Tag Archives: DoL

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Technical guidance for self-insured health plans on federal external review process
The U.S. Department of Health and Human Services issued “Technical Guidance – Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Coverage.” This release replaces the technical guidance issued June 22, 2011, with standards adopted in the final regulation at 76 FR 37208 that further define requirements under Public Health Service Act (PHS Act) section 2719(b)(1).

For more information, click here.

Agencies issue ACA FAQs, Part 37
The U.S. Departments of Treasury, Labor (DoL), and Health and Human Services released frequently asked questions (FAQs) Part 37 regarding Patient Protection and Affordable Care Act (ACA) implementation. The FAQs highlight: health reimbursement arrangements (HRAs); integration of HRAs with group health plans sponsored by the employer of a spouse of an employee; Code Section 162(m)(6); and more.

To read the FAQs, click here.

DoL issues FY 2016 MHPAEA enforcement fact sheet
The Employee Benefits Security Administration (EBSA) enforces the law governing 2.2 million private employment-based group health plans, which cover 130.8 million participants and beneficiaries. EBSA relies on its 460 investigators to review plans for compliance with ERISA, including the Mental Health Parity and Addiction Equity Act (MHPAEA). EBSA released its first annual MHPAEA enforcement fact sheet, summarizing its enforcement activity in fiscal year (FY) 2015.

To read the fact sheet, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Final rule on health insurance premium tax credit
The Internal Revenue Service (IRS) released a final rule relating to the health insurance premium tax credit (premium tax credit). These final regulations affect individuals who enroll in qualified health plans through health insurance exchanges and claim the premium tax credit, and exchanges that make qualified health plans available to individuals and employers.

These final regulations also affect individuals who are eligible for employer-sponsored health coverage.

To read the entire rule, click here.

New HHS report details impact of the Affordable Care Act
The U.S. Department of Health and Human Services (HHS) released an extensive compilation of national and state-level data illustrating the substantial improvements in healthcare for all Americans in the last six years. According to the HHS data, the uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Patient Protection and Affordable Care Act (ACA). But beyond those people who would otherwise be uninsured, millions of Americans with employer, Medicaid, Medicare, or individual market coverage have benefited from new protections as a result of the law.

To access the report, click here.

Guide for electronically filing ACA Information Returns (AIR) for software developers and transmitters
A new IRS publication outlines the communication procedures, transmission formats, business rules, and validation procedures for information returns transmitted electronically through the AIR system.

For more information, click here.

DoL issues final rule on claims procedures for disability benefits
The U.S. Department of Labor (DoL) released a final regulation revising the claims procedure regulations under ERISA for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the ACA. This rule affects plan administrators, participants, and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

To read the final rule, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Agencies release mental health and substance use disorder parity guidance
The Mental Health and Substance Use Disorder Parity Task Force published its final report highlighting the progress to date on parity implementation, summaries of comments from stakeholders, and actions taken during the Task Force’s tenure. The report offers the following recommendations on how to support consumers, improve parity implementation, and enhance parity compliance and enforcement.

Parity aims to eliminate restrictions on mental health and substance use coverage—like annual visit limits, higher copayments, or different rules on how care is managed, such as frequent preauthorization requirements or medical necessity reviews—if comparable restrictions are not placed on medical and surgical benefits.

To download the entire report, click here.

IRS general rules and specifications for ACA substitute forms
The Internal Revenue Service (IRS) issued Publication 5223 setting forth 2016 requirements for using official IRS forms to file information returns with the IRS, preparing acceptable substitutes of the official IRS forms to file information returns with the IRS, and using official or acceptable substitute forms to furnish information to recipients.

To download the entire publication, click here.

Agencies release final rule on excepted benefits, lifetime and annual limits, and more
The IRS, the Department of Labor (DOL), and the Department of Health and Human Services (HHS) have released a final rule regarding the definition of short-term, limited-duration insurance for purposes of the exclusion from the definition of individual health insurance coverage, and standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits. The document also amends a reference in the final regulations relating to the prohibition on lifetime and annual dollar limits.

To read the entire final rule, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

DoL issues ACA implementation FAQ on premium reduction arrangements for student health coverage
The Department of Labor (DoL) has issued frequently asked questions (FAQs) about Patient Protection and Affordable Care Act (ACA) implementation (Part 33), concerning premium reduction arrangements for student health plan coverage.

To read the entire FAQ, click here.

ACA Information Returns (AIR) submission composition and reference guide
The Internal Revenue Service (IRS) issued “Early Look AIR Submission Composition and Reference Guide – Processing Year 2017.” The purpose of the document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to the IRS. The document covers details on composing and submitting Forms 1094/1095-B and Forms 1094/1095-C by transmitters to the IRS.

To read the entire guide, click here.

Agencies propose new, expanded Form 5500 group health plan reporting

Group health plan sponsors would be required to provide significant amounts of information about the plans when filing the annual Form 5500 with the U.S. Department of Labor (DoL), under a recently released proposed rule from the agency, along with a separate proposed rule from the DoL, Treasury/Internal Revenue Service (IRS), and the Pension Benefit Guaranty Corporation (PBGC).

The DoL’s proposal, which affects only ERISA-covered plans, would amend the reporting and disclosure requirements for other welfare benefits and retirement plans, but this Client Action Bulletin (CAB) focuses only on group health plan information, including from sponsors of grandfathered group health plans and from sponsors of certain small plans that to date have been exempt from filing. The DoL anticipates applying the new requirements to plan years starting in 2019 (i.e., filings made in 2020).

For simplicity, this CAB refers to both sets of rules as the DoL’s proposed rule.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

House panel advances health bills
The House Ways and Means Committee approved seven healthcare bills recently, including the following that would apply to employer-sponsored plans:

• H.R.5445 (the “Health Care Security Act”), which would increase the annual contribution limits for health savings accounts (HSAs), allow for catch-up contributions by both spouses to a single account, and permit the payment of expenses incurred 60 days before an account is established.
• H.R.5447 (the “Small Business Health Care Relief Act”), which would permit qualified small employers that do not offer a group health plan to reimburse up to $5,130 annually/employee ($10,260/family) for the cost of buying health insurance.
• H.R.210 (the “Student Worker Exemption Act”), which would exclude full-time students who are employed by an institution of higher education from being counted as full-time employees in calculating the institution’s shared responsibility coverage requirement under the Patient Protection and Affordable Care Act (ACA).
• H.R.3080 (the “Tribal Employment and Jobs Protection Act”), which would eliminate the ACA’s employer mandate for businesses owned by Indian tribes.

House panel approves mental health bill with group health plan implications
The House Energy and Commerce Committee voted 53-0 to approve a substitute mental health bill (H.R.2646) called the “Helping Families in Mental Health Crisis Act.” The full House is not expected to act on the measure until sometime in September.

The bill generally calls for improving oversight of certain mental health and substance abuse programs. There are, however, some provisions that affect employer-sponsored plans, including a directive for the Departments of Health and Human Services, Labor, and Treasury to coordinate and issue a “compliance program guidance” document relating to mental health parity that provides examples/illustrations of informative disclosures and nonquantitative treatment limitations, as well as descriptions of the violations uncovered during the course of compliance investigations.

In addition, if a group health plan or group insurance provides coverage for eating disorder benefits, then the plan/insurance, under the bill, must provide such benefits consistent with the mental health/substance use disorder benefits parity requirements.