On September 13, 2021, proposed regulations were issued that would implement certain provisions of the No Surprises Act, requiring group health plans to submit information related to air ambulance claims to the Department of Health and Human Services (“HHS”) for 2022 and 2023. Plans Subject to the Requirement Major medical health plans (insured and self-insured, […]
As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carrier collects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and […]
Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Also, following the plan’s annual renewal, the employer must notify the […]
On September 9, 2021, President Biden announced a “Path out of the Pandemic,” indicating that he will use regulatory powers and other actions to increase the number of vaccinated Americans. In short, his plan provides the following: Employers with at least 100 employees must require their employees to be vaccinated or require unvaccinated employees to […]
The IRS recently announced in Revenue Procedure 2021-36 that the Affordable Care Act (“ACA”) affordability indexed amount under the Employer Shared Responsibility Payment (“ESRP”) requirements will be 9.61% for plan years that begin in 2022. This is a decrease from the 2021 percentage amount (9.83%). Background Rev. Proc. 2021-36 establishes the indexed “required contribution percentage” […]
On August 20, 2021, the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively called “the Departments”) jointly issued an FAQ which implements parts of the Consolidated Appropriations Act (“CAA”) that was passed at the end of 2020 and the Transparency in Coverage (“TiC”) final regulations that were issued in November […]
The Departments of Labor (“DOL”), Health and Human Services (“HHS”), and the Treasury (collectively, “the Departments”) have jointly released a new FAQ regarding preventive care services and coverage for pre-exposure prophylaxis (“PrEP”). As background, non-grandfathered group health plans must cover certain preventive care items and services without cost-sharing. On June 11, 2019, the USPSTF released […]
On July 23, 2021, the IRS issued proposed rules that would significantly expand the number of employers required to electronically file information returns with the IRS. Among others things, this change would impact filing of Forms 1094-C/1095-C. If finalized “as is,” this change would take effect for filings due in 2022 (e.g., calendar year 2021 […]
On July 19, 2021, the Secretary of Health and Human Services (“HHS”), announced that the administration will renew the COVID-19 pandemic Public Health Emergency, scheduled to expire on July 20, 2021. This will once again extend the period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in […]
On July 26, 2021, the IRS released Notice 2021-46 providing additional guidance on the 2021 COBRA premium assistance (or “COBRA subsidy”). The 2021 COBRA subsidy was included as part of the American Rescue Plan Act (“ARP”). This IRS guidance is coming relatively late, with only two months remaining in the COBRA subsidy period. Background Assistance […]