Insights

There are a few different notice requirements in play when an employer makes a midyear change to benefits. First, ERISA includes a summary of material modification (SMM) requirement. The SMM requirement pertains to material changes in a group health plan. ERISA does not define “material,” but this term would generally refer to any information or changes that impact the rights or obligations of plan participants and beneficiaries. Such changes may include, but are not limited to, changes in plan

HHS recently announced inflation-adjusted penalty amounts related to violations of Summary of Benefits and Coverage (SBC), Medicare Secondary Payer (MSP), and HIPAA privacy and security rule requirements. These new penalty amounts are calculated based on a cost-of-living increase of 1.03241% and are applied to penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015. Summary of Benefits and Coverage (SBC) The ACA requires insurers and group health pla

On August 5, 2024, the Seventh Circuit Court of Appeals (Seventh Circuit) affirmed the district court’s ruling in favor of insurer Group Health Cooperative (the defendant) when they denied claims for therapy treatment brought by parents on behalf of their autistic child (plaintiffs) based upon then-current medical literature. The plaintiffs asked the defendant health insurer to pay for certain treatments for their autistic child that occurred between 2017 and 2019. The defendant refused to pay

On August 20, 2024, representatives Robert Scott and Mark DeSaulnier, ranking members, respectively, of the House Committee on Education and the Workforce and the Subcommittee on Health, Education, Labor, and Pensions, sent a letter to the DOL’s Employee Benefits Security Administration (EBSA) assistant secretary Lisa Gomez asking for increased oversight on group health plan service providers. In part, the letter stems from a springtime New York Times (NYT) investigation into a data analytics c

On August 19, 2024, the IRS released Notice 2024-63, which provides interim guidance pursuant to the SECURE 2.0 Act for employers that want to provide matching contributions based on eligible student loan payments made by participating employees. In brief, among many other changes to retirement plan rules, SECURE 2.0 permits employers to amend their 401(k), 403(b), 457(b), and SIMPLE IRA plans to make matching contributions with respect to qualified student loan payments (QSLPs) for plan years

On July 23, 2024, the Colorado Division of Insurance released Bulletin B-4.139, to clarify the Division's position regarding coverage for abortion services in the individual and small market after the passage of Senate Bill (SB) 23-189, which requires carriers to provide coverage for the total cost of abortion care without requiring any cost-sharing from enrollees. The bulletin emphasizes the Division’s position that carriers are required to include abortion service coverage in health benefit p

As reported in the April 25, 2023, edition of Compliance Corner, the Delaware Expanding Access for Retirement and Necessary Saving (EARNS) program was signed into law in August 2022. The program was launched on July 1, 2024, and covered employers must register or certify their exemption by October 15, 2024. Employers with five or more employees who have wages or other compensation allocable to Delaware must register for the EARNS Program or certify their exemption if they already offer a tax-qu

Yes, employers are generally permitted to offer taxable cash incentives to employees who waive group health coverage under the employer’s Section 125 cafeteria plan. The details of the opt-out arrangement should be specified in the cafeteria plan document and clearly communicated to employees in the annual enrollment materials. However, there are several compliance issues to consider with an opt-out arrangement. First, for an applicable large employer (ALE) with 50 or more full-time or equivale

Industry experts recently shared these key takeaways in a recent webinar on the implications of the new PFAS designation under CERCLA.