Insights

On February 2, 2024, the DOL, HHS, and IRS (the departments) issued FAQ guidance on the implementation of certain requirements under the Transparency in Coverage (TiC) Final Rules. This FAQ clarifies the participant cost-sharing tool compliance requirements where a plan is providing cost estimates based on claims data, but there is extremely low utilization of the item or service at issue. As background, the TiC Final Rule issued in October 2020 requires non-grandfathered group health plans to

On December 5, 2023, in Ian C. v. United Healthcare Ins. Co., the Tenth Circuit Court of Appeals (Tenth Circuit) reversed the district court’s ruling that the defendant’s claim denial was not arbitrary and capricious because the defendant did not provide a “full and fair review” of the plaintiff’s claims. The plaintiff was a participant covered by an employer-sponsored group health plan. The plaintiff’s son underwent inpatient residential treatment for mental health and substance abuse issues,

The IRS recently released the updated Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans for use in preparing 2023 tax returns. This publication provides information about consumer-directed healthcare vehicles such as Health Savings Accounts (HSAs), Medical Savings Accounts (MSAs), Flexible Spending Arrangements (FSAs) and Health Reimbursement Arrangements (HRAs). The update includes reminders on important guidance and other provisions for these plans, including: Sunset

On February 8, 2024, HHS released a final rule modifying the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations under 42 CFR Part 2 (referred to as “Part 2”). The final rule implements confidentiality rules required under the CARES Act to align certain aspects of Part 2 with HIPAA rules. The final rule implements many of the proposed modifications originally published in the December 2, 2022, Notice of Proposed Rulemaking (NPRM), which we discussed in a prior Compliance

On January 24, 2024, the DOL finalized rules to amend the individual application procedure for prohibited transaction exemptions under ERISA and the Code. The final rules (termed the “Final Amendments”) follow the proposed rules published on March 15, 2022, but reflect certain changes in response to public comments received. Please see our prior article for further information regarding the proposed rules. ERISA sets forth standards and rules that govern the conduct of ERISA plan fiduciaries an

On January 25, 2024, the Delaware Department of Insurance issued a bulletin (No. 134) to remind all insurers in Delaware that beginning on January 1, 2024, insurers are required to cover annual behavioral health well checks. A “behavioral health well check” is defined in the law as a pre-deductible annual visit with a licensed mental health clinician with, at minimum, a master’s level degree. The behavioral health well check visit must include but is not limited to a review of medical history,

The Illinois DOL (IDOL) recently published the updated Illinois Consumer Coverage Disclosure Act (CCDA) template for 2024. The list of Essential Health Benefits (EHB) did not change from 2023 to 2024, but employers should begin using the 2024 template. As a reminder, the CCDA requires employers to provide eligible employees with a disclosure that compares their coverage to essential health benefits required for coverage received through the Illinois marketplace. The disclosure must be provided

Under ERISA, the plan administrator is obligated to provide certain documents to any participant or beneficiary under the plan when requested in writing. The documents that must be provided include the latest updated SPD (including interim summaries of material modifications), the latest annual report (i.e., Form 5500), any terminal report (i.e., final Form 5500 for a terminated plan), any bargaining agreement, any trust agreement, and “any contract or other instruments under which the plan is

In January, the DOL issued five fact sheets that focus on different aspects of the FMLA. Fact Sheet 28D explains employers’ obligations to provide employees with information about their FMLA rights and responsibilities. The FMLA requires employers to distribute the following notices to employees who request leave that could qualify as FMLA leave: the General Notice; the Eligibility Notice; the Rights and Responsibilities Notice; and the Designation Notice. The fact sheet describes the function