Insights

As more employees approach Medicare age, it is important for employers to understand employee rights and employer obligations related to Medicare. In this webinar, the Benefits Compliance team provided an overview of Medicare basics, discussed Medicare Secondary Payer rules, and reviewed how Medicare interacts with other federal benefit laws.​​​​ Agenda Medicare and Your Plan: Benefit Issues to Consider Medicare Basics & Eligibility Medicare Secondary Payer (MSP) Rules Coordination of Ben

Over the last several years, we’ve all gotten used to uncertainty in the macroeconomic environment. However, one factor has felt certain — it seems that each time central bankers meet, the federal funds rate increases another 25 ‒ 50 basis points. We’re currently experiencing interest rates that are higher than we’ve seen since the 1990s. Many effects, like higher prices at the pump, increased borrowing costs and the cooling of the housing market are immediately apparent to consumers. But these

Recently, HHS issued the first in a series of five annual reports to Congress on the impact of the No Surprises Act (NSA). The NSA was enacted in 2020 to address certain instances of surprise billing, where individuals receive unexpectedly high medical bills after receiving treatment, either unknowingly or unavoidably, by an out-of-network (OON) provider, facility, or provider of air ambulance services subject to NSA requirements. This first report establishes a framework for evaluating the NSA

On August 11, 2023, the DOL, HHS, and IRS (“the agencies”) issued FAQs regarding administrative fees charged to group health plans, insurers, and out-of-network providers involved in payment disputes subject to the independent dispute resolution (IDR) provisions of the No Surprises Act (NSA). An administrative fee is levied against each party to the IDR process. In late December 2022, the agencies increased this fee from $50 per party to $350 for 2023. The Texas Medical Association (TMA), which

On August 9, 2023, the Congressional Research Service (CRS) issued the Medicare Secondary Payer (MSP) Coordination of Benefits report. The CRS serves Congress in the legislative process by providing policy and legal analysis to committees and members of both the House and Senate, regardless of party affiliation. This report reviews the MSP system, reporting requirements, Medicare beneficiary responsibility, payer liability issues, and issues for Congress. One report section also discusses the c

On August 4, 2023, the Ninth Circuit Court of Appeals affirmed in part and reversed in part the US District Court for the Central District of California’s granting of summary judgment to the defendants in an ERISA class action brought by former AT&T employees who contributed to AT&T’s retirement plan (the plaintiffs), a defined contribution plan. Defendants in the case are the plan’s administrator, AT&T Services, Inc., and the committee responsible for some of the plan’s investment-

On August 11, 2023, the DOL published a request for information (RFI) soliciting public comments on certain SECURE 2.0 provisions that impact ERISA’s reporting and disclosure framework. The public feedback will inform future DOL rulemaking or other guidance. Numerous sections of SECURE 2.0 establish new, or revise existing, ERISA reporting and disclosure obligations. In some cases, SECURE 2.0 also requires the DOL to undertake a review of existing or new requirements and submit reports to Congr

Effective August 7, 2023, carriers and PBMs must provide coverage for the single dispensing or furnishing of contraception intended to last for a duration of 12 months (as permitted by the covered person's prescription) and dispensed or furnished at one time unless requested otherwise by a covered person. Carriers and PBMs are also: Prohibited from implementing utilization management practices that prevent compliance with the 12-month mandate. Required to allow for alternate prescribed contrac

On July 26, 2023, Mayor Muriel Bowser signed the Short-Term Disability Insurance Benefit Protection Clarification Emergency Amendment Act of 2023 (DC Act 25-204) into law. The Emergency Act extends the prohibition of short-term disability policies reducing benefits (also known as offsetting benefits) based on an insured’s receipt of DC Paid Family and Medical Leave benefits. The prohibition applies to fully insured policies regardless of where the policy is issued but does not apply to self-ins