Insights

Effective January 14, 2022, the Occupational and Health Standards Board issued revised regulations implementing Cal-OSHA's COVID-19 Prevention Emergency Temporary Standards. The rules apply to all employees in all places of employment except worksites with one employee who has contact with no other persons, employees teleworking from a non-employer site and employees covered by the state's Aerosol Transmissible Diseases Standard. Employers must establish, implement and communicate a written CO

Answer: First, it is important to keep in mind that the employee's HSA eligibility is based upon whether she meets the HSA eligibility criteria, regardless of whether her spouse or any other individual enrolled on the HDHP is also HSA eligible. To review, to be eligible to make or receive HSA contributions, an individual must: Be covered by a qualified HDHP. Not have other 'impermissible coverage' (i.e., coverage that provides medical benefits before the HDHP statutory minimum deductible i

The Department of Financial Services (DFS) issued a series of circular letters designed to address the implementation of certain provisions of the No Surprises Act (NSA) of the Consolidated Appropriations Act, 2021 (CAA). These provisions became effective for plan years beginning on or after January 1, 2022. The guidance, which is directed at insurers and healthcare providers, outlines the necessary changes to existing state laws and processes to incorporate the NSA requirements. Circular Lett

On December 27, 2021, New York City's COVID-19 vaccine mandate for private sector employees took effect. This mandate applies to all employers, regardless of size. Related guidelines were issued by the Department of Health (DOH) to assist employers with compliance. Under the mandate, employees in New York City who perform in-person work or interact with the public must show proof they have received at least one dose of a COVID-19 vaccine (unless they have requested an accommodation for medical

On December 30, 2022, CMS issued guidance related to the external review requirement under the No Surprises Act (NSA). The NSA requires insurers and group health plans to have an external review process for any adverse determination related to NSA compliance matters. Examples of such matters, as provided by HHS regulations, include: Patient cost-sharing and surprise billing for emergency services. Patient cost-sharing and surprise billing protections related to care provided by nonparticipa

On January 4, 2022, Insurance Commissioner McVey issued Insurance Bulletin 22-01, which provides an easy-to-understand summary of the federal No Surprise Billing provisions going into effect in 2022. The bulletin defines 'surprise bills,' explains the new protections against surprise billing, provides examples to assist consumers in identifying the now prohibited practice, and confirms that the new law applies to both fully insured and self-insured plans. Lastly, it directs consumers to file an

On December 27, 2021, the Eighth Circuit Court of Appeals decided Roehr v. Sun Life Assurance Co. of Canada ('Sun Life'), a case involving Sun Life's termination of long-term disability ('LTD') benefits of Dr. Todd Roehr, an anesthesiologist who developed intermittent tremors in his hands and finger. Sun Life terminated Roehr's ERISA LTD benefits as of January 27, 2017, after they paid him the benefits for nearly ten years on the grounds that Roehr had failed to provide proof of disability. Alt

On January 11, 2022, Insurance Commissioner McVey issued Insurance Bulletin 22-04, which provides guidance on HB 2263. The new law is effective for policies, plans, contracts and agreements executed or renewed on or after January 1, 2022. Pharmacy benefit managers (PBM's) and health insurers providing prescription drug coverage are prohibited from the following practices: Providing a monetary advantage or imposing a monetary penalty on a participant for utilizing one in-network pharmacy over

On January 3, 2022, HHS issued a fact sheet directed to patients to promote understanding of the No Surprises Act (the Act) that was part of the Consolidated Appropriations Act, 2021 passed by Congress in late 2020. Beginning January 1, 2022, the Act prohibits surprise medical bills (i.e., balance billing) for most emergency services provided at both in- and out-of-network facilities and without prior authorization; out-of-network charges and balance bills for certain additional services such a