"With the end of the COVID-19 'outbreak period' in sight, employers will revert back to pre-pandemic deadlines and timeframes applicable to special enrollment rights, COBRA elections, COBRA premium payments, and claims processing. In addition to the usual second quarter compliance deadlines, a new requirement is added to report prescription and medical plan costs to CMS, which will be an annual task going forward."   MORE >>

"The U.S. Department of Health and Human Services (HHS), Labor and Treasury recently confirmed that group health plans and insurers will not be required to report information regarding air ambulance services until after final regulations are issued.... [T]he Departments had previously [stated] reporting would first be due in March 2023, based on an assumption that final rules would be issued by now."   MORE >>

"One practical effect of this change is that all employers subject to the ACA employer mandate will need to file electronically, since by definition they have 50 or more full-time and full-time equivalent employees. They will clear the 10-return threshold easily. Level-funded employers who previously relied on mailing in carrier-produced Forms 1095-B will now need to seek an electronic filing solution as well."   MORE >>

"Certified IDR entities (i.e., arbitrators) received guidance  ... instructing them to more directly consider multiple factors when deciding on an out-of-network payment amount.... Relative to past guidance, most recently a final rule that took effect in October 2022, the instructions give less weight to the qualifying payment amount (QPA) as a factor in arbitration cases."   MORE >>

"Age 65+ employees will often remain enrolled in the employer-sponsored group health plan and delay Medicare enrollment until retirement. Upon retirement and loss of active coverage, retirees will typically have the employer complete a portion of the Form CMS-L564 to verify key information as part of their Medicare special enrollment period process."   MORE >>

"This report presents data on health benefit plans' Form 5500 filings covering private-sector employees for statistical year 2020, ... Approximately 74,100 group health plans filed a Form 5500 for 2020, an increase of nearly 13 percent from 2019.... Self-insured plans covered nearly 35 million participants and held more than $112 billion in assets, while mixed-insured plans covered roughly 29 million participants and held $157 billion in assets." [ Appendix A : Group Health Plans Report: Abstract of 2020 Form 5500 Annual Reports Reflecting Statistical Year Filings; and Appendix B : Self-Insured Health Benefit Plans 2023: Based on Filings through Statistical Year 2020]   MORE >>

"Employers and carriers are now shifting to developing smaller networks that focus more on value-based healthcare. These networks are made up of providers that offer service at a reasonable cost that’s well-coordinated and results in fewer readmissions, focuses on prevention and takes a conservative approach to care. Narrow networks often don’t just involve primary care physicians, but typically include specialists, such as surgeons, and surgical facilities and hospitals."   MORE >>

"A bill recently introduced in the California Legislature would more than double the amount of paid sick days that employers must provide to their workers. The proposal would raise the number of paid sick days from three to seven per year and modify the way the leave must be accrued."   MORE >>

"This article discusses the ERISA and ACA requirements for non-English language assistance, including the threshold that the non-English-speaking employee population must reach in order to trigger those requirements. It concludes with the case for offering language assistance as a best practice even when the employer doesn't have enough non-English-speaking employees to make the assistance mandatory."   MORE >>

"Balancing the needs of remote, hybrid and onsite workers has left many employers feeling overwhelmed. Many companies continue to grapple with making the workplace attractive and keeping employees connected when so many are working remotely. [B]enefits and wellbeing have proved invaluable in supporting employee needs regardless of work style."   MORE >>