News Flash: There’s no actual statutory mandate that employers offer group health coverage at all, much less coverage for specific conditions. However, federal law requires health plans that provide mental health and substance use disorder coverage to ensure that the financial requirements (like coinsurance) and treatment limitations (like visit limits and provider access) applicable to
Implications of COVID-19 on Your Health and Welfare Benefit Plans
Employers are grappling with employee benefit issues in response to the 2019 Novel Coronavirus (“COVID-19”). Efforts are being made to pave the way for widespread testing by eliminating cost barriers such as deductibles, copayments, coinsurance, or High Deductible Health Plan restrictions to ensure employees and their families are proactively being diagnosed once symptoms present, to…
COBRA Notice Litigation Resulting in Big Dollar Claims
Can you imagine something as simple as a COBRA Notice missing a few technical requirements resulting in an employer needing to pay a 6 or 7-digit damages award? That is happening in Florida. Employers in and out of Florida should pay attention to this news, as what doesn’t start in California often starts in Florida.…
Beginning in 2020, Employers May Reimburse Health Insurance Premiums as an Alternative to a Traditional Group Health Plan (Subject to Several Requirements)
Many employers have contacted us over the years asking whether they may offer an “employer–payment plan” rather than offer a traditional group health insurance plan. An employer-payment plan is a type of account-based plan that provides an employee reimbursement for all or a portion of the premium expense for individual health insurance coverage or other…
EIGHTH CIRCUIT RULES AGAINST THIRD PARTY ADMINISTRATOR IN CROSS-PLAN OFFSETTING IN GROUP HEALTH PLANS
On January 15, 2019, the federal Eighth Circuit Court of Appeals issued its decision in Peterson v. UnitedHealth Group, Inc., 913 F.3d, 769 (8th Cir. 2019), in which the Court upheld the federal district court’s holding that UnitedHealth Group, Inc. (“United”) was not authorized to reduce (or “offset”) payments to medical providers under ERISA…
EEOC Pregnancy Discrimination Enforcement Guidance Implicates Contraception Coverage Concerns
On July 14, 2014, the EEOC issued new Enforcement Guidance on Pregnancy Discrimination and Related Issues. The immediately-effective Guidance sets forth the EEOC’s policies with regard to its enforcement of pregnancy-based employment discrimination prohibitions under Title VII — as clarified by the Pregnancy Discrimination Act of 1978 — and other federal laws.
With regard …
ACA Employer Mandate Delayed One Year
Employer shared responsibility and reporting requirements delayed one year.
Continue Reading ACA Employer Mandate Delayed One Year
Proposed Regulations on Certificates of Creditable Coverage
Proposed regulations published on March 21, 2013 addressed not only the 90-day waiting period rule discussed below but also the eventual elimination of notices of creditable coverage under HIPAA’s preexisting condition exclusions rules.
The 2010 health care reform law prohibits group health plans from imposing preexisting condition exclusions, effective for plan years beginning on or…
Health Care Reform Resource Center
We are pleased to announce the launch of Jackson Lewis’ Health Care Reform Resource Center. Our Resource Center provides one convenient place for you to obtain key health care reform-related law, agency guidance, Jackson Lewis articles and related information. We hope you find this resource helpful.
The DOL Has Started Auditing Group Health Plans for PPACA, as well as GINA and Wellness Program Compliance
The DOL has begun to audit PPACA compliance, is your plan ready?
Continue Reading The DOL Has Started Auditing Group Health Plans for PPACA, as well as GINA and Wellness Program Compliance