharge programs in employer-sponsored health plans across the U.S. These cases center on potential fiduciary breaches, with plaintiffs arguing that surcharges...more

McDermott Will & Emery

Election 2024: Gender-Affirming Care in the US

McDermott Will & Emery on

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

Schwabe, Williamson & Wyatt PC

Year-End Compliance Considerations for Employee Benefit Plans

Open enrollment is right around the corner (at least for employers that run calendar-year health benefit plans), so many employers will be updating their benefit communication plans. Though not comprehensive, the following is...more

Schwabe, Williamson & Wyatt PC

Is Your Group Health Plan “Affordable,” According to the IRS? ‎

The 2025 open enrollment season for employee benefits is swiftly approaching. With newly released IRS guidance, employers should review the cost of their group health plan(s) to ensure affordability. Companies that rely on...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 & Emery

Group Medical Captives, Level Funding and US Healthcare Policy

McDermott Will & Emery on

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

Bass, Berry & Sims PLC

Gender-Affirming Care Remains a Hot Topic in 2024

Bass, Berry & Sims PLC on

Our April 9 blog post highlighted several issues to watch during 2024, one of which was gender-affirming care considerations. Just over a month later, there have now been three key developments with respect to that issue:...more

McDermott Will & Emery

Special Report - Funding Employer-Sponsored Group Health Coverage: The Group Captive Solution - November 2023

McDermott Will & Emery on

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

Keating Muething & Klekamp PLL

Benefits Monthly Minute - September 2023

The September Monthly Minute highlights yet another tobacco surcharge case brought by the DOL, reminds plan administrators to prepare and submit the first annual gag clause attestation, and addresses the newly lowered ACA...more

Bass, Berry & Sims PLC

Planning for Open Enrollment? Note the ACA Affordability Threshold Drop

Bass, Berry & Sims PLC on

On August 23, the Internal Revenue Service issued Rev. Proc. 2023-29, announcing that the Affordable Care Act (ACA) affordability threshold will be 8.39% for plan years beginning in 2024, a substantial decrease from the 9.12%...more

Snell & Wilmer

Three Facts Every Employer Should Know about Code Section 4980H Penalties

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If you need help determining whether you are an “applicable large employer” subject to these rules or estimating the extent of potential penalty exposure, our Employer Shared Responsibility Penalty Checklist for Employers may...more

Sheppard Mullin Richter & Hampton LLP

Navigating the Wild West of the New ACA Preventative Care Ruling

On March 30, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a decision in Braidwood Management Inc. v. Becerra (“Braidwood”), invalidating the Affordable Care Act’s (“ACA’s”) mandate...more

Bradley Arant Boult Cummings LLP

Departments Issue Guidance on Preventive Services under the ACA Following the Braidwood Decision

In light of the March 30 Braidwood Mgmt. Inc. v. Becerra decision, the Department of Labor, Department of Health and Human Services, and Department of the Treasury (the “departments”) have issued FAQ guidance on how the...more

Holland & Hart - The Benefits Dial

It’s a Roller Coaster … Employer Considerations After Court Invalidates ACA Preventive Care Mandate

Since the Affordable Care Act (“ACA”) became law in 2010, numerous groups have attempted to invalidate the ACA or specific parts of the ACA through litigation. Even after a number of plaintiffs unsuccessfully attempted to...more

Fisher Phillips

5 Most Important Steps for Employers Doing Their 2023 ACA Compliance Planning

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Applicable large employers must adhere to many Affordable Care Act (ACA) rules to remain compliant regarding group health plan offerings. We offer the following checklist of the five most helpful reminders you should take...more

Bradley Arant Boult Cummings LLP

July 1 Deadline for Health Plan Website Disclosures

The Departments of Labor, Health and Human Services and the Treasury recently issued FAQs About Affordable Care Act Implementation Part 53 (FAQ), which provides additional guidance for non-grandfathered group health plans and...more

Woodruff Sawyer

Compliance Alert: IRS Proposes Permanent 30-day Extension to ACA Reporting Deadline

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Insights December 3, 2021 /Employee Benefits On November 22, 2021, the IRS filed a Notice of Proposed Rulemaking (“Proposed Rule”) that among other things, provides for an automatic 30-day extension of the deadline for...more

Fisher Phillips

The Cost of Employee Benefits Non-Compliance Just Went Up . . . Again

Fisher Phillips on

The U.S. Department of Health & Human Services (HHS) just announced increased penalty amounts for entities who violate the privacy, security, and breach notification rules under the Health Insurance Portability and...more

Bradley Arant Boult Cummings LLP

IRS Proposes Regulations on ACA Reporting: Good News and Bad News for Employers

The Internal Revenue Service (IRS) has published proposed regulations that, if finalized, will ease some of the requirements imposed on employers reporting offers of minimum essential health coverage, including a permanent...more

Kaufman & Canoles

2022 ACA Numbers & Limitations Reference Chart

Kaufman & Canoles on

John Peterson has created a 2022 ACA Numbers & Limitations Reference Chart. Applicable Large Employer (ALE) Shared Responsibility Penalty (IRC §4980H, Forms 1094-C & 1095-C) ...more

Snell & Wilmer

In Case You Missed It – Summer 2021

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Summer has come and gone, but there was no summer vacation for employee benefits legislation and guidance. In case you have been too busy to check out our blogs lately, here are some key items to help you stay organized and...more

Proskauer - Employee Benefits & Executive...

What Employers Should Know about ACA Shared Responsibility Payments

A recently released redacted report from the Treasury Inspector General for Tax Administration (TIGTA) offers some helpful insights for employers who may be assessed shared responsibility payments because the IRS thinks they...more

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