Under the Employee Retirement Income Security Act of 1974 (ERISA), employee welfare benefit plans are subject to certain fiduciary rules, claims procedures and plan document requirements (including providing participants with a Summary Plan Description (SPD) and possibly also filing a Form 5500 annual return). The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) generally requires [...]
Over the past several months, there has been a spate of federal legislation and corresponding guidance related to COVID-19 that requires group health plan changes and allows voluntary changes aimed at removing barriers to care and minimizing the impact of the pandemic on employees’ pocketbooks. Mandatory changes include first-dollar coverage for COVID-19 diagnostic testing and [...]
Last week, the U.S. Department of Health and Human Services released the HHS Secretary’s Report on Addressing Surprise Billing which was required under President Trump’s Executive Order 13877. The Report calls for steps, including Congressional action, to combat surprise billing and promote pricing transparency, with the following principles in mind: Patients receiving emergency care should [...]
A constellation of recent developments related to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) should prompt employers to take action to ensure there are no errors or omissions in their communications and procedures that could invite legal or regulatory penalties. COBRA is the government mandate that allows employees and their “qualified beneficiaries” to [...]
coronavirus The Department of Labor, the Department of Health and Human Services and the Department of the Treasury (the Departments) have jointly issued a new set of Frequently Asked Questions (FAQ #43) to provide additional guidance regarding the implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and [...]
Earlier this week, the Trump Administration issued a 172-page Notice of Proposed Rulemaking (NPRM) that, if finalized, would allow for the importation of certain prescription drugs and biologic products from Canada. The Administration also announced the availability of draft guidance on how manufacturers can import certain FDA-approved products that were originally intended for sale in [...]
The U.S. Senate voted last week to approve President Trump’s nomination of Eugene Scalia to the role of Secretary of Labor. If the name sounds familiar, it’s because Eugene Scalia is the son of the late Supreme Court Justice Antonin Scalia. He was also Department of Labor (DOL) Solicitor General during the George W. Bush [...]
Eric and Denise Kinsinger sued Eric’s employer, SmartCore, LLC, because its health plan failed to cover Denise’s hysterectomy despite preauthorization from the plan’s TPA. In addition to suing the corporation, the Kinsingers named plan administrators Steven Matthew Good and William H. Winn, Jr., personally as defendants for their roles as fiduciaries. On August 26, 2019, [...]
On July 17, 2019, the IRS, in conjunction with the Treasury Department, issued Notice 2019-45. This notice expands the list of preventive care items and services permitted to be covered by a high deductible health plan (HDHP) before the deductible is satisfied, without jeopardizing the covered person’s ability to make or receive contributions to a [...]
On June 13, 2019, the Departments of Health and Human Services, Labor and Treasury released final regulations that will expand the use of Health Reimbursement Arrangements (HRAs), starting in January of 2020. The regulations will allow the integration of HRAs with individual health insurance coverage and also allow certain HRAs to be recognized as “excepted [...]