Employee Benefits Archives - EMPLOYEE BENEFITS BLOG

Breaking Down the New No Surprises Act FAQs Post-TMA III

by Drew Elizabeth McCormick, Jamie Gelfman, Kristen O'Brien, Jeffrey Davis and Abygail Hoey | Mar 25, 2025 | Employee Benefits, Health and Welfare Plans

On January 14, 2025, the US Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management, released Part 69 of a series of FAQs aimed at helping stakeholders understand and comply with the federal No Surprises Act.

This latest set of FAQs focuses on how health plans and issuers should determine the qualifying payment amount and includes updates to disclosure and patient cost-sharing requirements, reflecting the recent rulings by the US District Court for the Eastern District of Texas and the US Court of Appeals for the Fifth Circuit in the case of Texas Medical Association, et al. v. United States Department of Health and Human Services, et al.

Read more here.

Price Transparency: A Trump Administration Regulatory Priority

by Jeffrey Davis and Leigh Feldman | Mar 13, 2025 | Employee Benefits, Health and Welfare Plans

On February 25, 2025, the Trump administration highlighted one of its priorities in an executive order on price transparency. While the order primarily focuses on enforcing existing price transparency requirements, it also suggests potential changes or expansions, which would necessitate rulemaking. Potential impacts on health plans include the requirement to make detailed pricing information publicly available and to provide an online shopping tool. This tool will allow consumers to see the rates negotiated by their providers and plans, as well as an estimate of their out-of-pocket costs for 500 of the most shoppable items and services.

Read more here.

How PPM Health Plans Can Solve the MEWA Problem

by Sarah Raaii, Alden Bianchi, Erin Turley, Teal Trujillo and Allison Wilkerson | Mar 6, 2025 | Employee Benefits, Health and Welfare Plans

A physician practice management (PPM) structure can help ensure compliance with corporate practice of medicine laws and simplify administrative tasks. However, it can also unintentionally lead to health plan issues that need to be carefully managed to prevent compliance problems or complications when selling PPM entities.

Read more here.

New York Assembly Passes Restrictive Health Information Privacy Act

by Katelyn Ringrose, Amy C. Pimentel, Alexander Southwell and Sam Siegfried | Mar 4, 2025 | Employee Benefits, Health and Welfare Plans, Privacy and Data Security

On January 22, 2025, the New York Assembly passed Senate Bill S929, known as the New York Health Information Privacy Act. If enacted, it will impose strict requirements on entities that handle health or wellness-related consumer data.

Read more here.

Examining Group Health Coverage Alternatives for Small Employers

by Alden Bianchi, Sarah Raaii, Teal Trujillo and Erin Turley | Feb 27, 2025 | Employee Benefits, Health and Welfare Plans

Small employers have long struggled to offer comprehensive major medical coverage to their workers and families, mainly due to underwriting hurdles. Groups with fewer than 50 employees are often confined to state small group market plans, which can be costly. Even slightly larger groups, underwritten based on their own claims history, still face a significant lack of transparency. As a result, many of these employers are exploring alternative solutions, such as association-style plans, group medical stop-loss arrangements, level-funded products, and individual coverage Health Reimbursement Arrangements.

This Special Report delves into the challenges small employers face and the various options they can consider to provide group health coverage.

Access the report.

Trump Administration Places DOL’s ESOP Proposals in Regulatory Moratorium

by Ted Becker, Allison Wilkerson, Erin Turley and Myriem Bennani | Feb 25, 2025 | Employee Benefits, Employee Stock Ownership Plans (ESOPs), Retirement Plans

On January 16, 2025, the US Department of Labor’s (DOL) Employee Benefits Security Administration released two proposed regulations related to employee stock ownership plans (ESOPs). One regulation aims to clarify the valuation process for non-publicly traded employer stock, while the other would provide a safe harbor for transactions involving newly established ESOPs.

However, on January 20, 2025, the Trump administration froze all pending proposals, including the DOL’s ESOP regulations. If finalized, these regulations would dramatically change the landscape for fiduciaries responsible for valuing stock in privately held corporations during transactions with ESOPs.

Read more here.

Congress Extends Certain Telehealth Flexibilities Through March 31, 2025

by McDermott Will & Emery | Feb 20, 2025 | Employee Benefits, Health and Welfare Plans

At the close of 2024, the US Congress passed a short-term extension of Medicare telehealth flexibilities as part of the American Relief Act, 2025. The Medicare telehealth waivers, originally enacted as part of the COVID-19 public health emergency and subsequently extended through legislation, were set to end on December 31, 2024. These flexibilities, along with the Acute Hospital Care at Home waiver program, are now set to expire March 31, 2025.

Read more here.

DOJ Announces Largest Employee Retention Credit Fraud Indictment

by Michael Scarduzio, Samuel Hamer, Edward Froelich and Shawn O’Brien | Feb 11, 2025 | Employee Benefits

On January 22, 2025, the US Department of Justice announced the indictment of seven individuals in the largest Employee Retention Credit fraud scheme to date. According to the indictment, the defendants filed more than 8,000 refund claims for ERCs and Sick and Family Leave Credits, totaling more than $600 million.

Read more here.

Global Equity Plan Reporting Obligations for Calendar-Year 2025: Part One

by Rob Marshall and Lauren Salas Mationg | Feb 6, 2025 | Employee Benefits, Fiduciary and Investment Issues

Companies with global equity plans should be aware of their reporting obligations with respect to their equity awards. This client alert highlights key reporting obligations in certain countries related to equity plan activity for the prior calendar year (i.e., 2024) and ongoing obligations during calendar-year 2025.

Read more here.

2025 Employee Benefits & Workplace Predictions

by Alden Bianchi | Jan 30, 2025 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

Managing healthcare costs often feels like an endless struggle for benefits professionals, employers, and employees. Nevertheless, benefits professionals persist in their efforts to control escalating healthcare expenses.

In this article, Alden Bianchi and industry members share their predictions about the healthcare landscape, zeroing in on primary care, weight loss drug coverage, the Affordable Care Act, and artificial intelligence.

Read more here.

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