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Employee Benefits Law Report Reporting on recent trends and developments affecting employee benefits

Tag Archives: Department of Health and Human Services

Health and Welfare Plans Audits on the Rise, Are You Ready?

Posted in Health and Welfare Plans

While audits of qualified retirement plans have become commonplace, audits of health and welfare plans have historically been much less common. Only a select group of “lucky” employers was subjected to health and welfare plan audits, and the scope of those audits was somewhat limited. Unfortunately, it appears that trend is ending. We are seeing a notable increase in the frequency of health and welfare plan audits, and the scope of these audits is becoming much broader. Employers have rights, and the agencies have rules the auditors are required to follow. We encourage employers who receive a phone call or …


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Health Care Plan Annual Enrollment Triage: The Summary of Benefits and Coverage Standards Have Not Been Issued Yet and May Just Have to Wait

Posted in Health and Welfare Plans, Health Care Reform

M*A*S*H* taught us how to do triage, and MacGyver taught us to creatively think our way out of an impossible situation. Both are skills that may come in handy for the many employers who maintain calendar year health plans and who were in the process of preparing for annual enrollment when the Summary of Benefit and Coverage (SBC) proposed regulations were recently announced.

The SBC requirements do not apply to this year’s enrollment process, and, as a practical matter, this proposed guidance is probably too late and incomplete for many employers to address right now. Further, for an insured plan, …


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PPACA Standards For Coverage Of Preventive Care Extended To Contraceptives

Posted in Health Care Reform

On Monday, August 1, 2011, the Obama administration announced new guidelines that require health care plans to cover certain women’s preventive services, including birth control and voluntary sterilization. The action taken by the United States Department of Health and Human Services (the “HHS”) adopts recommendations made by the Institute of Medicine, which recently issued a report dealing with a review of women’s health needs. In that report, the Institute of Medicine concluded that contraceptive coverage was justified because nearly half of all pregnancies in the United States are unintended and a significant percentage of these pregnancies lead to abortions. Thus, …


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After Earlier Grace, Departments Now Relax Certain Health Claims Procedure Requirements

Posted in Health and Welfare Plans, Health Care Reform

Fresh off an extension this past spring of an enforcement grace period with respect to internal health claims and appeals requirements, sponsors of non-grandfathered group health plans received some more welcome news recently with the relaxation of certain group health claims procedure requirements first announced in interim final rules issued in July 2010. Although plan sponsors have been challenged to keep up with the various pieces of claims procedure guidance issued by the regulatory agencies over the past year, they may find these recent changes to be, in many ways, worth the wait and effort.…


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Department of Labor Extends More Grace on Internal Health Claims and Appeals

Posted in Health and Welfare Plans, Health Care Reform

In Technical Release 2011-01, the Department of Labor has extended the enforcement grace period with respect to certain internal claims and appeals requirements applicable to non-grandfathered health plans under the Patient Protection and Affordable Care Act (PPACA) and its implementing regulations. The internal health claims and appeals requirements generally apply to non-grandfathered plans as of the first plan year beginning on or after September 23, 2010. The requirements do not apply to grandfathered plans.…


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