"The regulations also require group health plan sponsors with Part D eligible individuals to submit a similar notice to [CMS] ... The filing deadline is 60 days following the first day of the plan year. If you operate a calendar year plan, the deadline is the end of February."  MORE >>

"This post addresses the narrow question of the reporting of general agent commissions under the new rules and in light of Field Assistance Bulletin 2021-03. The question is of practical interest, and it also sheds light on the [DOL's] initial approach to the interpretation of the statute."  MORE >>

"The same guidance separately addresses the coverage of follow-up colonoscopies for those age 45 to 49 without cost sharing and clarifies how insurers and plans should be covering the full scope of contraceptives under the [ACA]."  MORE >>

"The guidance is effective for tests purchased on or after January 15, 2022, and provides, among other things, that [1] over-the-counter tests generally must be covered without cost to the participant, [2] only diagnostic tests are required to be covered without cost, not employer-mandated tests or other tests for surveillance purposes, and [3] a plan or insurer can apply limits on the number of covered tests per month, with a safe harbor limit of eight tests per eligible individual per month."  MORE >>

"[Plan] sponsors will want to contact their pharmacy benefit managers or other networks in short order to determine whether they have a direct coverage solution that will satisfy the safe harbor requirements and allow the plan to impose a dollar limitation on out-of-network costs."  MORE >>

"Although plans may not apply medical management to the purchase of over-the-counter test kits, they may implement reasonable steps to prevent fraud or abuse.... Plan sponsors are allowed to amend their plans to address the new guidance without satisfying notice requirements for modifications."  MORE >>

"Plans may require attestation that test is not for employment purposes ... [although] it would be very difficult for a plan to determine whether an employee is in violation of the attestation ... [and] the plan would be prohibited from sharing the data with the employer.... Individualized clinical assessment still necessary for other forms of testing ... [although] most doctors can plausibly order a test on the basis of individuals being in a high-transmission area."  MORE >>

"Until a plan establishes a direct coverage program, the plan must reimburse participants' actual cost to purchase the OTC Tests. Given the variability in the price of OTC Tests (including those sold on secondary markets), employers may see a significant increase in costs to the plan."  MORE >>

"[If] a health plan intends to limit which OTC COVID-19 tests qualify for coverage, they will need to carefully evaluate and identify which tests (including new tests entering the market) meet these requirements and provide appropriate guidance to participants."  MORE >>

"A group health plan may limit its reimbursement of at-home tests to the lesser of $12 or the actual cost of the test, if [certain] requirements are met ... If a group health plan satisfies these requirements, it may also impose cost-sharing on at-home tests that are purchased from non-preferred pharmacies and retailers."  MORE >>

"The most significant issue in the 2023 draft letter is its proposed substantive standards for network adequacy.... HHS also details its expectations for collecting information from insurers about whether in-network providers are offering telehealth services or not.... HHS proposes a similar approach for appointment wait times."  MORE >>

"Premium contributions and deductibles in employer health plans accounted for 11.6 percent of median household income in 2020, up from 9.1 percent a decade earlier.... Middle-income workers in Mississippi and New Mexico faced the highest potential costs relative to income, 19 percent and 18 percent, respectively. The total cost of premiums plus potential spending on deductibles ranged from a low of $6,528 in Hawaii to a high of more than $9,000 in Florida, Kansas, Missouri, South Dakota, and Texas."  MORE >>

"Prudential informed the executor in December 2014 that the benefits had already been paid. When the executor received the Form 712 form, it was confirmation that the benefits would not be paid to the children and constituted a clear and unequivocal repudiation of benefits. The one-year contractual limitations period began to run from this date." [D.S.S. v. Prudential Insurance Company of America, No. 21-5315 (6th Cir. Jan. 10, 2022)]  MORE >>

"Victims of flooding and mudslides beginning November 13, 2021 now have until March 15, 2022, to file various individual and business tax returns and make tax payments ... Individuals and households affected by the flooding and mudslides that reside or have a business in Clallam, Skagit, and Whatcom counties and the Lummi Nation, Nooksack Indian Tribe, and Quileute Tribe qualify for tax relief."  MORE >>

234 pages. "Calendar year 2021 was surely the most challenging year taxpayers and tax professionals have ever experienced -- long processing and refund delays, difficulty reaching the IRS by phone, correspondence that went unprocessed for many months, collection notices issued while taxpayer correspondence was awaiting processing, limited or no information on the Where's My Refund? tool for delayed returns, and -- for full disclosure -- difficulty obtaining timely assistance from TAS.... One irony of the past year is that, despite its challenges, the IRS performed well under the circumstances." [Also available: 2022 NTA Purple Book, Compilation of Legislative Recommendations to Strengthen Taxpayer Rights and Improve Tax Administration.]  MORE >>

"While [Professional Employer Organizations (PEOs)] respond to long-standing challenges faced by smaller employers and have the potential to increase access to workplace benefits, this Article argues that they also introduce new and significant governance concerns that are not adequately addressed by the existing regulatory framework.... [T]his Article recommends strengthening and uniformly applying registration, disclosure and oversight requirements for all non-employer intermediaries, including PEOs."  MORE >>