Compliance Corner

Announcements

Podcast Episode 122: Transparency in Coverage Updates

April 26, 2022

In this episode, Suzanne Spradley and Chase Cannon update us on employer compliance obligations under the Transparency in Coverage (TIC) rules. Suzanne begins with an overview of the TIC rules and how they are meant to address consumerism and rising health care costs. Suzanne and Chase then hone in on the actual requirements, including posting of plan information, with both in-and-out-of-network rates. Next, Suzanne dives in on the different challenges for fully and self-insured plans, and the importance of employers working closely with their carriers and TPAs. The episode closes out with a discussion on provider and TPA contracting.

Periodically, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page for the most up-to-date episode.

Subscribe on iTunesListen on Google Play Music

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May Get Wise Wednesdays – Register Now

April 26, 2022

Topic: Plan Documents Galore: Understanding the Differences and What’s Required

Plan sponsors have to deal with several compliance obligations, chief among them are the requirements to maintain and potentially distribute plan documents to participants. Join us as we discuss plan documents that are required by the different benefits-related laws and the nuances between them.

Time: May 18, 2022
2:00 to 3:00 p.m. CT (3:00 to 4:00 p.m. ET)

Register Now

This program is pending approval for 1.0 (general) recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at hrci.org.

Note: Those listening to a recorded webinar will not be eligible for credit.

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Reminder: Public Disclosure of Provider Reimbursement Rates Begins July 1, 2022

April 26, 2022

On July 1, 2022, enforcement of the machine-readable file requirement of the Transparency in Coverage (TiC) final rule begins. Under the rule, non-grandfathered group health plans and insurers must publicly post machine-readable files that disclose in-network provider negotiated rates and historical out-of-network allowed amounts and billed charges for plan years beginning on or after January 1, 2022. (Enforcement of the prescription drug rate file requirement is postponed pending regulatory review.)

The files must be in a specified format, updated monthly and posted on a public website accessible to any person free of charge. No conditions can be imposed to access the files, such as establishing a user account or password or submitting personally identifiable information.

Group health plan sponsors should be in consultation with their insurers or third-party administrators to ensure timely compliance with the July 1 deadline. For fully insured plans, the legal obligation can be contractually transferred to the insurer. For self-insured plans, the sponsor remains liable for TiC compliance even if a TPA contractually agrees to assist with the creation and implementation of the files.

For further information, please see:

Transparency in Coverage Final Rule »
FAQs on ACA and CAA, 2021 Implementation »

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Podcast Episode 121: Looking Ahead: The Impact of the 9th Circuit’s Reversal on Wit v. United Behavioral Health

April 12, 2022

In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on March 22, 2022. Next, they address the impact of this decision on future mental health claims litigation and the Department of Labor’s MHPAEA enforcement efforts. The episode closes with MHPAEA compliance reminders for employer plan sponsors.

Periodically, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page for the most up-to-date episode.

Subscribe on iTunesListen on Google Play Music

Read More

April Get Wise Wednesdays – Register Now

April 12, 2022

Topic: Making the Switch: Benefits Compliance Differences Between Fully Insured and Self-Insured Plans

Many of the benefits-related laws apply to fully insured and self-insured health and welfare plans in the same manner. However, there are differences that employer plan sponsors should be aware of when they contemplate changing between the two. Join us as we discuss some of the major compliance obligations to consider when a plan goes from fully insured to self-insured (or vice versa).

Time: April 20, 2022
2:00 to 3:00 p.m. CT (3:00 to 4:00 p.m. ET)

Register Now

This program is pending approval for 1.0 (general) recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at hrci.org.

Note: Those listening to a recorded webinar will not be eligible for credit.

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Reminder: 2021 HSA Contributions and Corrections Deadline April 18

April 12, 2022

Individuals who were HSA-eligible in 2021 have until the tax filing deadline to make or receive contributions. So, 2021 HSA contributions must generally be made by April 18, 2022. This includes employer contributions. The 2021 contribution limit is $3,600 for self-only coverage and $7,200 for any tier of coverage other than self-only. Those aged 55 and older are permitted an additional catch-up contribution of $1,000. Generally, an individual’s maximum annual contribution is limited by the number of months they were eligible for the HSA.

There is an exception to this rule. An individual that was HSA eligible on December 1 is permitted to contribute the full statutory maximum for the year. However, if eligible employees do not remain HSA eligible through December of the following year, they may experience tax consequences.

Individuals who contributed more than the allowable amount for 2021 should be refunded the excess contributions and associated interest by April 18, 2022. The excess would be subject to income tax. If the excess is not refunded from the account, it will not only be subject to income tax but also a 6% excise tax penalty. Employees who were not eligible for a contribution or contributed more than the allowable amount for 2021 should work with the HSA bank/trustee to process the excess contributions.

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Podcast Episode 121: Looking Ahead: The Impact of the 9th Circuit’s Reversal on Wit v. United Behavioral Health

March 29, 2022

In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on March 22, 2022. Next, they address the impact of this decision on future mental health claims litigation and the Department of Labor’s MHPAEA enforcement efforts. The episode closes with MHPAEA compliance reminders for employer plan sponsors.

Every other week, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page every two weeks for the most up-to-date episode.

Subscribe on iTunesListen on Google Play Music

Read More

April Get Wise Wednesdays – Register Now

March 29, 2022

Topic: Making the Switch: Benefits Compliance Differences Between Fully-Insured and Self-Insured Plans

Many of the benefits-related laws apply to fully-insured and self-insured health and welfare plans in the same manner. But there are differences that employer plan sponsors should be aware of when they contemplate changing between the two. Join us for a discussion of some of the major compliance obligations that should be considered when a plan goes from fully-insured to self-insured (or vice versa).

Time: April 20, 2022
2:00 to 3:00 p.m. CT (3:00 to 4:00 p.m. ET)

Register Now

This program is pending approval for 1.0 (general) recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at hrci.org.

Note: Those listening to a recorded webinar will not be eligible for credit.

Read More

Reminder: 2021 HSA Contributions and Corrections Deadline Is April 18

March 29, 2022

Individuals who were HSA-eligible in 2021 have until the tax filing deadline to make or receive contributions. So, 2021 HSA contributions must generally be made by April 18, 2022. This includes employer contributions. The 2021 contribution limit is $3,600 for self-only coverage and $7,200 for any tier of coverage other than self-only. Those aged 55 and older are permitted an additional catch-up contribution of $1,000. Generally, an individual’s maximum annual contribution is limited by the number of months they were eligible for the HSA.

There is an exception to this rule. An individual that was HSA eligible on December 1 is permitted to contribute the full statutory maximum for the year. However, if eligible employees do not remain HSA eligible through December of the following year, they may experience tax consequences.

Individuals who contributed more than the allowable amount for 2021 should be refunded the excess contributions and associated interest by April 18, 2022. The excess would be subject to income tax. If the excess is not refunded from the account, it will not only be subject to income tax, but also a 6% excise tax penalty. Employees who were not eligible for a contribution or contributed more than the allowable amount for 2021 should work with the HSA bank/trustee to process the excess contributions.

Read More

Podcast Episode 119: Mental Health Parity Civil Litigation and Administrative Action

March 15, 2022

In this episode, Patrick Myers and Suzanne Spradley review recent litigation and administrative action brought under the Mental Health Parity and Addiction Equity Act (MHPAEA). Suzanne begins the discussion by providing background on the requirements imposed on plans by MHPAEA, with a particular focus on non-quantitative treatment limitations (NQTLs). Suzanne then discusses the report submitted to Congress by the DOL, HHS and the IRS that highlighted several deficiencies they found when examining plan sponsors and insurance providers for MHPAEA compliance. She follows up by discussing a large civil case involving a behavioral health provider. And the episode closes with a discussion on two large settlements between the DOL and administrative service providers as part of the agency’s efforts to enforce MHPAEA compliance.

Every other week, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page every two weeks for the most up-to-date episode.

Subscribe on iTunesListen on Google Play Music

Read More

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