Insights

On December 23, 2024, President Biden signed the Paperwork Burden Reduction Act (PBRA) and Employer Reporting Improvement Act (ERIA) into law. As previously reported in our December 17, 2024, announcement, this legislation makes certain modifications to the ACA’s employer mandate reporting requirements that aim to simplify Forms 1095-B and 1095-C reporting for employers and health insurance providers, as highlighted below. Paperwork Burden Reduction Act (PBRA) Provides statutory authority

On December 23, 2024, the DOL, HHS, and IRS (the departments) withdrew proposed rules that would have provided an additional method for individuals to obtain no-cost contraceptive services if their health plan or insurer did not provide such services due to a religious exemption. Current regulations require non-grandfathered group health plans and non-grandfathered group or individual health insurance coverage to cover certain contraceptive services without cost-sharing unless an exemption due

As reported in our September 24, 2024, Compliance Corner FAQ, employers that sponsor HDHPs paired with HSAs will no longer be able to provide first-dollar telehealth coverage to participants without negatively impacting their HSA eligibility. To the disappointment of many employers and employees, Congress did not extend the exception permitting first-dollar telehealth coverage in their recent temporary government funding legislation. As background, for a participant to be eligible to make or re

Join the Benefits Compliance team for a year-end recap of 2024's key benefits updates, including MHPAEA rules, ACA changes, court cases, and 2025 outlook.

On December 2, 2024, the IRS released Notice 2024-83, which announces that the adjusted applicable dollar amount for PCOR fees for plan and policy years ending on or after October 1, 2024, and before October 1, 2025, is $3.47. This is a $0.25 increase from the $3.22 amount in effect for plan and policy years ending on or after October 1, 2023, and before October 1, 2024. PCOR fees are payable by insurers and sponsors of self-insured plans (including level-funded plans, HRAs, and many point solu

In November 2024, HHS issued its inaugural report on prescription drug spending and trends, as required under Section 204 of the CAA 2021, which directs the agency to report on “prescription drug reimbursements under group health plans and group and individual health insurance coverage, prescription drug pricing trends, and the role of prescription drug costs in contributing to premium increases or decreases under such plans or coverage.” The report is an analysis of data for the years 2020 and

In a report issued last month, the HHS Office of Inspector General (OIG) advocated for increased HIPAA audits and enforcement efforts from the Office for Civil Rights. Of particular concern for OIG was the recent increase in cyberattacks and the vulnerability of electronic information protected by HIPAA. As background, the Office for Civil Rights (OCR) is the HHS agency tasked with implementing and enforcing HIPAA. In 2009, HIPAA’s protections and requirements with respect to electronic protect

On November 15, 2024, the Congressional Research Service (CRS) published a report on HSA Qualified Medical Expenses. The report describes HSA-qualified medical expenses and legislative approaches to amend HSA-qualified medical expenses. HSA funds that are distributed for qualified medical expenses of the account holder, spouse, and any of their tax dependents are not subject to federal tax. Over the years, Congress has broadened the items and services that are considered qualified medical expen

Not necessarily. It’s true that an employee’s enrollment in (aka entitlement to) Medicare renders the employee ineligible to make or receive HSA contributions. Medicare is considered “impermissible” first-dollar coverage for HSA eligibility purposes because it pays or reimburses for medical care before the HDHP statutory deductible is met. However, an employee who turns 65 and is eligible for but does not enroll in Medicare can continue to make or receive HSA contributions, assuming the employe