Healthcare Reform
New Reporting Requirement for Employer-Sponsored Wraparound Coverage
CMS has imposed a new reporting requirement on employers who sponsor wraparound coverage. Few employers will be impacted by the new requirement as wraparound coverage is a specific type of coverage that is rarely offered.
As background, wraparound coverage was introduced in 2015 as a new type of excepted benefit. As an excepted benefit, it's exempt from certain ACA insurance mandates (such as the essential health benefits requirement and the prohibition on lifetime and annual dollar limits) and HIPAA portability (including special enrollment rights).
Wraparound coverage must supplement either non-grandfathered/non-grandmothered individual or multi-state plan coverage. The plan must provide meaningful coverage beyond general cost sharing. The cost of the wraparound coverage must be no more than the greater of the annually indexed health FSA employee contribution limit ($2,650 in 2018) or 15 percent of the cost of the employer's primary medical plan. Importantly, the employees who are eligible for the wraparound coverage must either be retired employees or employees who are not reasonably expected to be full-time (i.e. part-time employees). They must be offered non-excepted coverage by the employer. Further, the employer must still offer full-time employees the opportunity to enroll in minimum value, affordable employer-sponsored medical coverage. Lastly, the coverage must first be implemented between Jan. 1, 2016 and Dec. 31, 2018 and be in effect for no more than three years.
The one-time reporting requirement is due within 60 days after the publication of the form (on June 25) or 60 days after the first of the plan year that the coverage is offered, whichever is earlier. The Wraparound Coverage Reporting Form will collect the following information: the type of coverage that is supplemented (individual or multi-state plan); who is eligible to enroll; number of enrolled; and additional benefits provided by the coverage (for example, services such as home health care or access to an onsite health clinic at no cost).
While wraparound coverage has been available since 2016, very few employers have implemented such coverage because of the limited application. It's really only beneficial for employers wanting to help supplement individual coverage purchased by non-full-time employees who are already eligible for one of the employer's medical plans. Employers are generally not required to offer any type of coverage to such employees. Thus, most employers do not sponsor such a plan and will not be impacted by this new requirement.
Federal Updates
IRS Provides Tax Relief for Victims of Hawaii Volcanic Eruptions and Earthquakes
The IRS recently published guidance containing certain relief for those individuals and businesses affected by the continuing Hawaii volcanic eruptions and earthquakes that started on May 3, 2018.
Specifically, the IRS offered extensions of certain tax filing deadlines because of this natural disaster. The extensions apply automatically to any individual or business in an area designated by the Federal Emergency Management Agency (FEMA) as qualifying for individual assistance. So, in Hawaii, individuals who reside or have a business in Hawaii County may qualify for tax relief. As a result, if a form was due on or after May 3, 2018, and before Sept. 17, 2018, additional time to file the form through Sept. 17, 2018, is available.
The relief would apply to quarterly payroll/employment/excise tax filings due. Additionally, employers in Hawaii County should also keep the relief in mind if they have difficulty gathering the documentation needed to complete their Form 5500. Some employers may still wish to file Form 5558 (Application for Extension of Time to File Certain Employee Returns), which, if timely filed, provides an automatic two-and-a-half months extension (i.e., to October 15 for calendar-year plans).
Stolen Laptop Leads to $4.3M HIPAA Breach Penalty
On June 18, 2018, HHS announced that a $4,348,000 penalty against The University of Texas MD Anderson Cancer Center (MD Anderson) was affirmed by an administrative law judge (ALJ). The penalty resulted from HIPAA privacy and security rule violations and represents the fourth largest amount awarded to OCR for a HIPAA violation.
As background, HHS's Office for Civil Rights (OCR) is responsible for HIPAA enforcement and investigated MD Anderson after three separate data breaches were reported in 2012 and 2013. One breach involved the theft of an unencrypted laptop from the residence of an MD Anderson employee and the other two involved the loss of unencrypted universal serial bus (USB) thumb drives containing electronic protected health information (ePHI) of over 35,500 individuals.
OCR's investigation into MD Anderson found that it was not following its own encryption policies and did not take action when an internal risk analysis discovered that the lack of device-level encryption posed a high risk to the security of ePHI. MD Anderson asserted three different claims as to why their breach was not an unauthorized disclosure. First, they argued that a disclosure had not occurred because there was no proof that a third party had received or viewed the PHI that was left on those devices. The ALJ rejected that argument as nothing in the HIPAA regulations requires that lost information must be viewed by unauthorized individuals in order to be disclosed. Instead, simply releasing PHI constitutes a disclosure for which OCR has the authority to impose a penalty.
Second, MD Anderson defended its actions by asserting that the obligation to encrypt did not exist, since the ePHI was being used for 'research' and was, therefore, not subject to HIPAA's nondisclosure requirements. The ALJ rejected this argument because there is nothing in HIPAA that subjects that HIPAA rules do not apply to PHI that is disclosed in the course of research.
Third, MD Anderson claimed that the actions of employees were unsanctioned and the result of theft, and therefore their actions couldn't be imputed to MD Anderson. However, the ALJ reasoned that HIPAA holds principals liable for the acts of their agents, including employees, when they act within the scope of their duties. In this case, the employees in question had access to the laptop and USB pursuant to their official capacity. So MD Anderson was not off the hook for the actions of its employees.
For employers, this decision is a great reminder that the OCR is pursuing HIPAA privacy violations, especially those issues related to risk management. Employers should conduct routine risk assessments and address any discovered vulnerabilities. When a company is investigated, the OCR will likely impose penalties if a company fails to implement effective safeguards, such as data encryption, as required to protect sensitive information.
Retirement Update
Fifth Circuit Officially Vacates Fiduciary Rule
On June 21, 2018, the United States Court of Appeals for the Fifth Circuit issued an order officially vacating the DOL's Fiduciary Rule. This action comes after the government failed to file an appeal (with the Fifth Circuit or the US Supreme Court) in the U.S. Chamber of Commerce v. DOL case. As a reminder, we discussed this case in the March 17, 2018 edition of Compliance Corner .
The fact that the Rule has been vacated means that the prior five-part test that was used to determine if an investment adviser was a fiduciary is back in place. Specifically, the original regulations identified investment fiduciaries using a test in which the fiduciary:
- Renders advice as to the value of securities
- Does so on a regular basis
- Renders advice pursuant to a mutual agreement
- Gives advice which serves as the primary basis for investment decisions
- Provides individualized advice
It's also possible that the DOL could choose to promulgate new rules. While they have issued a non-enforcement policy for any financial institutions that have relied on the Best Interest Contract (BIC) Exemption and other Rule-related prohibited transaction exemptions (PTEs), the DOL has acknowledged that the Rule being vacated has resulted in a compliance gap that might need to be overcome by new regulations. In other words, investment advisers that are making conflicted investment advice will still need a way to comply with ERISA, even though the Rule and its PTEs have gone away. Until the DOL proposes new rules, advisers who rely on the BIC or other PTEs will be safe from DOL enforcement.
Keep in mind, also, that the SEC has now presented its own rule and some states have even proposed regulations that would mirror the Rule. So it seems clear that the Rule will still affect the retirement industry in some ways.
Although this order seems to end a years-long journey that saw the creation and ultimate demise of this Rule, we will continue to follow any developments concerning the fiduciary status of investment advisers and employer plan sponsors who provide retirement plans.
IRS Updates Voluntary Correction Program Compliance Forms
On July 3, 2018, the IRS released updated model submission forms for its Voluntary Correction Program (VCP). The updated model forms (now dated June 2018) include: Form 14568-B (Other Nonamender Failures and Failure to Adopt a 403(b) Plan Timely), Form 14568-E (Plan Loan Failures including Qualified Plans and 403(b) Plans), and Form 14568- H (Failure to Pay Required Minimum Distributions Timely).
As background, the VCP is a self-correction program that allows an employer to apply to correct mistakes in either the plan document language or plan operations. The updated forms are used in conjunction with Form 1568 -The Model VCP Compliance Statement.
When needed, employers should use the updated model forms going forward. Please note that not all of the VCP model forms have been updated. Those that weren't, seem to have been last updated in either August 2016 or September 2017.
For additional information about the VCP and the related forms, visit: https://www.irs.gov/retirement-plans/voluntary-correction-program-general-description
Announcements
Reminder: Form 5500 Filing for Calendar Year Plans Due July 31
Each year, PPI Benefit Solutions files the Annual Return/Report Form 5500 Schedule A for the ACSA and BIEB Group Insurance Trusts. This filing includes all coverages provided and administered through the Trusts, eliminating the need for Trust members to file for these coverages. Clients may be responsible for filing Form 5500 for benefits and products purchased outside of the ACSA or BIEB Trusts, as well as any employer-sponsored fringe plans such as cafeteria plans, educational assistance plans, or legal plans.
Applicable plan sponsors must file Form 5500-series returns on the last day of the seventh month after their plan year ends. As a result, calendar-year plans generally must file by July 31 of this year (reporting on the 2017 plan year). Plans may request a two-and-a-half-month filing extension by submitting Form 5558, "Application for Extension of Time to File Certain Employee Plan Returns," by that plan's original due date.
As a reminder, group health plans sponsored by a governmental or church entity aren't required to file a Form 5500, as those plans aren't subject to ERISA. Additionally, unfunded, insured or combination unfunded and insured health plans with fewer than 100 participants on the first day of the plan year are also exempt from the filing.
Forms and Instructions >>
Form 5500 EFAST2 >>
Form 5558, Extension of Time >>
PCOR Fee, Form 720 Filing Due July 31
The ACA imposed the PCOR fee on health plans to support clinical effectiveness research. The PCOR fee applies to plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. The PCOR fee is generally due by July 31 of the calendar year following the close of the plan year.
PCOR fees are required to be reported annually on Form 720, "Quarterly Federal Excise Tax Return," for the second quarter of the calendar year. Plan sponsors that are subject to PCOR fees but not other types of excise taxes should file Form 720 only for the second quarter. No filings are needed for the other quarters for such employers.
The PCOR fee is generally assessed based on the number of employees, spouses and dependents that are covered by the plan. For plan years ending in 2017 on or before Oct. 1, 2017, the fee is $2.26 multiplied by the average number of lives covered under the plan. For plan years ending between Oct. 1, 2017, and Oct. 1, 2018, the fee increases to $2.39. Form 720 and corresponding instructions were revised to reflect the increased fee.
The PCOR fee can be paid electronically or mailed to the IRS with the Form 720 using a Form 720-V payment voucher. According to the IRS, the fee is tax-deductible as a business expense.
As a reminder, the insurer is responsible for filing and paying the fee for a fully insured plan. The employer plan sponsor is responsible for filing on a self-insured plan, including an HRA. A stand-alone dental or vision HRA would be exempt and wouldn't be subject to the PCOR fee.
FAQ
With the PCOR fee due date around the corner, can we get a refresher on the employer obligations?
Due Date
The PCOR fee is due Tuesday, July 31, 2018, for all plan years that ended in 2017. The fee is generally due on July 31 of the year following the plan year end date. Please keep in mind that the PCOR fee applies to plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. So, the end of the PCOR fee era is near.
Responsibility
Insurers are generally responsible for the PCOR fee payment and filing for fully insured plans; whereas the employer is generally responsible for the PCOR fee payment and filing for self-insured plans. Special rules apply for determining who is responsible in the situation of an association plan, MEWA or VEBA. The IRS has a helpful
chart
to remind employers which types of plans are subject to the fee. The requirement to pay the fee will remain in place until the plan years ending before Oct. 1, 2019.
Fee Calculation
The general rule is that the PCOR fee is based on the average number of covered lives during the plan year. Importantly, this includes not only employees, but also dependents (spouses, children and others) as well as former employees still receiving coverage under the plan (former employees on disability who are still covered, retirees, COBRA participants, etc.). The IRS allows employers to use any one of four methods for calculating lives, as described below:
- Actual Count Method : Calculate the sum of the lives covered for each day of the plan year and divide that sum by the number of days in the plan year.
- Snapshot Method : Add the total number of lives covered on any date (or more dates, if an equal number of dates are used for each quarter) during the same corresponding month in each of the four quarters of the benefit year (provided that the date used for the second, third and fourth quarters must fall within the same week of the quarter as the corresponding date used for the first quarter). Divide that total by the number of dates on which a count was made.
- Snapshot Factor Method : The calculation is the same as the snapshot method, except that the number of lives covered on a date is calculated by adding the number of participants with self-only coverage on the date to the product of the number of participants with coverage other than self-only coverage on the date and a factor of 2.35. For this purpose, the same months must be used for each quarter (for example, January, April, July and October).
- Form 5500 Method : The plan may use the data reported on the most recent Form 5500. A plan may only use this method if it filed the Form 5500 by July 31. A plan filing an extension for the Form 5500 would have to use another calculation method. If a plan covers only employees, then the plan sponsor would add the number of participants at the beginning of the plan year and at the end of the plan year and divide by two. If the plan covers dependents, the plan sponsor would add the number of participants reported for the beginning of the plan year and the number of participants at the end of the plan year, and report this total.
Employers may switch methods from one year to the next, and should calculate the average number of lives under all four methods and choose the one that is most favorable. For example, a plan that has many covered dependents (employees generally cover three or more dependents) may find that the snapshot factor method is advantageous, since it allows employers to disregard actual dependent count and instead assume 2.35 lives per covered employee. Similarly, if the employer hires more individuals at the end of quarters, the snapshot method may allow an employer to use a date early in each quarter to make a count, which may be advantageous.
Payment
The PCOR fee is filed and paid via IRS Form 720, Quarterly Federal Excise Tax Return. The PCOR fee is reported in Part II of that form, which also includes the amount of the fee (based on when in 2017 the plan year ended). Employers should work with their advisors and tax advisers in ensuring proper filing and payment of the fee.
Penalties
The PCOR fee is treated as a tax. As such, it is generally assessed, collected and enforced in the same manner by the IRS as other taxes. We know of no amnesty or leniency for noncompliance with the PCOR fee filing.
Specifically, the fee is found in the excise tax portion of the IRC, and since the fee is reported on IRS Form 720, there are general penalties that apply for failure to file a return or pay a tax. Those are found in IRC Section 6651 and the penalties vary based on the amount failed to be reported or paid.
The general penalty would be up to 25 percent for a failure that is beyond five months. Like any other tax payment failures, there is also the risk of interest on top of the required amount. There are additional penalties if the failure was due to willful neglect, which means that the employer knew about the requirement but did nothing about it. So, there is definitely a risk involved with not filing and paying the PCOR.
There is no specific guidance on how to correct a failure. Ultimately the employer will want to consult their tax advisor as soon as the problem has been identified. However, as with other tax form and payment failures, it seems prudent and appropriate to come into compliance as soon as possible. Most likely, the employer could start by filing a Form 720 for past years as soon as possible. Generally speaking, the employer needs to file a separate Form 720 for each year, but could file multiple at the same time. Ideally, the employer should consult their tax adviser for advice on precisely how to proceed.
Here are some helpful IRS links:
IRS PCOR Fee Landing Page >>
IRS PCOR Fee FAQs >>
IRS Form 720 >>
IRS Form 720 Instructions >>
State Updates
Connecticut
Telehealth Services
On June 12, 2018, Gov. Malloy signed SB 302 into law. The new law, effective July 1, 2018, revises provisions regarding telehealth services to specify that "telehealth" means delivering health-care services through information and communication technologies to facilitate health-care management, consultation, diagnosis, education, self-management, or treatment of plan participants' physical and mental health when participants are located at originating sites and telehealth providers are located at distant sites. Telehealth includes synchronous interactions, asynchronous store and forward transfers or remote monitoring. Telehealth doesn't include fax transmissions, audio-only telephone, texts or e-mail.
There is no specific action required of employers, but they should work with insurers to understand the required coverage and update the plan accordingly.
Act Mandates Coverage of Essential Health Benefits and Expands Health Benefits for Women, Children and Adolescents
On May 25, 2018, Gov. Malloy signed HB 5210 into law. The new law requires small employer plans to provide coverage for certain preventive care services with no cost sharing to participants. The coverage is similar to that required of non-grandfathered plans under the ACA, but the state mandate will also to grandfathered plans and will remain in place even if the federal requirement is repealed or altered.
The law also requires certain treatment for women, children and adolescents and seems aimed at protecting some of the preventive services guaranteed by the ACA on the state level (should the ACA be repealed, and based on the changes to the contraceptive mandate).
Specifically, plans must provide coverage for preventive care screenings for plan participants age 21 and younger in accordance with most recent edition of American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents or any subsequent corresponding publication. Issuers can't impose coinsurance, copayments, deductibles or other out-of-pocket expenses for coverage of preventive care screenings benefits and services. Cost-sharing when such benefits and services are provided out of network is permissible except in high-deductible health plans that are used to establish HSAs.
Additionally, plans that provide coverage for prescription drugs must provide coverage for immunizations recommended by the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, and immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention
Plans must also provide coverage for evidence-informed preventive care screenings for infants, children, adolescents and women provided in guidelines supported by the federal Health Resources and Services Administration, as effective on Jan 1, 2018, and such additional preventive care and screenings provided for in any comprehensive guidelines effective after Jan. 1, 2018; and evidence-based items or services that have a rating of 'A' or 'B' in the current recommendations of the US Preventive Services Task Force effective after Jan. 1, 2018.
Further, plans must provide coverage for screening and counseling for interpersonal and domestic violence for female plan participants.
And as it pertains to tobacco use by women, plans must provide coverage for tobacco use intervention and cessation counseling for female plan participants who consume tobacco.
In seeking to protect some of the women's services offered under the ACA, the law also requires plans to must also provide certain women's healthcare services coverage for the following preventive care, benefits and services:
- Well-woman visits for female plan participants who are younger than age 65
- Breast cancer chemoprevention counseling for female plan participants who are at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by participants' physicians or advanced practice registered nurses
- Breast cancer risk assessment, genetic testing and counseling
- Gonorrhea, human immunodeficiency virus, chlamydia, cervical and vaginal cancer and sexually transmitted infections screenings for sexually-active female participants
- Human papillomavirus screening for female plan participants with normal cytology results who are age 30 or older
- Anemia screening and folic acid supplements for pregnant female participants and female participants likely to become pregnant
- Hepatitis B and Rh incompatibility screenings for pregnant female participants and follow-up testing for such participants who are at risk for Rh incompatibility
- Syphilis screening for pregnant female participants and female participants who are at increased risk for syphilis
- Urinary tract infection and other infection screenings for pregnant female participants
- Gestational diabetes screening for female participants who are 24-28 weeks pregnant and female participants who are at increased risk for gestational diabetes
- Osteoporosis screening for female participants who are age 60 or older
The same is true of maternity healthcare, and the law requires plans to provide coverage for:
- Anemia screening and folic acid supplements for pregnant female participants and female participants likely to become pregnant
- Rh incompatibility screenings for pregnant female participants and follow-up testing for such participants who are at risk for Rh incompatibility
- Syphilis screening for pregnant female participants and female participants who are at increased risk for syphilis
- Urinary tract infection and other infection screenings for pregnant female participants
- Breastfeeding support and counseling for pregnant or breastfeeding plan participants
- Breastfeeding supplies, including, but not limited to, breast pumps for breastfeeding participants
- Gestational diabetes screenings for female participants who are 24-28 weeks pregnant and female participants who are at increased risk for gestational diabetes
Finally, the law imposes a state requirement for plans to provide coverage for all contraceptive methods. Specifically, plans must provide coverage for the following benefits and services:
- All contraceptive drugs, including, but not limited to, all FDA-approved over-the-counter contraceptive drugs (such plans can require plan participants to use contraceptive drugs designed by the FDA as therapeutically equivalent to contraceptive drugs prescribed to participants prior to using prescribed contraceptive drugs, unless participants' prescribing health-care providers determine otherwise)
- All contraceptive devices and products, excluding all FDA approved over-the-counter contraceptive devices and products (such plans can require plan participants to use contraceptive devices or products designated by the FDA as therapeutically equivalent to contraceptive devices or participants' prescribing providers request less than a 12-month supply. Participants aren't entitled to receive a 12-month supply of such contraceptive drugs, devices, or products more than once during any policy year
- All FDA-approved sterilization procedures for female plan participants
- Routine follow-up services related to FDA-approved contraceptive drugs, devices and products
- Counseling in FDA-approved contraceptive drugs, devices, and products and proper use of such drugs, devices, and products
Keep in mind, though, that the law includes a Religious Employer Exemption. Essentially, employers that are organized to promote religious beliefs, such as churches and church-affiliated organizations aren't required to offer plans that provide coverage for prescription contraceptive methods if contraceptive use conflicts with employer's' religious beliefs. Employers that are organized to promote religious beliefs, such as churches and church-affiliated organizations, aren't required to offer plans that provide coverage for contraceptive benefits and services if contraceptive use conflicts with employers' religious beliefs. There's no specific action required of employers in this regard, but employers with fully-insured plans in Connecticut should work with insurers to understand the required coverage and update the plan accordingly.
Massachusetts
Paid Family and Medical Leave Law
On June 28, 2018, Gov. Baker signed into law Chapter 175M, making Massachusetts the seventh state to provide workers with paid family and medical leave. The new law provides up to 12 weeks of paid family leave and up to 20 weeks of paid medical leave (subject to a combined maximum of 26 weeks total leave in a year). The bill imposes a three year phase-in period, but as of Jan. 1, 2021, all private MA employers must provide "covered individuals" with paid family and medical leave.
Under the law, workers on paid leave will earn 80 percent of their wages (capped at 50 percent of the state average weekly wage) and up to 50 percent of their wages beyond that amount (capped at $850/week, adjusted annually). Unlike federal FMLA that impacts employers with at least 50 employees, the state law will apply to all employers with one or more employees working in MA and will be available to eligible new employees without any hours worked or service time requirements. The law also will apply to certain former employees and self-employed workers.
The paid leave program will be paid by a newly created state trust fund, which will be funded by a payroll tax of 0.63 percent that can potentially be split between the employer and employee (slated to begin by July 1, 2019). The program will be administered by a newly established Department of Family and Medical Leave that is tasked to craft proposed regulations by March 31, 2019. The new law includes notice requirements and associated penalties for noncompliance.
This new law requires significant changes for private employers with employees in MA. Though the funding will not begin until July 1, 2019 and the law's details have not yet been provided, it is important that employers prepare and consider consulting with outside counsel to review policies and practices in response to this new law.
New Hampshire
General Anesthesia for Dental Procedures
On June 8, 2018, Gov. Sununu signed HB 1577 into law. This law requires plans that provide coverage for hospital or medical expenses or oral surgery to provide coverage for general anesthesia and medically necessary hospital or surgical day care facility charges and in-office dental procedures related to dental procedures performed for plan participants who are younger than age 13 and determined by a licensed dentist, in conjunction with a licensed physician, to have a condition of significant dental complexity or have exceptional medical circumstances or developmental disabilities as determined by a licensed physician.
This bill is effective Aug. 7, 2018. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new laws to better understand the required coverages.
Telemedicine Services Must Be Provided
On June 18, 2018, Gov. Sununu signed HB 1471 into law. This law provides that plans cannot exclude health-care services from coverage solely because they are provided through telemedicine if such services are covered when provided through in-person consultation between health-care providers and plan participants. Telemedicine includes delivery of health-care services through audio, video, or other electronic medical for the purpose of diagnosis, consultation, or treatment. Telemedicine doesn't include audio-only telephone conversations or fax transmissions.
This bill becomes effective Aug. 17, 2018. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new laws to better understand the required coverages.
New York
Nondiscrimination Protections
On June 25, 2018, the New York Department of Financial Services issued Ins. Circ. Ltr. No. 9 (2018) as a reminder to all insurers authorized to write accident and health insurance in New York State that, regardless of protections at the federal level, New York State requires non-discrimination protections based on sexual orientation, gender identity and/or gender dysphoria.
As background, Gov. Cuomo believes that the Trump Administration plans to repeal a federal regulation that includes gender identity within the ACA's nondiscrimination protections based on sex. The circular letter notes that New York State Non-Discrimination Provisions protect individuals based on sexual orientation, gender identity and gender dysphoria and remain in-force regardless of the federal non-discrimination protections or lack thereof.
Fully-insured employers do not need to take any action, but it is a good reminder that insurance carriers issuing policies in NY would continue to be bound by that state's laws regarding non-discrimination regardless of whether the related federal regulation is repealed.
Vermont
Mammography Screenings
On May 21, 2018, Gov. Scott signed HB 639 into law. The newly enacted law requires plans to provide coverage for mammography screenings to detect the presence of occult breast cancer. Specifically, plans must provide coverage for annual screening mammograms for female plan participants age 40 and older and screening mammograms for participants younger than age 40 if recommended by participants' health-care providers. Plans must also provide coverage for screening by ultrasound for plan participants whose screening mammogram results were inconclusive, showed dense breast tissue, or both.
The coverage must meet the following requirements:
- Coverage must include the full cost of mammography services and can't be subject to any copayments, coinsurance, cost-sharing requirements or additional charges
- Coverage applies only to screening procedures conducted by test facilities accredited by the American College of Radiologists
- Mammography means x-ray examination of breasts using equipment dedicated specifically for mammography, including x-ray tubes, filters, compression devices, screens, filters and cassettes
- Screenings include mammography test procedures and a qualified physician's interpretation of procedure results, including additional views and interpretation as needed
The bill is effective for plan years beginning after Jan. 1, 2019. The bill contains no new employer obligations, but employers with fully-insured plans in Vermont should review the new laws to better understand the required coverages.
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.
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Industry news topics covered in the Compliance Corner are chosen based on general interest to most employers and may include articles about services not available through PPI.
FAQ
With the PCOR fee due date around the corner, can we get a refresher on the employer obligations?