Insights

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

Under the final legislation (House File 902) issued on October 29, 2021, an employer must waive its COVID-19 vaccine requirements if an employee submits a statement that the vaccine would be harmful to the health and well-being of the employee or an individual residing with the employee, or that the vaccine conflicts with the employee's religious practices. Further, an employee who is discharged for refusing to receive the COVID-19 vaccine will not be disqualified from unemployment benefits. Fo

The IRS recently published the final version of the instructions for the 2021 Form 8955-SSA, Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits. Form 8955-SSA is used to report information about retirement plan participants who separated from service with the employer and are entitled to deferred vested benefits. The instructions assist employers with the preparation of the 2021 Forms 8955-SSA filing. The instructions explain that the IRS does not pe

On January 3, 2022, the IRS released Revenue Procedure (Rev. Proc.) 2022-4, which outlines the procedures for requesting determination letters and private letter rulings from the IRS for qualified retirement plans. Rev. Proc. 2022-4 is a general update of the information provided in Rev. Proc. 2021-4. Determination letters indicate whether the IRS finds an employer's employee benefit plan to meet the requirements necessary for the plan to be a qualified plan. Private letter rulings interpret an

On January 12, 2022, Commissioner Conway adopted amendments to Regulation 4-2-73. This regulation applies to all carriers marketing and issuing individual and group health benefit plans subject to the state's regulation. The regulation requires carriers to provide coverage for the federal Food and Drug Administration (FDA)-approved medication prescribed for pre-exposure prophylaxis (PrEP) without copayment or cost-sharing for individuals who, according to their provider or pharmacist, are indic

On January 14, 2022, the Pension Benefit Guaranty Corporation published revised civil penalty amounts for failure to provide certain notices or other material information, as required by ERISA. The amounts apply to penalties assessed on or after the publication date. The adjusted maximum amounts are $2,400 (up from $2,259) for Section 4071 penalties and $320 (up from $301) for Section 4302 penalties, which are related to multiemployer plan notices. PBGC Revised Penalties »

The Department of Fair Employment and Housing (DFEH) updated the 'Your Rights and Obligations as a Pregnant Employee' and 'Family Care and Medical Leave and Pregnancy Disability Leave' posters. These publications inform employees of their rights under California's Family Rights Act (CFRA) and Pregnancy Disability Leave (PDL). Employers with five or more employees must post the notices at their California worksites. If employees work remotely, the notice may be delivered electronically. If 10% o

The Department of Fair Employment and Housing (DFEH) revised the Certification of Health Care Provider, which is used for an employee requesting leave under the California Family Rights Act (CFRA). CFRA is California's version of FMLA. It previously applied to employers with 50 or more employees. However, effective January 1, 2021, the law and its requirements apply to employers with five or more California employees. The law provides up to 12 weeks of unpaid leave for an eligible employee with