Aug. 6, 2024. "Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage. Eligibility for certain types of minimum essential coverage can affect a taxpayer's eligibility for the premium tax credit." [Also available: 2024 Form 1094-B, Transmittal of Health Coverage Information Returns; and 2024 Form 1095-B, Health Coverage]  MORE >>

"The final rules mark another push by the Departments to implement and enforce mental health parity laws, and impose new requirements on group health plan sponsors to review and analyze any nonquantitative treatment limitations their plans impose on mental health and substance use disorder (MH/SUD) benefits. The new rules are generally effective for plan years beginning on or after January 1, 2025, but certain provisions that require significant plan sponsor effort will not go into effect until plan years beginning on or after January 1, 2026."  MORE >>

"Most importantly for employers and dental plan members, AB 1048 prohibits fully insured large group dental plans from imposing a dental waiting period or preexisting condition provision for any plan year beginning on or after January 1, 2025."  MORE >>

"[AB 3275] requires health plans and insurers to pay claims within 30 calendar days.... [AB 3221 allows] the Department of Managed Health Care (DMHC) to request health plan records in a searchable digital format, take disciplinary action when health care service plans do not either fully or timely respond to records requests, and seek relief on consumers' behalf through administrative hearings rather than court proceedings."  MORE >>

"There is a new series of putative class action lawsuits in which the plaintiffs allege that employers that sponsor self-funded health plans with health plan premium surcharges related to tobacco use or vaccination status violate the HIPAA non-discrimination requirement notwithstanding the exception for 'outcome-based wellness programs' that provides a basis for plans to apply such surcharges.... This alert summarizes the HIPAA non-discrimination requirement, the wellness program rules, key allegations in the lawsuits, and the status of the lawsuits."  MORE >>

"One of the secrets to open enrollment success is conducting a comprehensive assessment of your OE initiatives so you can make ongoing improvements to your program. This involves evaluating the hard data at your disposal as well as the more qualitative and experience-based feedback your team (and employee base) can provide. Here's a quick round-up of open enrollment metrics you can track this season, and every year moving forward."  MORE >>

"[T]he ubiquity of two-income families and the need for intergenerational care ... have led to an increase in the prevalence of childcare subsidies, caregiver support and flexible time off.... Mental health coverage is also on the upswing, as younger people express a heightened awareness of the importance of psychological well-being.... Good intentions are one thing. Selecting the right providers is another. That's particularly the case with mental health coverage."  MORE >>

"A lack of employee health care literacy reduces utilization, negatively impacts population health and adds to rising costs. Employers can make benefits more approachable by being more purposeful in communications to an increasingly diverse workforce, personalizing benefits education, and streamlining offerings to make programs feel less overwhelming."  MORE >>

"Groom mourns the passing of our dear friend and colleague, Ian Lanoff, on September 29, 2024.  Ian had a long and prolific career in both public service and private practice. As Administrator for Pension and Welfare Benefit Programs at the [DOL] during the Carter Administration, Ian played an important role in the implementation of ERISA, and his work laid the foundation for decades of jurisprudence. Ian also represented some of the nation's largest public and private benefit programs, helping to protect the benefits for millions of workers and retirees."  MORE >>

"DOL is too focused on marginally relevant ESG investments, and the investment advice fiduciary rule for IRA rollovers when they lack authority under ERISA Title II to regulate IRAs. By not focusing on the key issues where they actually have legislative authority, they are allowing plaintiff lawyers to regulate the key fiduciary duties for retirement and health plans in America.... Recognizing that the government is not going to help us restore fairness, plan sponsors need to work together to combat the litigation abuse. "  MORE >>