[Guidance Overview]

The DOL's Laser Focus on Mental Health Parity: Practical Considerations for Plan Sponsors

"[D]esign and implement a comprehensive MHPAEA compliance program, including the designation of key personnel within the organization to be in charge of parity compliance.... Determine which vendors to contact.... Develop a list of specific questions.... Document all communications.... Analyze the data provided by the insurer/TPA and other vendors.... Complete the section of the DOL's MHPAEA Self-Compliance Tool that relates to NQTLs.... If needed, identify areas of concern and implement appropriate corrective action."  MORE >>

Maynard Cooper & Gale

Cigna Sued Over Coverage Limitations on Mental Health Treatment

"The plaintiff appealed these denials internally with Cigna, indicating that Cigna was holding the mental health treatment to a higher standard than medical treatment which is not permissible under the MHPAEA, as well as denying the treatment simply based on the name of the treatment and not on its medical necessity. Cigna denied and the plaintiff now seeks court review." [S.S. v. Cigna, No. 21-544 (D. Utah complaint filed Sep. 16, 2021)]  MORE >>

Law|Street

Ways and Means Committee Proposes National Paid Family and Medical Leave

"Beginning in July 2023, the bill provides up to 12 weeks of federal benefits to replace lost wages due to time off for medical leave or caregiving for an ill family member.... The program covers all workers including full-time and part-time workers, independent contractors, and public and private sector workers. It also applies without regard to employer size."  MORE >>

Ballard Spahr

Are Patients Able to Shop for Lower Priced Providers?

"One key concern if you pay patients would be whether individuals use health care services just to get paid to do so. Thus, while the scheme appears to have had its intended impact of lowering the prices employers paid, it is unclear the extent to which such a scheme could be rolled out more broadly."  MORE >>

Healthcare Economist

How Much Can the Health Plan Surcharge on Unvaccinated Employees Be?

"The allowable surcharge amount will vary for every employer depending on the cost of health insurance, any other surcharges or incentives under an existing wellness program, the level at which health insurance is currently subsidized, and the rate at which employees are compensated."  MORE >>

Jackson Lewis P.C.

Are You Ready for a Medical Stop-Loss Captive?

"At a time when tough-to-place risks are flocking to the captive market, employers with self-funded benefit programs could do well to consider the option.... [A] captive could provide some insulation from the unwieldy, potentially long-term COVID-19 claims that could be extremely difficult for a smaller organization to absorb."  MORE >>

NFP; free registration required to view full report

[Opinion]

Telehealth Bill Would Require ERISA Plans to Cover Virtual Care

"While select private health plans have taken voluntary steps to increase telehealth access during the pandemic and beyond, the movement has been insufficient. That's especially true for patients whose health care coverage is from health plans [covered by ERISA] ... And unless Congress acts to make permanent the temporary rules that allowed telehealth to happen on such a large scale, the flexibilities that Medicare beneficiaries have relied on will not be able to continue once the public health emergency ends either."  MORE >>

American Medical Association [AMA]

House Budget Reconciliation Text Includes Significant Health, Paid Leave, and Retirement Provisions

"The Budget Legislation creates a new federal paid family and medical leave program ... [T]he Legislation requires employers that have more than five employees to provide access to a retirement plan that automatically enrolls employees by 2023. Governments and churches are exempt from the mandate."  MORE >>

Groom Law Group

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Which Company Provides the Form 1095 in a Merger?

"Seller is a subsidary of holding company. Holding company sponsors the health plan that seller's employees participate in. Purchaser buys seller from holding company and merges seller into purchaser. My thought is that seller employees, who are merged into purchaser post-close, receive two 1095s: 1 from holding company that sponsored health plan pre-merger and 1 from purchaser? Does that sound correct?"

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The Wagner Law Group Grows to 40 Lawyers with the Addition of Former DOL Attorney

Wagner Law Group P.C.

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Paid Family Leave and Medical Leave Laws

October 7, 2021 WEBCAST

Society of Actuaries

Employee Benefit Plan Audit Readiness

November 18, 2021 WEBCAST

Clear Law Institute

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Five ACA Items Employers Should Know Heading Into 2022

Accord

Comparison Chart for Reimbursement Health Accounts: FSA, HSA, and HRA (PDF)

TRI-AD

Determining Full-Time Employee Status for Purposes of the ACA Employer Shared Responsibility Provisions (PDF)

Gallagher