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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 …

… 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

… 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,