News

"Covered Entities will need to appoint a Section 1557 coordinator, implement policies and procedures, provide training, distribute and post notices containing specified content and provide auxiliary aids and services to individuals with disabilities and to those with limited English proficiency. The Final Rule will become effective on July 5, 2024, but many of the requirements imposed on Covered Entities have delayed compliance dates[.]"

"Regulations implementing Section 1557 have been the subject of Presidential administration tug-of-war since their original 2016 issuance.... The  Final Rule  restores Section 1557 protections against discrimination based on sexual orientation, gender identity, and disability, as well as religious objections. It also expands the reach of the Rule to Part B Medicare providers, private health insurance plans and the use of AI patient decision-making tools."

"[1] Requirement to timely file an Annual Report with the [DOL] ... [2] Use of forfeitures in 401(k) plans ... [3] Expected pension de-risking report ... [4] Adequate consideration rule ... [5] Locating lost participants."

"Davis not only submitted invoices for medical services he did not receive, but also furthered the scheme by recruiting Atlanta-area chiropractor Rashad Sanford to resubmit previously denied false invoices provided by Williams. Together, Davis and Sanford received a $44,000 payout from the plan."

"[I]ndividuals and businesses in Ohio that were affected by tornadoes that began on March 14, 2024 ... now have until Sept. 3, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Auglaize, Crawford, Darke, Delaware, Hancock, Licking, Logan, Mercer, Miami, Richland and Union counties qualify for tax relief."

"[I]ndividuals and businesses in Nebraska that were affected by severe storms, straight-line winds, and tornadoes that began on April 25, 2024 ... now have until September 3, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Douglas and Washington counties qualify for tax relief."

"Mandatory changes: HIPAA special enrollment events  ... What about dental and vision? ... Are tag along changes [for dependents] allowed? ... (Optional) permitted changes: Section 125 cafeteria plan permitted changes  ... Examples."

"Oklahoma's insurance department asked the U.S. Supreme Court to review the Tenth Circuit's decision in PCMA v. Mulready  ... which held that parts of an Oklahoma law regulating pharmacy benefit managers (PBMs) were preempted by ERISA and by Medicare Part D. In its petition, the state says that Mulready 'is irreconcilable with [the Supreme Court's] unanimous decision in Rutledge ,' and that Mulready also created a 'textbook' circuit split with the Eighth Circuit." [ PCMA v. Mulready , No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. filed May 10, 2024, No. 23-1213 )]

"The Eleventh Circuit also concluded that the county, which had been delegated the functions of administering and providing health insurance for a county sheriff's office employees, was an employer for Title VII purposes.... Much of the recent litigation over health plan exclusions for gender-affirming care is being brought under ACA Section 1557.... Title VII can also be the basis for a successful challenge to such exclusions." [ Lange v. Houston County, Georgia ., No. 22-13626 (11th Cir. May 13, 2024)]

"More companies are using AI to deliver a more intuitive and effective user experience for choosing benefits as generative AI applications become more sophisticated. However, the possibilities of AI go far beyond open enrollment to deliver an improved benefits experience year-round. ... [1] Content creation ... [2] Personalization ... [3] Data analytics ... [4] Improved efficiency ... [5] Benefits offerings and selection ... [6] Improved call centers."

"Initially geared towards ERISA-governed retirement plans, the DOL has subsequently stated that its 2021 cybersecurity best practices also apply to ERISA-governed group health plans.... [T]he DOL lists 12 best practices to help ERISA plan fiduciaries to mitigate cybersecurity risks: ... [E]mployers are encouraged to consider adopting these best practices to help withstand any DOL scrutiny related to cybersecurity."

"A majority of employers (69%) advocate for shared fiduciary responsibility between themselves and carriers, emphasizing collaboration in decision-making and goal alignment. There is a near-even split between those employers who handle CAA document filing internally (51%) and those who enlist third-party vendors (43%), indicating a reliance on external assistance and potential gaps in employer knowledge. Notably, a percentage (6%) of employers were unsure about their company's filing method, signaling a need for increased understanding and education on CAA requirements."

"QDIAs received a unanimous vote for further study by the Council. As a default investment selected by a plan for their participants, the QDIA is of increasing importance due to the proliferation of automatic enrollment in defined contribution plans.... The second ... topic for study is welfare claims and appeals ... This group will look at how to make welfare plans claims and appeals easier to access for participants."

"This alert outlines employers’ duties under the new law, provides clarity on pregnant workers’ rights and protections, and guides employers on ways to minimize risk and liability under the PWFA."

"New Section 1557 regulations published on May 6, 2024, which go into effect August 6, 2024, restore some repealed 2016 provisions and add provisions to enhance nondiscrimination requirements to which covered healthcare providers must adhere."

"A federal appeals court has upheld a lower court's ruling that the Houston County, Ga., Sheriff's Office violated antidiscrimination law by denying transition-related health care to a deputy.... It is only the second decision by a federal appellate court affirming that it is unlawful for an employer to discriminate against transgender people in an employee health plan ... [and] is immediately binding on employers in Georgia, Florida, and Alabama, the states covered by the 11th Circuit[.]" [ Lange v. Houston County, Georgia ., No. 22-13626 (11th Cir. May 13, 2024)]

"[1] Claims could be processed instantly ... [2] Employee experience could be improved with AI-powered self-service ... [3] Analysis of benefits performance could be easier and more insightful ... That gives the benefits professional of the future significantly more bandwidth to focus on the areas of the job that require human touch, empathy, and ingenuity."

"[1] Failure to indicate that Minimum Essential Coverage was offered to full-time employees.... [2] Ignoring correspondence from the IRS.... [3] Failure to file altogether.... [4] Failure to show reasonable cause.... [5] Failure to consider all entities of an 'ALE group'.... [6] Not using safe harbor codes on 1095-C line 16."

"With a new Complaint to be filed, in some sense, the case is starting all over again. But, there is some learning from the Defendants' letter and their Memorandum on dismissal that are worth a review, and that Plaintiff is no doubt taking into account for purposes of a First Amended Complaint." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]

"As staff members in the HR and benefits department often wear multiple hats, from overseeing an organization's retirement plan to managing a company's health care benefits, it is easy for these workers to feel overwhelmed, stressed and burnt out at times. For plan sponsors ... it is important to be aware of the challenges that HR and benefits staff members face daily and not blur the line of fiduciary responsibility with these employees."

"[T]he preamble to the Final Rule clarifies that the provisions would not apply to employers as it relates to the provision of employee health benefits.... In addition, the preamble to the Final Rule clarifies that even if a plan sponsor or a third-party administrator of a group health plan receives Federal financial assistance, such assistance does not make the group health plan a 'covered entity'."

"[B]ecause most insurers will be covered entities, [the authors] expect they (and their TPA and PBM counterparts) will request that plan sponsors remove potentially discriminatory plan designs to avoid liability. Insurers, TPAs, and PBMs can be held responsible for discriminatory plan designs that they originated or controlled. Conversely, when a plan sponsor controls a discriminatory plan design, the plan sponsor can be held liable if it is a Section 1557 covered entity."

"[1] Regularly review and update plan documents ... [2] Conduct thorough due diligence on current and potential vendors ... [3] Implement strategies to proactively identify and mitigate potential threats to the plan's financial stability and participant satisfaction.... [4] Compliance adherence and conflict of interest avoidance ... [5] Education and training ... [6] Maintain open lines of communication with plan participants ... [7] Engage independent third-party reviewers ... [8] Maintain detailed records of all decisions ... [9] Proactive cost-containment efforts."

"The FAQ is in response to feedback that plans and insurers need additional time to complete the 'significant efforts' associated with recalculating QPAs consistent with the guidance that remains in effect after TMA III.... [U]pdates regarding IDR portal availability and process changes continue to be posted on the CMS website , including a recent announcement of a new process for resubmitting IDR disputes that were originally improperly batched or bundled."

6-page chart summarizes key dates for calendar year 2024 regarding activities and policies that are outlined in other documents. Rev. May 8, 2024,