ThomsonReuters

MARCH 30, 2023

Report to Congress: Annual Report on Self-Insured Group Health Plans (Mar. 2023); Appendix A, Group Health Plans Report: Abstract of 2020 Form 5500 Annual Reports Reflecting Statistical Year Filings (Oct. 1.0); Appendix B, Self-Insured Health Benefit Plans 2023: Based on Filings Through 2020 (Sept.

Compliance 94

Compliance 94

ThomsonReuters

JUNE 15, 2023

For more information, see EBIA’s Group Health Plan Mandates manual at Sections IV.F (“Governmental Employers”) and IX.A (“What Is Mental Health Parity and Who Must Comply?”) 3 (“Plans Sponsored by Certain Governmental Entities”). Contributing Editors: EBIA Staff.

Equity 96

Equity 96

ThomsonReuters

MARCH 16, 2023

QUESTION: Our company sponsors a high-deductible health plan (HDHP) in conjunction with employee HSAs. As group health plans, HDHPs that provide dependent coverage of children must make the coverage available until a child turns age 26. The age 26 mandate does not generally apply to HSAs because they are not group health plans.)

88

88

ThomsonReuters

NOVEMBER 17, 2022

QUESTION: Does our company have to pay for employees’ health coverage while they are on FMLA leave? ANSWER: Your company does not have to pay your employees’ share of health coverage premiums while they are on FMLA leave.

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98

ThomsonReuters

APRIL 20, 2023

QUESTION: Next year, we plan to amend our company’s cafeteria plan to add a health FSA under which participants elect a coverage amount for the year and pay for it with pre-tax salary reductions. There will be no employer contributions, so participants’ health FSA salary reductions will equal the elected annual coverage amount.

104

104

ThomsonReuters

MAY 18, 2023

2023-23 (May 16, 2023) Available at [link] The IRS has released the 2024 cost-of-living adjusted limits for health savings accounts (HSAs), high-deductible health plans (HDHPs), and excepted benefit health reimbursement arrangements (EBHRAs). Here are the details: HSA Contribution Limits. Contributing Editors: EBIA Staff.

98

98

ThomsonReuters

FEBRUARY 17, 2022

QUESTION: We’ve heard there is a requirement to report prescription drug and health care spending to the government in 2022. The agencies have indicated that the data is to be submitted through the RxDC module in the Health Insurance Oversight System (HIOS) (see our Checkpoint article ). Contributing Editors: EBIA Staff.

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ThomsonReuters

MARCH 3, 2022

The HHS Health Resources and Services Administration (HRSA) has issued updated preventive services guidelines for women, which it approved on December 30, 2021. 1 (“Preventive Health Services”). You may also be interested in our upcoming webinar “ Group Health Plans Quarterly Update: Q1 2022 ” (live on 3/24/2022).

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98

ThomsonReuters

MARCH 2, 2023

CMS Fact Sheet: CMS Waivers, Flexibilities, and the Transition Forward From the COVID-19 Public Health Emergency (Feb. Here are highlights relevant to employer-sponsored group health plans: COVID-19 Vaccines, Testing, and Treatments. When covered, plans may impose cost-sharing, prior authorization, or other forms of medical management.

97

97

ThomsonReuters

JULY 21, 2022

QUESTION: Our company currently offers a general-purpose health FSA. Like health FSAs, HSAs can provide tax-free reimbursement of out-of-pocket expenses for medical care as defined in Code § 213(d). Like health FSAs, HSAs can provide tax-free reimbursement of out-of-pocket expenses for medical care as defined in Code § 213(d).

105

105

ThomsonReuters

JANUARY 13, 2022

While six of the FAQs provide anticipated guidance on plan coverage of over-the-counter COVID-19 tests (see our Checkpoint article ), three FAQs address issues relating to the Affordable Care Act (ACA) preventive health services requirements. See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1 Contraceptives.

Compliance 98

Compliance 98

ThomsonReuters

FEBRUARY 16, 2023

Publication 502 has also been revised to reflect that the health coverage tax credit (HCTC) is not available after 2021. For more information, see EBIA’s Cafeteria Plans manual at Sections XX.D.7 Clarifications have been added regarding expenses to treat excessive use of alcohol and drugs, and relevant dollar amounts (e.g.,

98

98

ThomsonReuters

SEPTEMBER 15, 2022

QUESTION: We’ve heard that group health plan claims for certain services must be resolved under federal IDR rules. For more information, see EBIA’s Health Care Reform manual at Section XII.B.3 What is IDR, and what claims does it apply to? 3 (“Surprise Medical Billing: Emergency and Non-Emergency Services”).

98

98

ThomsonReuters

APRIL 7, 2022

United Behavioral Health, 2022 WL 850647 (9th Cir. The Ninth Circuit has reversed a federal trial court’s ruling that a large insurer breached its fiduciary duty to health plan participants by using overly restrictive guidelines for administering claims. Available at [link]. Contributing Editors: EBIA Staff.

Compliance 97

Compliance 97

ThomsonReuters

JANUARY 20, 2022

Other Group Health Plan Penalties. See also EBIA’s 401(k) Plans manual at Sections VIII.D.2 3 (“Additional Notice and Disclosure Relating to State Premium Assistance Subsidy”); EBIA’s Health Care Reform manual at Section XVI.I (“Consequences of Failing to Provide the SBC”); EBIA’s Group Health Plan Mandates manual at Section XXII.F.1

Compliance 98

Compliance 98

ThomsonReuters

JULY 14, 2022

ANSWER: Telehealth benefits (also referred to as telemedicine benefits) are often offered under an employer’s group health plan, which is governed by ERISA if sponsored by a private sector employer. Even if telehealth benefits are offered separately from the employer’s group health plan, the benefits are likely subject to ERISA.

Compliance 98

Compliance 98

ThomsonReuters

MARCH 23, 2023

Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness, and General Health (Mar. 17, 2023) FAQs News Release The IRS has issued FAQs that explain when certain costs related to nutrition, wellness, and general health are medical expenses under Code § 213 that may be paid or reimbursed under a health FSA, HSA, or HRA.

98

98

ThomsonReuters

MARCH 17, 2022

Here are highlights of the adjustments potentially affecting employer-sponsored health plans: HIPAA Administrative Simplification. HIPAA administrative simplification encompasses standards for privacy, security, breach notification, and electronic health care transactions. Summary of Benefits and Coverage (SBC).

97

97

ThomsonReuters

OCTOBER 20, 2022

Health FSAs. For 2023, the dollar limit on employee salary reduction contributions to health FSAs will be $3,050 (up from $2,850). For 2023, the dollar limit on employee salary reduction contributions to health FSAs will be $3,050 (up from $2,850). Small Business Health Care Tax Credit. Archer MSAs.

97

97

ThomsonReuters

JUNE 15, 2023

QUESTION: As required, our group health plan has extended the length of HIPAA special enrollment periods due to the COVID-19 emergency. 60-day special enrollment periods may be triggered by changes in eligibility for Medicaid or state premium assistance under the Children’s Health Insurance Program (CHIP).

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98

ThomsonReuters

SEPTEMBER 1, 2022

In a long-running dispute between HHS and a group of faith-based health care providers over the reach of Affordable Care Act (ACA) Section 1557, the Fifth Circuit has upheld a permanent injunction prohibiting HHS from requiring the providers to perform or provide insurance coverage for gender-transition procedures or abortions.

52

52

ThomsonReuters

FEBRUARY 24, 2022

A COVID-19 testing laboratory alleged that numerous health plans and TPAs violated the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) by failing to cover the laboratory’s diagnostic tests at a publicly disclosed price of $900 per test. Contributing Editors: EBIA Staff.

98

98

ThomsonReuters

MARCH 17, 2022

QUESTION: Our self-insured health plan would like to reduce required employee contributions for employees who do not use tobacco. The program must be reasonably designed to promote health and prevent disease. For more information, see EBIA’s Self-Insured Health Plans manual at Section XIII.D (“Benefits Must Not Be Discriminatory”).

105

105

ThomsonReuters

MARCH 3, 2022

QUESTION: Several of our employees were hospitalized over the past year with COVID-19 and incurred large medical expenses, which our self-insured health plan was obligated to cover. Any restriction on benefits must apply uniformly to all similarly situated individuals and must not be directed at individuals based on a health factor.

105

105

ThomsonReuters

FEBRUARY 17, 2022

The minor beneficiary of an employer-sponsored group health plan, with his parents, sued the employer, the plan administrator, and the claims administrator, alleging that the plan’s exclusion of non-restorative speech therapy for autism spectrum disorder (ASD) violated the Mental Health Parity and Addiction Equity Act (MHPAEA).

Compliance 98

Compliance Equity 98

ThomsonReuters

MARCH 17, 2021

QUESTION: Next year, our company will set up an HRA and a health FSA covering the same employees. ANSWER: Unless you design your plan differently, the general ordering rule is that expenses are paid first from the HRA, until the HRA balance is exhausted, and then from the health FSA.

119

119

ThomsonReuters

JANUARY 5, 2023

Congress has passed, and the President has signed, the Consolidated Appropriations Act, 2023 (CAA, 2023), containing provisions that impact both retirement and group health plan sponsors and advisors. Here are highlights of the provisions affecting group health plans: Telehealth/HDHPs. Mental Health Parity.

Compliance 88

Compliance Equity 88

ThomsonReuters

MARCH 30, 2023

3, 2023) Available at [link] HHS has released revised instructions for group health plans and insurers to report prescription drug and health care spending data, as required by the Consolidated Appropriations Act, 2021 (see our Checkpoint article ). See also EBIA’s Self-Insured Health Plans manual at Section XXIX.D.4

52

52

ThomsonReuters

APRIL 6, 2023

2023) A federal trial court has vacated all agency actions taken on or after March 23, 2010, to implement or enforce the preventive health services mandate of the Affordable Care Act (ACA) in response to an “A” or “B” recommendation of the United States Preventive Services Task Force (USPSTF). 1 (“Preventive Health Services”).

52

52

ThomsonReuters

APRIL 7, 2022

For more information, see EBIA’s Health Care Reform manual at Sections XXI.E.3.a See also EBIA’s ERISA Compliance manual at Section IX.I (“Eligibility Issues Involving Independent Contractors, Leased Employees, and Others”); EBIA’s Cafeteria Plans manual at Section IX (“Who Can Participate in a Cafeteria Plan?”)

Compliance 98

Compliance 98

ThomsonReuters

APRIL 28, 2022

The letter responds to a request for guidance on when the cost of health and wellness coaching is medical care that can be reimbursed under health FSAs, HSAs, and other tax-favored accounts. See also EBIA’s Consumer-Driven Health Care manual at Sections XV.C (“What Is an HSA-Qualified Medical Expense?”)

105

105

ThomsonReuters

JUNE 2, 2022

QUESTION: The claims administrator for our ERISA group health plan sometimes records telephone conversations between a plan participant or beneficiary and the claims administrator’s representative. In addition, group health plans may be subject to an excise tax for failing to provide full and fair review.

Compliance 98

Compliance 98

ThomsonReuters

JULY 15, 2021

QUESTION: We have heard from our company’s group health plan insurer that our plan must continue covering certain patients who are undergoing treatment when we change our contractual relationship with their provider. If these continuity of care conditions are satisfied, the group health plan must—. Contributing Editors: EBIA Staff.

98

98

ThomsonReuters

FEBRUARY 10, 2022

The DOL, HHS, and IRS have issued a pointed report to Congress on the pervasive failure by group health plans to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA). See also EBIA’s Self-Insured Health Plans manual at Section XIII.E (“Coverage Limitations and Exclusions”).

Compliance 98

Compliance Equity 98

ThomsonReuters

MAY 5, 2022

The IRS has released the 2023 cost-of-living adjusted limits for health savings accounts (HSAs), high-deductible health plans (HDHPs), and excepted benefit health reimbursement arrangements (EBHRAs). See also EBIA’s Cafeteria Plans manual at Section XVI.K (“Special Considerations for HSAs Offered Through Cafeteria Plans”).

105

105

ThomsonReuters

FEBRUARY 23, 2023

QUESTION: For 2023, an employee elected $2,400 of health FSA coverage under our calendar-year cafeteria plan, which is funded solely through employee salary reductions and does not provide for carryovers or include a grace period. The post Can Employees Be Reimbursed for Their Entire Health FSA Election Early in the Year?

98

98

Mogin Rubin M&A

AUGUST 3, 2022

which owns the patent on the global blockbuster drug, Humira, has again defeated a pair of claims by welfare-health plans that the company violated Sections 1 and 2 of the Sherman Antitrust Act. AbbVie Inc., 1 the Seventh Circuit U.S.

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