Federal Requirements for Fully Insured and Self-Funded Plans

Posted by Matt Schwartz on Fri, Aug 28, 2020 @ 11:08 AM

Updated August 2020

A plan sponsor’s requirements under federal law will vary depending on factors such as group health plan design, size, grandfathered status, and whether the plan is fully insured or self-funded.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Compliance Recap - July 2020

Posted by Matt Schwartz on Thu, Aug 6, 2020 @ 08:08 AM

July was a busy month in the employee benefits world. The U.S. Supreme Court (Supreme Court) upheld the religious exemption and moral exemption final rules to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Anthem: MLR Rebates Will Go Out Early This Year

Posted by Matt Schwartz on Wed, Aug 5, 2020 @ 08:08 AM

Anthem states they are continuing to look for ways to ease the financial burden COVID-19 is creating for many of their employers and members. With that goal in mind, this year they are fast-tracking the annual medical loss ratio (MLR) rebates that groups and individual members typically receive in late September. 

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Frequently Asked Questions about the Exchange (Marketplace) Notice

Posted by Matt Schwartz on Tue, Aug 4, 2020 @ 08:08 AM

On September 11, 2013, the Department of Labor (DOL) issued an FAQ that stated that no penalties will apply to employers that fail to provide the exchange/marketplace notice. Despite this FAQ, employers may still want to provide the notice, to provide information to employees and to reduce the risk of unanticipated liability.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Webinar: Counting Employee Hours Under ACA Eligibility Rules in Light of COVID-19

Posted by Matt Schwartz on Thu, Jul 30, 2020 @ 10:07 AM

Tuesday, August 11, 2020
2:00 p.m. ET / 11:00 a.m. PT

The Patient Protection and Affordable Care Act (ACA) specifies when employers of a certain size must offer their employees health plan coverage.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits, Learning Events

Proposed Rules on Grandfathered Group Health Plan Coverage

Posted by Matt Schwartz on Mon, Jul 27, 2020 @ 08:07 AM

In response to the President’s Executive Order 13765 “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” issued on January 20, 2017, the Department of Health and Human Services (HHS), Department of Labor (DOL), and the Department of the Treasury (Treasury) issued proposed rules for grandfathered health plans.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Compliance Recap - June 2020

Posted by Matt Schwartz on Mon, Jul 13, 2020 @ 08:07 AM

June was a busy month in the employee benefits world. The Internal Revenue Service (IRS) released the updated patient-centered outcomes research institute (PCORI) fee amount and announced transition relief.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Update on Nondiscrimination Regulations Relating to Sex, Gender, Age and More

Posted by Matt Schwartz on Tue, Jun 23, 2020 @ 08:06 AM

The Patient Protection and Affordable Care Act (ACA) Section 1557 provides that individuals shall not be excluded from participation in, denied the benefits of, or be subjected to discrimination under any health program or activity which receives federal financial assistance from the Department of Health and Human Services (HHS), on the basis of race, color, national origin, sex, age, or disability.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Compliance Recap - February 2020

Posted by Matt Schwartz on Tue, Mar 10, 2020 @ 09:03 AM

February was a busy month in the employee benefits world.

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits

Highlights of the Summary of Benefits & Coverage Requirement

Posted by Matt Schwartz on Thu, Feb 27, 2020 @ 11:02 AM


Plan administrators of group health plans must provide a Summary of Benefits and Coverage (SBC) to eligible individuals. Insurer is responsible for creating the SBC for fully insured plans, and the insurer and plan administrator are both responsible for distributing to participants in insured plans. 

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Topics: Compliance Issues, Affordable Care Act, Employee Benefits