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July Business Services
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FuturePlan, by Ascensus
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Compass Retirement Consulting Group, Inc.
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All News > Health Plan Administration

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Proposed Regs Extend ACA Individual Statement Due Dates
Mercer Link to more items from this source
[Guidance Overview]
Dec. 2, 2021

"Five states ... and Washington, DC, have implemented or enacted individual health coverage mandates. Reporting entities with health plan participants living in these jurisdictions may need to provide Form 1095-B or an alternative form to responsible individuals, despite the federal relief."

Tags: Health Plan Administration

Good Faith Compliance Standard for ACA Reporting by Large Employers Is Ending
MZQ Consulting, LLC Link to more items from this source
[Guidance Overview]
Dec. 2, 2021

"Up until this reporting year, employers just had to 'try their best' when it came to filling out reporting forms.... Now ... employers ... not only need to file their Forms 1094/1095-C with the IRS, but they also need to get them right.... [E]mployers may be penalized for inaccurate/incomplete information returns, which comes with a fine of up to $280 per form for 2021."

Tags: Health Plan Administration

Illinois DOL Releases Guidance for Consumer Coverage Disclosure Act
EPIC Link to more items from this source
[Guidance Overview]
Dec. 2, 2021

"A new disclosure requirement ... requires employers sponsoring health plans in Illinois to disclose a written list of offered benefits compared to the list of essential health benefits offered by the State of Illinois. According to the rule, because the requirement is on employers, not insurance plans, the disclosure is not preempted by [ERISA]. The [Illinois DOL] provided a sample chart of essential health benefits employers can use to fulfill the disclosure requirement. There are penalties for failure to comply."

Tags: Health Plan Administration  •  Local Regulation

CMS Makes Templates Available to Help with Aspects of the New Surprise Billing Regs
Healthcare Financial Management Association [HFMA]; free registration required Link to more items from this source
Dec. 2, 2021

"The resources ... include forms for: [1] Notifying self-pay and uninsured patients of their right to receive a good-faith estimate of expected charges; [2] Generating a good-faith estimate; [3] Tracking the data elements that are required in the good-faith estimate; [4] Tracking required documents for the provider-patient dispute resolution process, which can be used when charges exceed the good-faith estimate by at least $400."

Tags: Health Plan Administration  •  Health Plan Costs

HHS Adjusts 2021 HIPAA, ACA and MSP Monetary Penalties
Mercer Link to more items from this source
[Guidance Overview]
Dec. 1, 2021

"Inflation adjustments released by [HHS] apply to penalties assessed on or after Nov. 15, 2021, for violations occurring on or after Nov. 2, 2015. This most recent inflation increase is 1.182%. This article highlights the changes of interest to employers sponsoring group health plans."

Tags: HIPAA  •  Health Plan Administration

Eighth Circuit: Ordinary Summary Judgment Procedures Apply to Review of ERISA Benefit Claims
Roberts Disability Law Link to more items from this source
Dec. 1, 2021

"The Eighth Circuit ... held that ordinary summary-judgment procedures under FRCP 56 apply in ERISA benefit cases where the administrator lacked discretionary authority. Parties in an ERISA case that want the district court to exercise its factfinding function under FRCP 39(b) and 52(a)(1) to decide the case on the administrative record should request that the district court do that." [Avenoso v. Reliance Standard Life Ins. Co., No. 21-1772 (8th Cir. Nov. 30, 2021)]

Tags: Health Plan Administration  •  Retirement Plan Administration

Editor's Pick Employer Checklist for New Health Plan Price Transparency Rules and CAA
Foley & Lardner LLP Link to more items from this source
[Guidance Overview]
Dec. 1, 2021

"[S]everal provisions [of the Consolidated Appropriations Act of 2021 and related regulations, and the Transparency in Coverage Rule] that will have a large impact on self-funded health plans are effective in January 2022, including requirements related to surprise billing. [This checklist is designed] to help employers with self-funded health plans be aware of the obligations imposed by these laws and the steps they may need to take to comply[.]"

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration

Illinois Imposes Group Health Coverage Disclosure Requirements
Haynes and Boone, LLP Link to more items from this source
[Guidance Overview]
Dec. 1, 2021

"The Illinois Consumer Coverage Disclosure Act, which went into effect on August 27, 2021, requires an employer to notify employees in Illinois who are eligible for its group health plan whether such plan does or does not cover each of the essential health benefits identified by the Illinois [DOL].... Because this is a disclosure requirement and not a benefits mandate, the Illinois DOL maintains that this requirement also applies to self-funded group health plans regulated by ERISA."

Tags: Health Plan Administration  •  Local Regulation

Nevada Jury Finds Against United Healthcare's Efforts to Underpay for Emergency Medical Services and Generate Profit for Itself
Zuckerman Spaeder LLP Link to more items from this source
Nov. 30, 2021

"Plaintiff's central allegation was that United Healthcare, the nation's largest health insurer and plan administrator, engaged in a multi-pronged scheme to dramatically reduce emergency reimbursement rates and artificially generate profits for itself. The case offers a revealing window into the 'black box' process by which reimbursement rates are set and the enormous power of United Healthcare." [Fremont Emergency Services (Mandavia) vs. UnitedHealth Group, Inc., No. A-19-792978-B (Clark Co., NV)]

Tags: Health Plan Administration  •  Health Plan Costs

Proposed Regs Shed Light on Upcoming Health Plan Disclosure Requirements
Fisher Phillips Link to more items from this source
[Guidance Overview]
Nov. 30, 2021

"[T]he Departments have announced that they will not start enforcing the reporting requirements until December 27, 2022.... The IFR states that the Departments plan to issue a form with instructions that will give more details for these new requirements. Further, the Departments have announced that they will be developing an internet portal for electronic reporting."

Tags: Health Plan Administration

Editor's Pick ACA Reporting for Employers with a Self-Insured Plan
Newfront Link to more items from this source
[Guidance Overview]
Nov. 30, 2021

"ALEs with a self-insured medical plan (including a 'level funded' plan) must complete Part III of the Form 1095-C to report the months of coverage for the employee and any covered dependents. Non-ALEs with a self-insured medical plan must provide employees with the Form 1095-B to report coverage."

Tags: Health Plan Administration

Don't Forget Medicare Prescription Drug Reporting to CMS
Fisher Phillips Link to more items from this source
[Guidance Overview]
Nov. 30, 2021

"Plan sponsors must provide the required coverage disclosure to CMS annually no later than 60 days following the start of a new plan year.... Plan sponsors must use CMS's creditable coverage portal to complete the necessary creditable coverage disclosure form."

Tags: Health Plan Administration

Who Has the Burden of Proof When an ERISA Claim Is Denied?
DeBofsky Sherman Casciari Reynolds P.C. Link to more items from this source
Nov. 30, 2021

"In most instances, the claimant has the burden of proof by a preponderance of the evidence that they are entitled to benefits.... What is the definition of a 'Preponderance of the Evidence'? What's different about ERISA cases? When does the burden of proof shift to the insurance company?"

Tags: Health Plan Administration  •  Retirement Plan Administration

Satisfying Electronic Disclosure Requirements for SPDs to New Hires
PLANSPONSOR; free registration may be required Link to more items from this source
Nov. 30, 2021

"[The DOL states] that you need to first provide a notice, on paper, that the participant will be emailed/texted at a specific specified email address/smartphone number with the information necessary to access the website where the SPD will be posted. After that you would then email/text the notice (described as a 'notice of internet availability' in the final rule) that is similar to what you proposed be included in your new hire packet."

Tags: Health Plan Administration  •  Retirement Plan Administration

Editor's Pick Proposed Regs Permanently Extend Due Date to Furnish Forms 1095-B and 1095-C, Clarify Other Lingering Issues
Accord Link to more items from this source
[Guidance Overview]
Nov. 29, 2021

"The proposed regulations provide relief from the penalty under section 6722 for entities required to furnish the Form 1095-B to individuals in certain cases.... Unfortunately, a similar transition relief provision was not extended to the Form 1095-C except in an extremely limited circumstance.... [T]he proposed regulations make it [clear] that the IRS is no longer going to continue to ignore Forms 1094-B, 1095-B, 1094-C, and 1095-C that are submitted incorrectly or incompletely."

Tags: Health Plan Administration

IRS Provides ACA Reporting Relief
Jackson Lewis P.C. Link to more items from this source
[Guidance Overview]
Nov. 29, 2021

"[It] isn't yet clear whether these new (or analogous) rules will apply for states with their own individual mandate and reporting requirements (currently, California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia). And, in perhaps their only downside, the proposed regulations confirm the end of the transitional good-faith relief for incorrect or incomplete ACA reporting."

Tags: Health Plan Administration

Agencies Issue Regs Implementing Prescription Drug and Health Care Spending Reporting Requirements, Including Rules for Aggregating Data
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
Nov. 24, 2021

"In addition to general identifying information such as the beginning and end dates of the plan year, the number of enrollees covered, and each state in which the plan is offered, a broad range of health care spending information must be reported.... [T]he agencies advise that plans, insurers, and third-party reporting entities may submit most of the required information on an aggregate basis. The only plan-level information collected will be the general plan information."

Tags: Health Plan Administration

IRS Proposes Permanent, Automatic 30-Day Extension for Furnishing ACA Forms
HUB International Link to more items from this source
[Guidance Overview]
Nov. 24, 2021

"The IRS recently released proposed rules that would make permanent and automatic the 30-day extension for furnishing ACA reporting forms to individuals.... [T]he proposed relief is available for 2021 reporting.... This has not changed the deadline for filing with the IRS.... [T]he preamble to these proposed rules reiterated that good faith relief will not be available anymore."

Tags: Health Plan Administration

IRS Proposes ACA Reporting Relief and Deadline Extensions
Groom Law Group Link to more items from this source
[Guidance Overview]
Nov. 24, 2021

"[T]he proposed regulations provide that an employer would not be required to send Forms 1095-B/C to part-time employees and non-employees enrolled in the employer's self-insured plan, as long as the employer posts a 'clear and conspicuous notice' on the employer's website stating that individuals may receive a copy of their statement upon [request].... [T]his relief does not apply with respect to full-time employees."

Tags: Health Plan Administration  •  Reporting to Government Agencies

IRS Proposes Regs on ACA Reporting: Good News and Bad News for Employers
Bradley Link to more items from this source
[Guidance Overview]
Nov. 24, 2021

"During the era of transitional good faith relief, the IRS has been accommodating of employers filing incomplete or inaccurate information on Forms 1094 and 1095. With the relief coming to an end, employers should take extra care to ensure the information they are reporting, especially the coding on Forms 1095-C, is accurate.... [T]he effective cost of [any] corrections may be the information reporting penalties."

Tags: Health Plan Administration

Key Dates for Calendar Year 2022: Qualified Health Plan Data Submission and Certification; Rate Review; and Risk Adjustment (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
Nov. 24, 2021

"This document summarizes proposed key dates for calendar year 2022 regarding some activities and policies that are outlined in other documents. CMS is not soliciting additional comments on the substance of the underlying policies or proposed key dates through release of this document."

Tags: Health Plan Administration

EBSA Restores Over $2.4 Billion to Employee Benefit Plans, Participants and Beneficiaries in FY 2021 (PDF)
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
Nov. 24, 2021

"In FY 2021, EBSA closed 1,072 civil investigations with 741 of those cases (69%) resulting in monetary results for plans or other corrective action.... EBSA's enforcement program helped 16,024 terminated vested participants in defined benefit plans collect benefits of $1.548 billion owed to them.... In FY 2021, EBSA obtained 449 non-monetary corrections ... [including] removal of 6 fiduciaries, orders barring 34 individuals from acting as fiduciaries, court appointments of 16 independent fiduciaries, and 124 cases involving reforms of plan procedures, such as improved search procedures for missing participants."

Tags: Fiduciary Duties  •  Health Plan Administration  •  Lost/Missing Participants  •  Retirement Plan Administration

Agencies Issue Two Rounds of No Surprise Billing Guidance
The Wagner Law Group Link to more items from this source
[Guidance Overview]
Nov. 23, 2021

"Health plans must work now to understand the [independent dispute resolution (IDR)] requirements for certain payors and out-of-network providers, as well as the other requirements to implement the prohibitions on surprise billing, as many of these rules are expected to be effective next year.... With external review procedures affected, even for grandfathered plans, amendments to health plan claims procedures will be necessary to comply."

Tags: Health Plan Administration  •  Health Plan Design

HHS Secretary Says Surprise Billing Rules Force Doctors Who Overcharge to Accept Fair Prices
Kaiser Health News Link to more items from this source
Nov. 23, 2021

"The doctor groups say giving the insurers the upper hand will let them drive payment rates down and potentially force doctors out of networks or even out of business, reducing access to health care. [HHS] has heard those concerns, [HHS Secretary Xavier Becerra] said, but the bottom line is protecting patients. Medical providers who have taken advantage of a complicated system to charge exorbitant rates will have to bear their share of the cost, or close if they can't, he said."

Tags: Health Plan Administration  •  Health Plan Costs

Text of IRS Proposed Regs: Information Reporting of Health Insurance Coverage and Other Issues Under Sections 5000A, 6055, and 6056 (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Nov. 22, 2021

37 pages. "This document contains proposed regulations providing ... an automatic extension of time for providers of minimum essential coverage (including health insurance issuers, self-insured employers, and government agencies) to furnish individual statements regarding such coverage and would provide an alternative method for furnishing individual statements when the shared responsibility payment amount is zero. Additionally, the proposed regulations would provide an automatic extension of time for 'applicable large employers' ... to furnish statements relating to health insurance that the employer offers to its full-time employees." [Editor's note: Link is to 'advance copy' released by IRS Nov. 22, 2021.]

Tags: Health Plan Administration

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