Insights

Following the expiration of any federal FMLA or state protected leave, an employee may stay on health benefits for as long as the eligibility terms of the plan allow. The Summary Plan Description, any employee handbooks or other communication describing benefit eligibility during leaves of absence should be consistent with the plan terms and approved by the carrier (stop-loss carrier if self-insured). In addition to ERISA's fiduciary requirement to follow the terms of the plan, if a group unila

On August 8, 2022, Insurance Commissioner McVey issued Bulletin 2022-09, which provides clarification related to the maximum cost-sharing that may be charged to a covered participant for insulin drugs. Existing law prohibits health insurance policies from charging a participant more than $100 cost-sharing per 30-day period for insulin drugs. Some insurers interpreted this to mean $100 per insulin drug category. For example, if a participant was prescribed both rapid-acting insulin and short-act

On May 12, 2022, Gov. Hogan signed HB 820 into law. The new law requires health insurance policies issued or renewed on or after January 1, 2023, to provide coverage for rituximab for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute onset neuropsychiatric syndrome (PANS). Employer plan sponsors of fully insured policies issued in Maryland should be aware of the coverage change and work with the insurer to upd

On August 19, 2022, the DOL, HHS and IRS (the departments) released final rules (the final rules) related to the surprise billing requirements of the No Surprises Act (NSA) of the Consolidated Appropriations Act, 2021 (CAA). The final rules modify certain requirements under the July 2021 and October 2021 interim final rules, which implemented the NSA provisions and federal independent dispute resolution (IDR) process, respectively. (Please see our prior articles on the July 2021 and October 202

The DOL recently announced it will hold a virtual public hearing regarding a proposed amendment to the prohibited transaction exemption filing and processing procedures. The DOL is also reopening the comment period for the proposed amendment. ERISA and the Code generally prohibit a plan fiduciary from causing the plan to engage in a variety of transactions with certain related parties (including sponsoring employers, affiliates and service providers) unless a statutory or administrative exempti

A Michigan court has delayed the effective date of its July 19, 2022, ruling in Mothering Justice et al. v. Nessel, et al. The ruling, first covered in our August 2, 2022, edition of Compliance Corner, found that the state's legislature violated the Michigan Constitution when it amended two recently adopted ballot initiatives in 2018. As a result, the court voided Michigan's then-current Paid Medical Leave Act (PMLA) and minimum wage laws, reverting to versions of those laws originally adopted

On August 19, 2022, the DOL, HHS and IRS (the departments) released 23 FAQs that address various aspects of the surprise billing requirements under the No Surprises Act (NSA), which was part of the Consolidated Appropriations Act, 2021. The NSA provisions apply to health insurers and group health plans effective for plan years beginning on or after January 1, 2022. The NSA provides patient protections against surprise medical bills for out-of-network (OON) emergency services, air ambulance ser

The Department of Insurance and Financial Institutions announced that its final rules implementing the Arizona Mental Health Parity Act (Jake's Law) are effective September 4, 2022. These five rules provide guidance for plans issued in the state to report their compliance with the statute. Jake's Law implements the federal MHPAEA at the state level. MHPAEA generally establishes that health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits may not, among o

By January 15, 2023, certain Washington, DC employers must report their compliance with the DC Parking Cashout Law of 2020. The reporting will cover future compliance. When available, the report templates will be available on the District Department of Transportation website. The Cashout Law applies to employers with 20 or more employees in the district who offer free or subsidized parking benefits to employees. To comply, covered employers must implement one of the following compliance option