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… Parity and Addiction Equity Act (MHPAEA). The DOL and New York Attorney General (NYAG) settled with United Behavioral Health and United Healthcare Insurance Co. (United) following litigation and investigation into MHPAEA violations. According to the settlement, United must pay affected participants and beneficiaries, pay penalties and take corrective actions. The Employee Benefits Security Administration (EBSA) investigates alleged violations of the MHPAEA, including those alleged in Walsh v. United Behavioral Health and UnitedHealthcare Insurance. The MHPAEA requires group health plans (GHPs), whether fully insured or self-funded, to provide the same level of benefits to participants for mental health and substance …

… by debit card transactions to the plan. When a debit card transaction gives the required information, substantiation occurs automatically or as a real-time substantiation. The rules also permit an FSA plan sponsor to coordinate with the participant’s health plan to use the information provided in an explanation of benefits (EOB) to substantiate a debit card charge without requiring more information. Further, the debit card rules allow automatic substantiation when a plan approves a recurring QME payment incurred at certain providers that match the amount, medical care provider and time period of previously approved QMEs. These rules permit an

On Monday, August 30, 2021, the Internal Revenue Service (IRS) issued Rev. Proc. 2021-36. The revenue procedure provides the required contribution percentage and applicable percentage table for the 2022 calendar year. An employer-sponsored benefits plan uses the required contribution percentage to determine whether the plan is affordable according to the Affordable Care Act (ACA) Section 4980H(b) requirements. The applicable percentage table is used to calculate an individual’s premium tax credit (PTC). These 2022 indexed adjustments for affordability and PTC determinations are discussed in more detail below. The employer shared responsibility (ESR) provisions under Section 4980H of …

The Departments of Labor, Health and Human Services (HHS) and the Treasury (collectively, the Departments) released the Transparency in Coverage (TiC) Final Rules on November 12, 2020. The TiC Final Rules set forth requirements for group health plans (GHPs) and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request to a participant, beneficiary, or enrollee. The Consolidated Appropriations Act, 2021 (CAA) became law on December 27, 2020. The year-end appropriations bill included ongoing relief and funds relating to the COVID-19 pandemic, permissible changes to Flexible Spending Accounts (FSAs) and Dependent Care …