The ACA requires insurers to submit an annual report to HHS to account for plan costs. If the insurer does not meet the medical loss ratio (MLR) standards, this means that too large a portion of the premiums charged in the previous year went toward the insurer’s administration, marketing, and profit instead of going toward paying claims and quality improvement initiatives.

The ACA imposed the PCOR fee on health plans to support clinical effectiveness research. The PCOR fee, which applies to plan years ending on or after October 1, 2012, and before October 1, 2029, is generally due by July 31 of the calendar year following the close of the plan year. PCOR fees must be...

The CAA, 2021 requires fully insured and self-insured group health plans to annually report certain information regarding prescription drug and healthcare spending to CMS. Reporting for the 2023 calendar year (termed the “reference year”) is due by June 1, 2024.

Individuals who were HSA-eligible in 2023 have until the tax filing deadline, April 15, 2024, to make or receive 2023 HSA contributions. The 2023 HSA contribution limit is $3,850 for self-only HDHP coverage and $7,750 for any tier of HDHP coverage other than self-only. Employer HSA contributions, if any, are included in the applicable limit.

Applicable large employers (ALEs) with 50 or more full-time employees (FTEs), including full-time equivalent employees, in the prior year who sponsored group health plans (whether insured or self-insured) must comply with IRC Section 6056 reporting in early 2024. Specifically, ALEs must complete and distribute Form 1095-C to full-time employees by March 1, 2024.

All fully insured and self-insured plans (including level-funded plans) of all sizes, including church and governmental plans, must annually disclose to CMS whether their plan’s prescription drug coverage is creditable. Generally, “creditable coverage” refers to prescription drug coverage that is expected to pay (based on the actuarial value) on average at least as much as Medicare Part D coverage.

The Transparency in Coverage Final Rule (TiC) requires non-grandfathered group health plans and carriers to make personalized out-of-pocket cost information available to participants through an internet-based self-service tool. The purpose of the self-service tool is to provide participants with real-time, accurate estimates of...

The deadline for the first CAA gag clause attestation is fast approaching! Employers should act now to ensure their group health plan contracts are compliant and attestations are timely submitted.

Employers must notify individuals who are eligible to participate in their medical plan whether the plan's prescription drug coverage is "creditable" or "non-creditable" as compared to Medicare Part D coverage.

The ACA requires insurers to submit an annual report to HHS to account for plan costs. If the insurer does not meet the medical loss ratio standards, this means too large a portion of the premiums charged in the previous year went towards the insurer’s administration, marketing, and profit, rather than going toward paying claims and quality improvement initiatives. In such case, the insurer must provide rebates to policyholders.