Search the News Archive

Tenth Circuit Provides a Framework for Consideration of MHPAEA Claims

"According to the Court, a plaintiff must: [1] Provide a valid determination that the health plan is subject to MHPAEA; [2] State what the underlying Quantitative/Nonquantitative Treatment Limitation (QTL/NQTL) being used by the plan to deny or limit benefits; [3] Name the [medical and surgical (M/S)] benefit used to compare to the MH/SUD benefit in question; and [4] Explain how the health plan applies the QTL/NQTL differently to the M/S benefit than to the MH/SUD benefit. Significantly, the Court did not apply any sort of reasoning requiring that outcomes of MHSUD claims be consistent with M/S claims." [E.W. v. Health Net Life Ins. Co., No. 21-4110 (10th Cir. Nov. 21, 2023)]

Latest HHS Updates to Prohibition on Discrimination in Health Care: Employer Action Items

"[1] Speak with insurers and third-party administrators to understand whether, and to what extent, the coverage provided is offered in compliance with the non-discrimination requirements, as detailed in the 2024 HHS rulemaking.... [2] Confirm that, absent a religious freedom and conscious exemption, the plan does not enforce a blanket restriction or any types of nominal restrictions prohibiting plan-level coverage of healthcare benefits related to the treatment of gender dysphoria ... [3] Understand the Section 1557 complaint process, including submission, evaluation, retaliation, and disposition."

Cybersecurity Best Practices for Employers in the Wake of the Change Healthcare Attack

"As a group health plan sponsor, an employer's responsive obligations arising in the context of certain cybercrime events depends largely upon the underlying funding status of the employer's core employee benefit plans ... Additional privacy and security related obligations for the employer may be detailed in various state-level statutory mandates or even within certain international laws or other global-scope regulations.... Several notifications may be required as a consequence of a data breach.... Communication with employees is important[.]"

New California Law Requires Insurers to Cover COVID-19 Testing and Vaccinations Without Cost Sharing

"The law applies to plans that cover medical, surgical and hospital benefits regulated by the either the California Department of Managed Health Care or Department of Insurance, which includes most fully insured health plans and HMOs (excluding specialized health care plans) situated in the State."

Approaching Fast: July 31 Deadline for PCORI Fee Payment

"The PCORI Fee is considered an excise tax that must be reported on IRS Form 720 for the second quarter reporting period. It is due by July 31 of the year following the last day of the plan year being reported on.... The Fee is not assessed against most healthcare flexible spending accounts, as well as employee assistance, disease management, and wellness programs not providing significant medical care benefits, and plans covering primarily employees working outside the United States. A plan sponsor is also able to treat multiple self-insured plans with the same plan year as a single plan for reporting and payment purposes."

Can a Spousal Relocation from Outside the U.S. Qualify as a Life Event for an Enrollment Change?

"Yes, if the change in the spouse's place of residence is deemed to be an IRS qualifying life event ... [However,] the written plan document may not adopt the full range of IRS qualifying life events related to enrollment eligibility, or the document may specifically exclude 'change in residence' from its enumerated qualifying life events; thus, curtailing the plan's observance of certain IRS identified QLEs."

Are Annual Fees Charged by Concierge Doctors Considered an Eligible Medical Expense for Reimbursement from an HSA or FSA?

"Depending on how the underlying program is structured, some services might be reimbursable if presented as a requirement implicating the plan's cost sharing features, such as member copays. In such instances, part or all of the fee might actually satisfy IRC Section 213(d), thereby qualifying for reimbursement on the basis of a qualifying and eligible individual healthcare related expense."

ACA Non-English Language Requirements Update

"[CMS] has recently published its listing of U.S. counties in which certain notices must be provided to individuals in a non-English language ... [The ACA] mandates that relevant notices must be provided in a culturally and linguistically appropriate manner to those residing in counties that have a population with at least 10 percent of their population illiterate only in the same non-English language. The listing ... is applicable for plan years beginning on or after January 1, 2025." [Also available: Agency FAQs, Part 63]

Price Comparison Transparency Tool Expanded for 2024

"Plan sponsors of fully insured health plans ... [should] obtain written confirmation that the health insurance issuer has agreed to provide the price comparison tool on their website ... Plan sponsors of self-insured ... health plans ... [should] contract with the TPA to confirm that they are providing this tool and that this responsibility is addressed in a written agreement.... Unlike fully insured plans, the legal responsibility for this tool stays with a self-insured plan even if its service provider agrees to provide the price comparison tool on [the plan sponsor's] behalf."

HHS Rescinds Enforcement Safe Harbor for Prescription Drug Machine-Readable File Requirement

"Plan sponsors that have relied on the Departments' delay with respect to the prescription drug machine-readable file requirements ... and the associated delayed enforcement ... should work with their carrier or TPA to confirm compliance (in writing).... To be clear, this is a totally separate requirement from the RxDC report required under the Consolidated Appropriations Act, 2021."