Blog Posts
Category: Health and Welfare Benefit Plans
Pharmacy Benefit Manager (“PBM”) arrangements have long relied on rebates with limited transparency into true drug costs. Recent regulatory and...
Federal Tax Treatment and Reporting of State PFML Benefits – IRS Extends Compliance Deadline to 2027
Over the last decade, more than a dozen states have established state-run mandatory paid family and medical leave (PFML) programs, including...
The cost of GLP-1 medications to group health plans continues to increase rapidly as FDA approval expands and the percentage of participants and...
Self-insured group health plans are HIPAA “covered entities” and—unlike most fully insured arrangements—typically must maintain and...
Introduction Maine’s new Act to Improve Accountability and Understanding of Data in Insurance Transactions (the “Audit Act” or “Act”)...
We often are asked how an employer’s existing short-term disability (“STD”) policy will interact with new state medical leave programs. While...
Severance plans subject to the Employee Retirement Income Security Act of 1974, as amended (“ERISA”) must satisfy certain compliance...
In the context of medical coverage, the terms “Preventive Services” and “Preventive Care” are often used interchangeably. The two terms,...
Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity, and Wegovy, into...
The Departments of Labor, Health and Human Services, and the Treasury, with the Office of Personnel Management (the “Departments”)...
On September 6, 2024, the U.S. Department of Labor (DOL) issued a press release announcing that it was publishing updated cybersecurity guidance in...
The long-anticipated final rule under the Mental Health Parity and Addiction Equity Act (MHPAEA) was published on September 9, 2024. The MHPAEA...
Summer is ending and fall is rapidly approaching. For employee benefit professionals with calendar-year health and welfare benefit plans that means...
On April 26, 2024, the U.S. Department of Health and Human Services (HHS) and Office for Civil Rights (OCR) published Final Regulations under...
It is a common practice for employers to offer employees a health care flexible spending account (“Health FSA”) option under a cafeteria plan....
Maine’s comprehensive paid family and medical leave (PFML) law, enacted in October 2023, establishes a state benefits program funded by employer...
We are sometimes asked whether a self-funded group health plan is required to cover gender-affirming medical services. As this post explains in...
For the past few years, we have encouraged plan sponsors to focus on matters of fiduciary governance for their health and welfare benefit plans (see...
Under Section 404 of ERISA, plan fiduciaries must act for the exclusive benefit of plan participants and beneficiaries and use plan assets only to...
We are well into the Affordable Care Act (“ACA”) information reporting season. Forms 1095-B/1095-C must be provided to employees by March 1,...
As part of the routine administration of employee benefit plans, shortly after the end of a calendar year, many transactions must be reported to the...
The interaction between employer-provided retiree medical coverage and COBRA[1] is complex. Many employers incorrectly assume they do not have to...
Introduction: Fifteen months ago, we wrote that the U.S. Department of Labor (“DOL”) had informed Congress that it intended to devote substantial...
The IRS’s recent Chief Counsel Advice Memorandum 202317020 (the “Memo”) brings into focus the importance of compliance with the debit card...
Certain provisions of the Transparency in Coverage Final Regulations and the Consolidated Appropriation Act, 2021 (“CAA”) require group health...
It seems the COVID-19 pandemic is ending in the benefits world the same way it started: in a flurry of new laws, announcements, and notices intended...
In a move akin to last-minute gift-giving, the Departments of Labor, Health and Human Services, and the Treasury (the “Departments”) released FAQ...
Final Regulations under Section 36B of the Internal Revenue Code On October 11, 2022, the Internal Revenue Service (IRS) issued Final Regulations...
On October 6, 2021, the IRS issued Notice 2021-58, providing helpful guidance on COBRA continuation coverage in two key areas: (1) the application of...
The Mental Health Parity and Addiction Equity Act (“MHPAEA”) provisions of the Consolidated Appropriations Act, 2021 (“CAA”) introduced a...