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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/

Market Pulse Survey: Cost Containment and Non-Traditional Benefits

How does your company balance increasing benefits plan costs while meeting employees’ evolving needs? Take our Cost Containment and Non-Traditional Benefits survey to see how other companies are addressing this challenge The suppression in medical costs stemming from the pandemic has ended and employers have seen that increased claims and medical cost inflation are back with a vengeance. Simultaneously, employers need to be highly competitive with their benefits and other perk offerings to attract and retain talent. Take our brief survey to let us know what cost containment strategies you are considering and what additional benefits/perks you offer …

https://www.epicbrokers.com/insights/market-pulse-survey-cost-containment-non-traditional-benefits/

Compliance Alert: Enforcement Action for Contraception Coverage

Quick Facts On June 27, 2022, the Departments released a letter encouraging group health plans to fully comply with requirements to cover contraception with no cost-sharing. 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 guidance is clear that medically appropriate or necessary contraception must be fully covered by the group health plan. Background On June 27, 2022, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury (collectively, the Departments) released a …

https://www.epicbrokers.com/insights/compliance-alert-contraception-coverage-enforcement/

Compliance Alert: Prescription Data Collection Reporting Is Coming Soon

… time by December 27, 2021, and then by June 1 of each year thereafter; however, In August 2021, the Departments delayed enforcement to December 27, 2022 for reports on 2020 and 2021 data. Subsequent reports will be due June 1. Reporting Requirements The IFR requires employer-sponsored health plans and carriers to annually submit certain information on prescription drug and other healthcare spending to the Departments. The instructions break down the required information into two categories, Plan Lists (P) and Data Lists (D). P1. Individual and Student Market plan list P2. Group Health plan list P3. Federal Employee Health Benefit

https://www.epicbrokers.com/insights/compliance-alert-prescription-data-reporting/