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… funded plans PCORI Fees A level-funded plan sponsor is required to pay the Patient Centered Outcomes Research Institute (PCORI) fee each year. Occasionally, the level-funded plan vendor may include the PCORI fee in the monthly payment amount and submit the payment to the Internal Revenue Service (IRS) on the employer’s behalf. Wrapping the PCORI fee into the monthly payment amounts, which may be paid in part by employee contributions, can be problematic. Accordingly, in most cases, the level-funded plan sponsor is responsible for reporting and paying the PCORI fee each year. ACA Reporting Because it is

Quick Facts On August 19, 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury released updated guidance on the prohibition against balance billing under the No Surprises Act (NSA) and the machine-readable files requirements under the Transparency in Coverage (TiC) rules. Under the NSA Final Rule, effective January 1, 2022, health plans (which include employer-sponsored health plans) and carriers must not balance bill patients for certain services including emergency care, non-emergency services provided at an in-network facility from an out-of-network provider, and air ambulance charges. Under the TiC Final …

Quick Facts Starting in 2022, employer-sponsored health plans must submit prescription drug and healthcare spending information to the Departments annually. The first report is due December 27, 2022, then annually on June 1. Employers may rely on a third-party reporting entity to submit information on their behalf. Employers must rely on their vendors to supply much of the information required for submission. Employers should take steps to ensure that reporting entities are fulfilling their obligations to report. Background As part of the Consolidated Appropriations Act of 2021 (CAA), employer-sponsored health plans will be required to submit certain …