Health and Welfare Plans 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.

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.

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.

Supreme Court’s Transgender Case May Affect Travel Benefits

by Alden Bianchi and Sarah Raaii | Jan 28, 2025 | Employee Benefits, Health and Welfare Plans

The US Supreme Court is currently reviewing a case (US v. Skrmetti) concerning Tennessee’s ban on gender-affirming care for youth. If the Court upholds the ban, some employers might consider offering travel benefits to help employees access healthcare services that are prohibited by state law. This could also apply to other plan-covered services that are not available within a certain geographic distance.

Read more here.

California SB 923: New Trans-Inclusive Healthcare Requirements for Health Plans

by Gregory Fosheim, Dane Chapman, Sarah Raaii and Teal Trujillo | Jan 24, 2025 | Employee Benefits, Health and Welfare Plans

Beginning in the first quarter of 2025, California healthcare service plans, health insurers, and certain other organizations must ensure that staff who have direct enrollee contact receive evidence-based cultural competency training focused on transgender-inclusive healthcare. This requirement arises from Senate Bill No. 923, a law passed by the California legislature in 2022. Provider directories must also be updated by March 1, 2025, to identify which in-network providers have previously offered gender-affirming services.

Read more here.

New Rules Simplify ACA Employer Shared Responsibility Reporting Obligations

by Jacob Mattinson, Sarah Raaii and Alden Bianchi | Jan 21, 2025 | Employee Benefits, Health and Welfare Plans

Two recently passed laws have modified the provisions of the Affordable Care Act (ACA) that require employers and insurers to prepare tax forms showing offers of health coverage, streamlining the compliance and reporting process.

Under the ACA’s employer shared responsibility provisions, applicable large employers must either offer qualifying health coverage to full-time employees (and their dependents), or they may face significant excise taxes. Employers may also face penalties if they fail to report, or make mistakes in reporting, the offered coverage. These new rules will ease the reporting burdens on employers seeking to prove that they follow these complex and demanding requirements.

Read more here.

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