[Guidance Overview]

Proposed Regs Shed Light on Upcoming Health Plan Disclosure Requirements

"[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."  MORE >>

Fisher Phillips

[Guidance Overview]

ACA Reporting for Employers with a Self-Insured Plan

"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."  MORE >>

Newfront

[Guidance Overview]

Don't Forget Medicare Prescription Drug Reporting to CMS

"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."  MORE >>

Fisher Phillips

CMS Barred from Enforcing Mandatory COVID-19 Vaccine Rule for Healthcare Workers in 10 States

"A federal court has granted 10 states' request for a preliminary injunction precluding [CMS] from enforcing its COVID-19 vaccine mandate for healthcare workers in Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota, and Wyoming.... The court found that the plaintiff-states were likely to succeed in establishing that CMS' IFR is arbitrary or capricious under the Administrative Procedures Act." [Missouri v. Biden, No. 21-1329 (E.D. Mo. Nov. 29, 2021)]  MORE >>

Jackson Lewis P.C.

Nevada Jury Finds Against United Healthcare's Efforts to Underpay for Emergency Medical Services and Generate Profit for Itself

"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)]  MORE >>

Zuckerman Spaeder LLP

One in Four Workers Experiencing Significant Medical Expenses Report Major Mental Health Impacts

"The need for employers to reassess overall health plan affordability is further underscored by the ... finding that the less respondents had saved, the more likely they are to report that major medical expenses have impacted their mental health. In fact, only when respondents reported more than $10,000 in savings do they also report low levels of mental health and family well-being issues ... [A] full 20% of respondents who experienced major medical expenses said they skipped or delayed needed mental healthcare/counseling due to cost concerns. "  MORE >>

Centivo

How Often Do Health Plans Use 'Provider Requirements'?

"Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, some health plans impose a utilization management tool known as 'prescriber requirements' where only certain types of physicians may prescribe a drug. While this may be useful for some complex therapies, it may also limit access and increase provider administrative burden."  MORE >>

Healthcare Economist

Risky Biases to Avoid in Benefits Planning, and How to Counter Them

"[It's] easy to believe that sameness equals safety.... Listening to employees can inspire transformative programs.... [U]sing the same playbook may not be enough to keep your top talent.... [L]eaders need to set their own opinions aside and dive into what employees are experiencing."  MORE >>

Tango Health

With Federal COVID Sick Leave Gone, Workers Feel Pressure to Show Up at Work

"[F]ederal laws that offered covid-related paid sick leave to workers have expired. Colorado, Los Angeles and Pittsburgh are among a small number of places that have put in place their own covid protections, but many sick workers across the country must wrestle with difficult financial and ethical questions when deciding whether to stay home."  MORE >>

Kaiser Health News

In Remembrance of Theodore R. Groom

"On November 26, 2021, Groom Law Group lost its founder, friend and leader, Theodore R. Groom. In 1975, Ted co-founded Groom and Nordberg, which evolved to become Groom Law Group, Chartered, the nation's foremost benefits, retirement and healthcare law firm.... In the 1970s, Ted was instrumental in the development of [ERISA], particularly its landmark fiduciary responsibility provisions.... We remember Ted as a mentor, teacher, trusted colleague and friend, as a man who loved the law, and, most of all, as a man who loved and supported his family, friends and colleagues."  MORE >>

Groom Law Group

Who Has the Burden of Proof When an ERISA Claim Is Denied?

"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?"  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Satisfying Electronic Disclosure Requirements for SPDs to New Hires

"[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."  MORE >>

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DATAIR Announces That Sam Venouziou Has Met All the Requirements to Be an Enrolled Actuary

DATAIR Employee Benefit Systems, Inc.

Industry Leaders Launch Operational Fiduciary Services Firm

Group Plan Systems [GPS]

Year-End Content at myStockOptions.com Helps Employees with Stock Compensation Planning Ahead of Uncertain Potential Tax Changes

myStockOptions.com

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Ethics for Employee Benefit Practitioners (2021)

December 2, 2021 WEBCAST

ASC

Implications of the No Surprises Act

December 28, 2021 WEBCAST

Law Practice CLE

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Proposed Regs Permanently Extend Due Date to Furnish Forms 1095-B and 1095-C, Clarify Other Lingering Issues

Accord

IRS Provides ACA Reporting Relief

Jackson Lewis P.C.

Telemedicine Will Remain Even as the COVID-19 Crisis Recedes

Foley & Lardner LLP