Insights

On January 10, 2024, the Ninth Circuit Court of Appeals (the Ninth Circuit) ruled that an assignment of benefits includes the right of South Coast Specialty Surgery Center, Inc. (South Coast) to sue Blue Cross of California dba Anthem Blue Cross (Anthem) under ERISA Section 502(a) for Anthem’s alleged failure to fully reimburse the costs of medical services provided to South Coast’s patients. The Ninth Circuit reversed the district court’s dismissal of South Coast’s claim and remanded the case

Recently, HHS released a set of FAQs concerning an individual’s right to access health information. HIPAA requires covered entities, which include insurers and self-insured group health plans, to provide individuals with access to their protected health information (PHI), such as medical records, information related to enrollment, payment, or claims adjudication, and other records used by the covered entity to make decisions about those individuals. This right of access includes the right to ob

The IRS recently published the 2024 IRS Publication 15-B, the Employer's Tax Guide to Fringe Benefits. This publication provides an overview of the taxation of fringe benefits and applicable exclusion, valuation, withholding, and reporting rules. The IRS updates Publication 15-B each year to reflect any recent legislative and regulatory developments. Additionally, the publication provides the applicable dollar limits for various benefits for 2024. The “What’s New” section of the publication inc

On January 12, 2024, the IRS released Notice 2024-22, which provides preliminary guidance to assist plan sponsors with implementing Pension-Linked Emergency Savings Accounts (PLESAs). Specifically, the notice addresses anti-abuse measures to discourage potential manipulation of the PLESA matching contribution rules. Created by Section 127 of the SECURE 2.0 Act, PLESAs are individual accounts in defined contribution plans (such as 401(k) and 403(b) plans) that are designed to allow eligible non-

Massachusetts requires its residents (over the age of 18) to carry minimum creditable coverage (MCC) or pay a penalty. It is a similar requirement to the now-repealed ACA Individual Mandate; however, a MCC determination involves a more in-depth review. Employers providing MCC to Massachusetts residents must distribute Form MA 1099-HC to them and submit reporting electronically to the Department of Revenue (DOR) by January 31, after the end of the medical plan year. However, employers are not re

For the first question, the answer is yes, if the carrier (for fully insured benefits) or stop-loss carrier and TPA (for self-insured benefits) allow the plan sponsor to extend eligibility to part-time employees. Employers need to ensure the eligibility criteria is clearly defined, properly documented in plan documents, and communicated effectively to employees. This should include information on how part-time hours are calculated to ensure only those who are truly eligible receive an offer of

Not in most cases, which can be an unwelcome surprise to a business owner who also works day-to-day for their business. After all, cafeteria plans are designed for employees and owner-employees are employees too, right?  Not according to the Internal Revenue Code (the Code), where Section 125 establishes the rules for cafeteria plans (aka Section 125 plans), which limits participation in those plans to “employees,” a term that excludes individuals deemed “self-employed” under the Code, includin

The Department of Health posted the 2024 covered-lives assessment (CLA) rates for professional education under the Health Care Reform Act (HCRA). These rates are applicable to health claim payers (including self-insured plans) that elect to pay the assessment directly to the state rather than facing higher surcharges for in-state hospital expenses. The annual amount owed by the payer is calculated based on the number of covered individuals residing in the state.  The HCRA was enacted to provide

On December 21, 2023, the Department of Financial Services (DFS) issued a circular letter to advise health insurers of the coverage reimbursement requirements for treatment provided by school-based mental health clinics.  Specifically, for comprehensive health insurance policies and contracts issued, renewed, amended, modified, or altered on or after January 1, 2024, insurers must provide reimbursement for covered outpatient care when provided by a school-based mental health clinic licensed at