resources

Wraparound Excepted Benefits: Two Pilot Programs

Health plan sponsors are permitted to offer wraparound coverage to employees purchasing individual health insurance in the private market, including the Marketplace, in limited circumstances, under a Final Rule issued by the U.S. Department of Labor (DOL) and other federal agencies. The Final ...

Compliance Recap | Year Review of 2018

During 2018, federal agencies and courts provided employers with a significant amount of new guidance, regulation, and FAQs relating to employer benefit plans. This month-by-month guide provides a timeline of these documents, highlighting the major changes and updates in 2018. To access the ...

Proposed 2020 Benefit Payment and Parameters Rule

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule for benefit payment and parameters for 2020. CMS also released its draft 2020 actuarial value calculator and draft 2020 actuarial value calculator methodology. According to CMS, the proposed rule is intended to ...

Advocacy in Action | Scheduling Assistance

Our Patient Advocates are serious about service. As an independent resource, they are available to our members to help them resolve any concerns about their benefit program.  They can assist with concerns about claims, patient referrals, balance bills, enrollment delays, or any benefits issue. ...

Court Modifies Order Regarding EEOC Wellness Rules

In August 2017, the United States District Court for the District of Columbia held that the U.S. Equal Employment Opportunity Commission (EEOC) failed to provide a reasoned explanation for its decision to allow an incentive for spousal medical history and adopt 30 percent incentive levels for ...

Status of Court Case Challenging ACA Constitutionality

On December 14, 2018, the U.S. District Court for the Northern District of Texas (Court) issued a declaratory order in ongoing litigation regarding the individual mandate and the Patient Protection and Affordable Care Act (ACA). The Court declared that the individual mandate is unconstitutional ...

Compliance Recap | December 2018

December was a relatively quiet month in the employee benefits world. A U.S. District Court issued an order declaring that the Patient Protection and Affordable Care Act (ACA) is unconstitutional. The Equal Employment Opportunity Commission (EEOC) issued two final rules to remove certain ...

DOL Issues Final Regulations Regarding Association Health Plans

On June 19, 2018, the U.S. Department of Labor (DOL) published Frequently Asked Questions About Association Health Plans (AHPs) and issued a final rule that broadens the definition of “employer” and the provisions under which an employer group or association may be treated as an “employer” ...

Compliance Recap | November 2018

November was a busy month in the employee benefits world. The Internal Revenue Service (IRS) extended the due date for employers to furnish Forms 1095-C or 1095-B to individuals, extended “good faith compliance efforts” relief for 2018, and issued specifications for employer-provided substitute ...

Culture Questions

With unemployment continuing at historically low numbers, it’s up to employers to win sought-after candidates. During an interview, employers are likely ready for the culture question. When asked about culture directly, according to an article in Fast Company, interviewers are quick to offer ...