I read the Lewandowski v. Johnson & Johnson class action complaint and couldn’t help but wonder – are plans and participants doomed, or can employers take proactive steps to satisfy their fiduciary duties and potentially reduce prescription drug costs under their plans? Although there is no one-size-fits-all approach, a plan fiduciary should understand what their pharmacy […]
On April 26, 2024, the Office for Civil Rights (“OCR”) at the U.S. Department of Health & Human Services (“HHS”) published a final rule to amend the HIPAA Privacy Rules to support reproductive health care privacy (the “Reproductive Health Care Rules”). The Agency also issued a Press Release, Fact Sheet, and Message from the Director […]
On September 27th, the Departments released FAQs about Affordable Care Act Implementation Part 61 (“FAQ 61”), announcing that the Departments are rescinding prior-issued enforcement relief for certain machine-readable file requirements under the Transparency in Coverage (the “TiC”) regulations. The final TiC regulations, published in the Federal Register on November 12, 2020, in part required group […]
We have reported previously on the importance of understanding the coverage and reporting rules of the Affordable Care Act. In particular, Code Section 4980H imposes penalties on large employers for failure to offer minimum essential coverage to 95% or more of their full-time employees (and dependents) or to provide affordable, minimum value health insurance. Whether […]
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 be a useful starting point. Copies are available on request.
Just when you thought the confusing COVID-19 ERISA deadline extensions were behind you, the Biden-Harris Administration asks you to reconsider. Recap – In response to the COVID-19 National Emergency, DOL and Treasury issued guidance requiring benefit plans to extend certain ERISA deadlines related to COBRA continuation coverage, HIPAA special enrollment, and benefit claims and appeals, […]
For more information regarding the principal requirements under the CAA that apply to employer-sponsored group health plans, see our updated CAA Chart.
The Biden Administration recently announced its plan to end both the National Emergency and Public Health Emergency for COVID-19 (together, the “COVID-19 Emergencies”) on May 11, 2023. The end of the COVID-19 Emergencies will trigger (immediately or within specified timeframes) the end of various COVID-19 requirements and related relief for group health plans. As further […]
On January 30, 2023, the Departments of Health and Human Services, Treasury, and Labor (collectively “the Departments”) issued proposed rules entitled “Coverage of Certain Preventive Services under the Affordable Care Act” (the “Proposed Rules”). The Proposed Rules reflect the Departments’ continuing efforts to ensure that women have access to contraceptive care without cost sharing through […]
If you sponsor a high deductible health plan (“HDHP”) and have been tracking telehealth relief, your head may be spinning and rightfully so! There have been various laws and guidance impacting HDHPs and telehealth since 2020 and most recently, new legislation extended relief for 2023 and 2024 plan years. The relief allows, but does not […]