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[Guidance Overview]

Agencies Issue Final Transparency Rule for Group Health Plans and Insurers

"[E]ffective January 1, 2022, non-grandfathered health plans and insurers must publish their negotiated rates and allowable out-of-network charges on a public website, updated monthly ... The files will show negotiated rates for in-network services as well as historical payments to and billed charges from out-of-network providers and in-network negotiated rates. They will also show historical net prices for covered prescription drugs at the pharmacy level. This information must be publicly available, accessible without charge, and cannot require a user account, password or other credentials[.]" Icon to read more


[Guidance Overview]

Transparency in Coverage Regs Add Expansive Cost-Sharing Disclosures for Health Plans and Insurers

"The regulations implement a trove of new disclosures for group health plans, and January 2022 will arrive sooner than we can imagine. Although a 'good faith' safe harbor allows for errors and temporary website inaccessibility (so long as the issue is corrected as soon as practicable), plans and insurers face significant work to implement these new requirements." Icon to read more

Thomson Reuters / EBIA

[Guidance Overview]

Departments Publish Mental Health Parity Compliance Tool

"[T]he additions to the tool include: [1] Best practices for establishing an internal compliance plan. [2] Revised and additional examples, particularly related to application of MHPAEA's [nonquantitative treatment limitation (NQTL)] rules and in response the 21st Century Cures Act. [3] Additional 'warning signs' -- plan terms that do not on their own signify a MHPAEA violation, but raise a red flag that a treatment limitation may be impermissible" Icon to read more


[Guidance Overview]

ACA 1557 Nondiscrimination Rule Revised, But What Is Effective Now? (PDF)

18 pages. "While the rule doesn't apply to most employer group health plans, the nondiscrimination standards and ongoing litigation will shape employee access to healthcare services covered by employer plans.... [T]he regulation's administrative and notice changes ... could eliminate the need for plan features put in place to comply with the 2016 rule.... [This paper provides] analysis of the 2020 regulation and the provisions currently in effect or on hold. An appendix provides a handy chart comparing key provisions of the 2016 and 2020 regulations." Icon to read more


Agencies Issue Regs on Coverage of COVID-19 Vaccines

"The regulations implement the CARES Act requirement that most group health plans cover, without cost-sharing, qualifying coronavirus preventive services, including immunizations, that receive specified recommendations from the CDC  ... To address plan concerns about providers failing to post cash prices, the regulations provide further posting instructions and details about how the requirement will be enforced. The agencies seek comments on related issues[.]" Icon to read more

Thomson Reuters / EBIA

Future of Health Benefits in the Workplace: Employers’ Perspectives During the COVID-19 Crisis

"Interviewees expressed optimism about the future of telemedicine.... Instead of using the COVID-19 pandemic as an opportunity to rework their benefits programs, most firms are retrenching their current benefits offerings and taking a wait-and-see approach.... [T]here was little appetite for severing the link between employment and health benefits." Icon to read more

Employee Benefit Research Institute [EBRI]

Judge to UnitedHealth: Redo 67K Claims Denied on ‘Overly Restrictive Guidelines’

"A federal judge has ordered UnitedHealth Group to reprocess tens of thousands of claims from behavioral health patients to remedy its past usage of overly restrictive coverage guidelines -- a 'fundamentally flawed' approach, the judge ruled last year, that was 'tainted' by the health insurer's financial interests.... Attorneys say that more than 50,000 patients are in the class of plaintiffs whose claims for residential or outpatient treatment were denied as [United Behavior Health (UBH)] used the guidelines." [Wit v. United Behavioral Health, Nos. 14-2346, 14-5337 (N.D. Cal. Nov. 3, 2020)] Icon to read more

Colorado Voters Approve Statewide Paid Family and Medical Leave

"To pay for the program, a premium of 0.9% will be assessed on each employee's wages (up to a cap), equally divided between the employee and the employer (each to pay 0.45% of the employee's wages). After December 31, 2024, the premium may be increased to 1.2% of employees' wages." Icon to read more

Fox Rothschild LLP

California Employers Cannot Forget Local Supplemental Paid Sick Leave Yet

"AB 1867 provides that its leave provisions will sunset on the later of December 31, 2020, or expiration of any federal extension of the Emergency Paid Sick Leave Act established by the [FFCRA]. However, several local ordinances differ, including the City of Los Angeles ordinance (2 weeks after the expiration of the COVID-19 local emergency period) and the San Francisco ordinance (currently December 12, 2020, unless extended by the Board of Supervisors). Other ordinances, including the City of Oakland, City of San Diego, and County of Los Angeles contain language which allow for extensions beyond December 31, 2020[.]" Icon to read more

Jackson Lewis P.C.

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View COVID-19 News and Resources, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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