Legal Update: 5th Circuit Requires Health Plans To Continue Providing Free Preventive Care
On June 21, 2024, the 5th U.S. Circuit Court of Appeals ruled that a key component of the Affordable Care Act’s (ACA) preventive care mandate is unconstitutional. However, in a decision it referred to as a “mixed bag,” the 5th Circuit limited its ruling to the plaintiffs in the case, a small group of individuals and businesses from Texas. This means that, for now, health plans and health insurance issuers must continue to provide first-dollar coverage for the full range of recommended preventive health services.
Legal Update: ERISA Penalties Awarded for Failing to Respond to Request for Information on Mental Health Benefits
The U.S. District Court for the District of Montana recently awarded over $32,000 in penalties against an employer’s self-insured health plan and its third party administrator (TPA) for failing to provide information to a plan participant upon request. This case, which involved a dispute over payment for mental health benefits, highlights the importance of promptly responding to participants’ requests for plan-related information.
If these documents are not provided within 30 days of receiving the written request, the participant or beneficiary may file a lawsuit under ERISA, and a court may impose monetary penalties of up to $110 per day, beginning on the date of the failure.
Legal Update: Federal Court Rules ERISA Preempts Oklahoma State PBM Legislation
On Aug. 15, 2023, the 10th U.S. Circuit Court of Appeals ruled in Pharmaceutical Care Management Association (PCMA) v. Glen Mulready that ERISA preempts certain provisions of an Oklahoma law aimed at regulating pharmacy benefit managers (PBMs). The ruling contrasts with the U.S. Supreme Court’s 2020 rulingin PCMA v. Rutledge, which held that ERISA did not preempt an Arkansas PBM regulation. The Oklahoma Insurance Commissioner has stated their intention to appeal, although the state has not yet filed a petition with the U.S. Supreme Court for review.
Legal Update: EEOC Announces July 9 Failure to File Deadline for 2023 EEO-1 Reports
On June 5, 2024, the U.S. Equal Employment Opportunity Commission (EEOC) announced
that it had entered the “Failure to File” phase for EEO-1 reporting, as described in the agency’s recently updated EEO-1 Reporting Instruction Booklet.The EEOC offers a fact sheet regarding the failure to file deadline.
This announcement means that if an employer failed to submit a required EEO-1 Report by the “Published Due Date” of June 4, 2024, the EEOC will send it a Notice of Failure to File letter requesting that it complete the submission as soon as possible but no later than
July 9, 2024.
Legal Update: PCORI Fees Due July 31, 2024
The Affordable Care Act (ACA) requires health insurance issuers and self-insured plan sponsors to pay Patient-Centered Outcomes Research Institute fees (PCORI fees). The fees are reported and paid annually using IRS Form 720, the Quarterly Federal Excise Tax Return.
Form 720 and full payment of the PCORI fees are due by July 31 of each year,and generally covers plan years that end during the preceding calendar year. For plan years ending in 2023, the PCORI fees are due by July 31, 2024.
Legal Update: HHS Updates HIPAA FAQs Regarding Change Healthcare Cybersecurity Incident
On May 31, 2024, the U.S. Department of Health and Human Services’ (HHS)Office for Civil Rights (OCR) updated its frequently asked questions (FAQs) regarding HIPAA and the recent cybersecurity incident involving ChangeHealthcare, a unit of UnitedHealth Group. OCR enforces the HIPAA Privacy,
Security and Breach Notification Rules (HIPAA Rules), which require covered entities and their business associates to protect the privacy and security of protected health information (PHI) and notify HHS and affected individuals following a breach.
Legal Update: DOL Issues Gag Clause Attestation Resources for 2024
On May 24, 2024, the U.S. Department of Labor (DOL) issued various resources to assist health plans and health insurance issuers in annually submitting their attestation of compliance with the Consolidated Appropriations Act’s (CAA) gag clause prohibition. These resources can be used to submit the next gag clause attestation, which is due by Dec. 31, 2024.
Legal Update: 3rd Circuit Rules USERRA May Require Paid Leave
On May 21, 2024, the U.S. Court of Appeals for the 3rd Circuit held that short-term military leave may be comparable to jury duty leave and bereavement leave and therefore may be subject to payment if the employer compensates jury duty and bereavement leave. The 3rd Circuit has jurisdiction over Delaware, New Jersey and Pennsylvania.
The opinion was issued in Scanlan v. American Airlines, Inc., reversing a lower court’s summary judgment ruling in favor of the airline and reinstating and remanding the plaintiff pilots’ class action suit for further proceedings. The plaintiffs claim their employer, American Airlines, violated The Uniformed Services Employee and Reemployment Rights Act (USERRA) by denying paid leave for short-term military absences (of no more than 16 days) from Jan. 1, 2013, through Oct. 31, 2021.
Legal Update: Deadline Reminder: RxDC Reports Are Due by June 1, 2024
Group health plans and health insurance issuers must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the “prescription drug data collection” (or “RxDC report”). This is an annual reporting requirement—plans and issuers must submit these reports by June 1 of each year, covering information for the prior calendar year.
The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023.
Employers should confirm they are taking steps to comply with this reporting
deadline, such as providing information to third-party vendors on a timely basis.
Legal Update: IRS Announces Excepted Benefit HRA Limit for 2025
The IRS has released the inflation-adjusted limit for excepted benefit health reimbursement arrangements (EBHRAs) for plan years beginning on or after Jan.1, 2025. Effective for 2025 plan years, the maximum annual employer contribution for an EBHRA will increase to $2,150 (up from $2,100 for plan years beginning in 2024).
Client and Employee Resources
The more your employees understand your benefit plans the more they become educated, empowered consumers. The programs you provide will also gain an enhanced value.
As your strategic partners in employee benefits, we can provide multiple avenues of ongoing support, including:
- Employee Meetings (English and Spanish)
- Webcasts
- Payroll Stuffers
- Poster Campaigns
- Newsletters
Carrier Directories
E-Verify is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States. Click the image below to begin.
