Health and Welfare Plans: Recent Topics in Year-End Compliance
As we bid farewell to 2024 and look ahead to the new year, we reflect on the many evolving compliance obligations that health and welfare plan sponsors tackle each year. Although this list is by no means exhaustive, it highlights four items and associated deadlines that have recently emerged on the health and welfare scene.
Affordable Care Act Reporting Changes: Good News for Plan Sponsors
In a win for plan sponsors, the recently enacted Employer Reporting Improvement Act and the Paperwork Burden Reduction Act (the Acts), among other things, introduce several significant changes to the reporting and enforcement rules of the Affordable Care Act (ACA).
The Current Rules
Forms 1095-B and 1095-C: Under the ACA, plan sponsors, specifically Applicable Large
Health Plan Coverage Mandate for Over-the-Counter Contraception Proposed by Biden Administration
With just a couple of weeks before election day, the Biden Administration announced on October 21, 2024, that it was issuing proposed rules designed, in part, to require health plans to cover over-the-counter contraception without cost sharing, including birth control, the morning-after pill, and the male condom. The proposed rules are the latest in a
Health Plan Hygiene Part 1: A Spoonful of Sugar Helps the Medicine Go Down
During the next several weeks, we will publish a series of articles that dive deeply into “health plan hygiene” relating to health and welfare benefit plan fiduciary issues and how employers can protect themselves in this quickly evolving area.
Section 408(b)(2) of the Employee Retirement Income Security Act of 1974 (ERISA) requires certain disclosures regarding
“Final” Section 1557 Nondiscrimination Regulations – Round 3: Impact on Employer Health Plans
Background
Section 1557 is the non-discrimination provision of the Affordable Care Act (ACA). Section 1557, which has been in effect since 2010, is intended to prevent discrimination in certain health programs or activities that receive federal financial assistance. In May of 2024, the Department of Health and Human Services’ (HHS) Office of Civil Rights
Health Plan Sponsors in the Crosshairs?
America’s cultural wars may be opening up a new front, and group health plans may be caught in the fray. Since the US Supreme Court decision in Dobbs ended almost fifty years of constitutional protection for abortion rights and gave states the authority to regulate abortion, lawmakers (or citizens) have either enacted new prohibitions on
Self-Insured Health Plans: Adjusted PCORI Fee Announced for 2024
As discussed in a previous blog, the Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit research organization that funds comparative clinical research, among other things. PCORI is funded through annual fees — provided for in the Affordable Care Act — paid by insurers of fully insured health plans and sponsors of self-insured health
ACA Affordability Updated: Rev. Proc. 2023-29
Under the Affordable Care Act (ACA), applicable large employers (ALEs) — i.e., those with, on average, fifty (50) or more full-time or full-time-equivalent employees in the preceding year — must offer in the following year affordable, minimum value group health plan coverage to their full-time employees and those employees’ dependents or risk imposition of
Open Issue: Employer-Sponsored Health Plans and Coverage of Gender-Affirming Care
Transgender protections and rights in the workplace are currently the subject of much confusion. This issue extends to employer-sponsored health plans. Whether an employer-sponsored health plan must cover gender-affirming care is complicated and depends, in part, on whether the employer’s health plan is fully-insured or self-insured.
Fully-Insured Plans
Fully-insured employer-sponsored health plans are subject to