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Compliance Alert: RxDC Reporting Obligations for Employer Plan Sponsors

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 …

https://www.epicbrokers.com/insights/rxdc-reporting-obligations-employer-plan-sponsors/

Warren Ables Joins EPIC

Further Expands Texas Employee Benefits Practice We’re thrilled to announce that Warren Ables has joined the firm as a Producer within our growing Employee Benefits Practice. In his new role with EPIC, Ables will be responsible for partnering with clients to develop employee benefit programs. His experience in employee benefits centered on creating and implementing innovative strategies with the goals of employee satisfaction and cost containment. With a background that includes messaging, marketing, and communications, Ables is known for his ability to distill complicated concepts into easily understood information. This allows him to work side-by-side with clients …

https://www.epicbrokers.com/insights/warren-ables-joins-epic/

The Inflation Reduction Act May Impact Employer Health Plans

Background On August 16, 2022, President Biden signed the Inflation Reduction Act (IRA) into law after the Senate and House narrowly approved the law. The new legislation does not directly affect group health plans, but plan sponsors should be aware of potential indirect impacts to their plans. Medicare can now negotiate drug prices Under the IRA, the Department of Health and Human Services (HHS) will establish a program to negotiate prescription drug prices for individuals covered by Medicare. The HHS Secretary will be responsible for negotiating with drug manufacturers to determine the fair price for drugs using factors outlined in …

https://www.epicbrokers.com/insights/inflation-reduction-act-impacts-employer-health-plans/

ERISA Preemption of State PBM Laws

… for state laws that regulate insurance, banking, or securities as provided for under the “saving clause” that allows insurers to be regulated by state law. States may regulate the insurers that provide services to an insurance plan, but not an employee benefit plan itself. The intent of ERISA preemption for employee benefit plans is to keep plan uniformity across the country. Courts use a test to determine whether a state law “relates to” an ERISA plan. As provided in §514, ERISA “shall supersede any and all State laws insofar as they may now and hereafter relate to any employee benefit …

https://www.epicbrokers.com/insights/erisa-preemption-state-pbm-laws/

Compliance Alert: ALE Affordability Considerations and Updates for 2023

… affordable coverage to full-time employees and their dependent children. In addition, individuals who are offered (or eligible for) minimum value, affordable coverage under an employer-sponsored group health plan are not eligible for a tax subsidy when purchasing individual health insurance through a public Exchange. Coverage is generally considered “affordable” if the employee contribution for employee-only (single) coverage does not exceed a set percentage (9.12% in 2023) of household income. Coverage is considered affordable for dependents as well, regardless of the contribution amount, so long as the employee-only (single) coverage is affordable. Coverage is also considered

https://www.epicbrokers.com/insights/compliance-alert-affordability-considerations-updates-2023/

Compliance Alert: New Considerations for Nondiscrimination in Health Plans

… VII of the Civil Rights Act of 1964 and the Affordable Care Act’s §1557 nondiscrimination rules. Court Decisions The 2020 SCOTUS decision in the case Bostock v. Clayton County interpreted that Title VII protection against employment discrimination based on sex extends to discrimination based on an individual’s sexual orientation or gender identity. While the case was not specifically related to employer-sponsored benefit offerings, employer-sponsored health and welfare benefits are part of the employment package and therefore fall under the broad protection of Title VII. Therefore, employers cannot discriminate in how benefits are provided based on sex,

https://www.epicbrokers.com/insights/compliance-alert-new-considerations-nondiscrimination-health-plans/

Compliance Alert: Departments Release Updated Guidance for Contraception Coverage

Quick Facts Under the Affordable Care Act (ACA), all non-grandfathered individual and group health plans are required to provide preventive services coverage with no cost-sharing. The list of required preventive services includes contraception. The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued a new set of frequently asked questions (FAQs) that clarify the requirements for contraception coverage under the Affordable Care Act’s (ACA’s) preventive services coverage mandate. Plans who do not comply with the requirements may be subject to penalties under the Internal Revenue Code (Code) and the …

https://www.epicbrokers.com/insights/compliance-alert-departments-release-updated-guidance-for-contraception-coverage/

EPIC in Central Pennsylvania

Watch Pamela, Brian, David, and John as they share their favorite things about EPIC and Central PA! Enjoy their video messages. What About EPIC Excites You the Most? EPIC Values That Resonate What Motivates You? Favorite Thing in Central PA Tell us More about the Harrisburg Office Pamela, Brian, David, and John are responsible for business development in employee benefits and property and casualty lines at EPIC. With this mighty team’s help, we are opening our new office and expanding our footprint in the community. Office Location 1007 Mumma Road Suite 100 Lemoyne, PA 17043 View our other locations!

https://www.epicbrokers.com/insights/epicinpa/