Jul. 11, 2023. "This [draft of] Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year.... [If] individuals in your tax family are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit." [Also available: Draft of 2023 IRS Form 1094-B, Transmittal of Health Coverage Information Returns]  MORE >>

"The FAQs make it clear that, for services within the ambit of the No Surprise Billing Rules, either the No Surprise Billing rules or the [ACA] cost-sharing limits will apply. The determination is based not on a formal designation of whether a provider is in-network or out-of-network, but on whether a plan makes its payment under a contractual arrangement with the provider. If it does, the plan participant's costs will be subject to the cost-sharing limits. If not, the No Surprise Billing rules will apply."  MORE >>

"The federal agencies responsible for policing employer compliance with the [ACA] have issued proposed regulations on fixed indemnity insurance that would effectively force employers to offer those coverages on an after-tax basis. The proposed rules also attempt to fix perceived abuses where the agencies believe the fixed indemnity coverage is pitched as comprehensive medical coverage."  MORE >>

"The Proposed Rule's new definition of 'health care provider' is modeled after the HIPAA definition of this term, but its inclusion of the new term 'health care service or supply' considerably expands the customary definitions of a health care 'service or supply' and a 'health care provider.' Through this definitional framework, the FTC asserts that developers of health and wellness apps are 'health care providers' -- akin to HIPAA covered entities -- for purposes of the Proposed Rule."  MORE >>

"Minnesota is the most recent state to enact a mandatory paid family and medical leave program, joining 11 other states and Washington D.C. in implementing paid leave laws. With a paid leave proposal being passed by the state legislature and publicly endorsed by its Governor, Maine is poised to soon follow."  MORE >>

"11th U.S. Circuit Court of Appeals dismissed a former employee's Family and Medical Leave Act (FMLA) claim, even though her employer did not notify her of her rights and responsibilities under the FMLA, because no harm came to the employee as a result of the lack of notification." [Graves v. Brandstar Inc., No. 21-13469 (11th Cir. May 9, 2023)]  MORE >>

"The Court upheld the lower court's decision, noting that while the participant argued that the plan had to cover his emergency treatment under the ACA and state law, neither law requires that a plan cover all emergency services.... Moreover, both laws say that coverage is subject to a plan's exclusions. The Court concluded that '(b)ecause the plan specifically excludes coverage of treatment for complications of weight-reduction surgery, neither state law nor the ACA require that his treatment be covered.' " [Shafer v. Zimmerman Transfer, Inc., No. 22-2275 (8th Cir. Jun. 7, 2023)]  MORE >>

"With the contribution limits for health savings accounts (HSAs) poised to take a significant leap in 2024, this is a good time for all types of employers to consider adding the arrangements to their benefits packages. These often-misunderstood health care vehicles come with valuable benefits for both employers and employees."  MORE >>

"Each of the ten assertions describes the challenges and steps that can be taken to address those challenges. [The authors] focus on issues that are traditionally studied by health services researchers such as cost, access, and quality, but then examine emerging and intersectional topics: equity, income, and justice; technology, pharmaceuticals, markets, and innovation; population health; and global health."  MORE >>

"This paper will review the history of litigation prior to the passage of MHPAEA and will then discuss the impact on litigation brought about by the MHPAEA, along with greater focus by the courts on coverage for treatment of mental illness. Finally, this paper will conclude with some predictions as to the future of litigation involving coverage denials for behavioral health conditions."  MORE >>

"Despite the acceptance and prevalence of domestic partner benefits, complex legal, tax, administration and other compliance issues come with the territory. Employers need to understand and effectively communicate these issues to employees with domestic partners. This GRIST summarizes major issues involving domestic partner benefits, provides a tax-dependent flowchart and a domestic partner checklist for employers, and includes two charts summarizing applicable state laws."  MORE >>

"According to the IRS, one of the most frequent errors on Forms 5500 is leaving fields blank that should be completed.... [O]ther common mistakes include using an incorrect employer identification number (EIN) for the plan sponsor or an incorrect plan number.... Further, it is not uncommon for a Form 5500 to indicate that the plan sponsor is also the plan administrator. While in many cases this is accurate, some plans name a committee or even an individual as the plan's administrator, and the Form 5500 should be completed accordingly."  MORE >>