Benefits Blast

While recent regulatory developments—including the Departments’ nonenforcement policy, proposed legislation, and new transparency rules—offer employers and plan fiduciaries greater flexibility and potential relief, they also underscore the need for continued vigilance. From ensuring compliance with longstanding MHPAEA obligations to evaluating benefit design changes, managing PBM relationships, and addressing nondiscrimination concerns in self-funded plans, stakeholders must stay proactive and informed to navigate the evolving health and welfare benefits landscape effectively.While recent regulatory developments—including the Departments’ nonenforcement policy, proposed legislation, and new transparency rules—offer employers and plan fiduciaries greater flexibility and potential relief, they also underscore the need for continued vigilance. From ensuring compliance with longstanding MHPAEA obligations to evaluating benefit design changes, managing PBM relationships, and addressing nondiscrimination concerns in self-funded plans, stakeholders must stay proactive and informed to navigate the evolving health and welfare benefits landscape effectively.

In the past few months, group health plans have experienced a surge of litigation challenging premium surcharges based on participants’ tobacco use.

As 2025 begins, we wanted to highlight several important changes that will impact employer-sponsored group health plans.

On December 15, 2022, the Internal Revenue Service (IRS) issued final regulations that permanently extend by 30 days the deadline for furnishing Form 1095-C and Form 1095-B to individuals. The forms will now be due on March 2 (March 3 in a leap year), or the next business day if the due date falls on a weekend or holiday. The proposed regulations were issued in November 2021.

In Internal Revenue Service (IRS) Notice 2022-59, the IRS released the new Affordable Care Act’s (ACA) Patient-Centered Outcomes Research Institute (PCORI) fee for policy and plan years that end on or after October 1, 2022, and before October 1, 2023.

The IRS recently published its annual inflation adjustment to the percentage of household income used to determine whether an employer’s offer of health care coverage under the Affordable Care Act (ACA) is considered affordable in the 2023 plan year.

Earlier this month, the Internal Revenue Service (IRS) issued Notice 2020-76, which has once again extended the due date for certain reporting requirements under Internal Revenue Code (Code) §§ 6055 and 6056, as added by the Affordable Care Act (ACA).

The signing of the Further Consolidated Appropriations Act, 2020, H.R. 1865 (Act) at the close of 2019 unfortunately provided an extension of the Affordable Care Act’s (ACA) Patient-Centered Outcomes Research Institute (PCORI) fees.

On September 12, the Department of Health & Human Services, Centers for Medicare & Medicaid Services published guidance on claiming a hardship exemption for failing to secure health insurance for the 2018 tax year.

We will know the answer to this question shortly. A Texas Federal judge said September 5, 2018, during court proceedings in Texas et. al v. United States of America et al, that he'll soon issue a ruling on whether the Affordable Care Act (ACA) should be struck down given the repeal of the individual mandate, effective for 2019.

The Department of Labor (DOL) recently issued an ERISA compliance assistance bulletin for Association Health Plans (AHPs). The guidance highlights the various rules that apply under ERISA for managing and operating a group health plan.

The IRS published its annual inflation adjustment to the percentage of household income used to determine whether an employer’s offer of health care coverage under the Affordable Care Act (ACA) is affordable in 2019.

The Affordable Care Act (ACA) introduced an annual fee on insurers and self-insured plan sponsors to help fund the Patient-Centered Outcomes Research Institute, often referred to as the “PCORI fee.” The fee has been in effect for several years, and the next payment deadline is fast approaching: July 31, 2018. This deadline includes, for example, payments due for the calendar year plan year that ended on December 31, 2017.

On January 22, 2018, President Trump signed into law a short-term continuing resolution passed by the House and Senate (H.R. 195) that ended a three-day federal government shutdown and will fund the government through February 8, 2018.

Yesterday, the IRS provided much needed relief to employers working to comply with Affordable Care Act (ACA) reporting requirements. The IRS relief extends the due dates for the 2015 reports that employers must provide to individuals and to the IRS.

The budget deal approved by Congress last week – and signed by President Obama on Friday – includes a delay of the so-called “Cadillac Tax” until 2020.