As you may recall, since 2013 Blue Cross has been involved in a class-action lawsuit regarding its alleged anti-competitive policies. Brought by a class of over one million plaintiffs, the suit alleged the company violated antitrust law through dividing insurance markets in order to avoid competition among its member companies, thereby boosting prices for individual and corporate policyholders.
For many of us, the experience of working entirely from home is a new one. It has required us to rethink the way we work and function as a team. Many of the routines, patterns, practices, and processes we have created over time are no longer effective, and we’ve had to institute new means of collaborating, getting our work done, and elevating the people around us.
Everyone experiences grief at some point in their life, and yet for being such a common experience, it’s also one that few of us are fully equipped to navigate when it comes. In part, this is because grief is such an overwhelming and horrible experience. Nothing can prepare you for it. You just have to go through it and get through it. Grief is also a unique experience for each person. Everyone has their own path through its stages, and what helped one person work through their grief may not help another.
Based on current election results, it looks like the most probable outcome of the election is a divided government. No major legislative changes are expected should this hold true. However, this does not mean things will remain the same for the foreseeable future. Here are the main events and issues Research and Compliance is currently monitoring:
Listen to this podcast to learn about the latest updates in Compliance.
DOL, HHS, and IRS guidance requires group health plans to embed an individual out-of-pocket maximum
in the plan’s family coverage when the family out-of-pocket maximum exceeds the ACA’s out-of-pocket
maximum for self-only coverage.
A recent decision from the Sixth Circuit Court of Appeals suggests commonly seen limitations and restrictions on dialysis treatment benefits in group health plans may violate the Medicare Secondary Payer Act (“MSP Act”).
The Sixth Circuit’s decision in DaVita Inc. et al. v. Marietta Memorial Hospital, et al., held that plans which would provide coverage primary to Medicare and which treat all dialysis patients the same may nevertheless violate the MSP Act’s “non-differentiation” and “take into account” provisions. According to the Court, those provisions protect individuals with end-stage renal disease (ESRD) if the plan’s provisions have a disparate impact on patients with a continuing need for dialysis.
HSAs (Health Savings Accounts) and FSAs (Flexible Spending Accounts): Are both accounts designed to help employees put aside money to pay for extra medical expenses on a pre-tax basis, both have rules around maximum contributions and permissible distributions, and both have remarkably similar sounding acronyms. However, the similarities for the most part, stop here.
On June 19, 2018, the Department of Labor (DOL) released final rules for Association Health Plans (AHP). In summary, the final rules will allow small businesses, including self-employed workers, to band together by geography or industry to obtain healthcare coverage as if they were a single large employer. The intent is to provide greater negotiating power for coverage that is typically only available to large employers.
The IRS’ increased flexibility permitting plan sponsors to allow health FSA and DCAP participants to make mid-year election changes during calendar year 2020 without experiencing a status change has prompted confusion regarding the circumstances in which employees may normally change their dependent care assistance plan (DCAP) and health FSA elections during the middle of a plan year. To aid our consultants and clients in understanding when these changes can be made, we have summarized the rules that allow employees to make mid-year changes to health FSA and DCAP elections on account of status change events (and, in the case of DCAPs, cost change events). While other exceptions allowing mid-year election changes to health FSAs and DCAPs exist, including exceptions related to HIPAA special enrollment, Medicare/Medicaid, FMLA leaves, and other coverage changes, we are focusing on the status change and cost change based exceptions in this article. We also have provided examples (with commentary) regarding scenarios we have been previously asked about.