71 pages. "Covers the ACA employer mandate basics for ALEs to avoid potential penalties. Who qualifies as a full-time employee under the mandate and why it matters. Overview of the ACA reporting requirements for employers"  MORE >>

"Once a 408(b)(2) disclosure is received, it is important that fiduciaries review both the services outlined and the fees and commissions disclosed, to make a good faith determination about whether those fees and commissions are reasonable based on services provided.... [P]lan sponsors should confirm receipt of a fee disclosure from each covered service provider."  MORE >>

"For members who made contributions in the gap months when they should not have ... but are otherwise HSA-eligible on Dec. 1, there's a quirky rule that arguably comes to the rescue.... This rule arguably, at least as a practical matter, solves the 'gap problem' for those HDHP enrollees under a non-calendar year plan who can take advantage of it."  MORE >>

"New requirements for maintaining an interactive tool for providing health plan participants with provider-specific information about the amount they will need to pay for services (and other useful information) apply, beginning in 2023. Health plan sponsors should be on the lookout for new guidance and enforcement efforts, including the issuance of forms for them to attest to their compliance with the anti-gag rules."  MORE >>

68 pages. "A full summary of the COBRA basics from qualifying events, elections and payment, to coverage options. Deep dive on persistent issues such as COBRA subsidies, M&A, Medicare, and domestic partners. A practical insight into the best practice approaches and strategies for employers who largely delegate day-to-day operations to a COBRA TPA."  MORE >>

"The Bulletin recognizes a distinction between user-authenticated and unauthenticated webpages. User-authenticated pages require a user to log in before access to the regulated entity's page. According to the Bulletin, information collected on a user-authenticated webpage will be presumed to be PHI and subject to HIPAA."  MORE >>

"Organizations must conduct a fact-based analysis to determine whether health data collection and tracking technology deployed on their websites and mobile apps complies with the federal Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws and guidance."  MORE >>

"The Ninth Circuit Court of Appeals ... has determined that an ERISA-covered group health plan has the right to recoup payments made to a participant to cover medical benefits when she subsequently recovers the amounts from a third party. In deciding the matter, the Ninth Circuit held that the plan's 'self-help' remedy of recoupment did not violate or undermine ERISA." [Mull v. Motion Picture Industry Health Plan, No. 20-56315 (9th Cir. Jul. 25, 2022)]  MORE >>

"[T]he court's decision was based primarily on Unum's failure to focus on the disabling symptoms the plaintiff actually experienced, contrary to the policy's 'plain language.' Instead, Unum concluded that because the plaintiff's symptoms were atypical, they were not real. In so doing, the court concluded that Unum inappropriately deviated from the policy." [Proctor v. Unum Life Insurance Co. of America, No. 20-2472 (D. Minn. Sep. 29, 2022)]  MORE >>

"Group long-term disability benefit calculations can be more complex than individual disability benefit determinations.... Determining pre-disability income can be challenging because different policies utilize different formulas and measurements.... Cost-of-living increases in group long-term disability insurance are extremely rare nowadays; and group long-term disability coverage is subject to a host of offsets. "  MORE >>

47 pages. The guide is organized by plan type. "This year's guide features new regulations pertaining to air ambulance claims reporting, gag-clause attestations and an annual statement of compliance for plans that receive special financial assistance. Some of the deadlines noted in this guide may be extended due to the COVID-19 public health emergency."  MORE >>