Articles Discussing Health Care Reform.

The Affordable Care Act (ACA) mandates that all group health plans and insurance companies provide individuals a “summary of benefits and coverage” (SBC) that outlines the key features and coverage under the plan. This month’s Compliance Corner gives an overview of what the SBC is, why it matters, and how employers can ensure compliance with regulations.

On February 21, 2025, the Internal Revenue Service (“IRS”) released Notice 2025-15, providing guidance to employers and insurers regarding the alternative manner of furnishing certain health insurance coverage statements to individuals under sections 6055(c)(3) and 6056(c)(3) of the Internal Revenue Code (the “Code”).

In the first few days of his second presidential term, newly inaugurated President Trump signed a number of executive orders that will have an impact on the health care industry, some issuing new policies and some rescinding policies set forth by prior administrations.

As we turn the page to 2025, employers and HR professionals are turning their attention to ensuring compliance with the reporting and disclosure requirements of the Affordable Care Act (ACA). Traditionally, this process required preparing and mailing Forms 1095-B and 1095-C to all full-time employees—a time-consuming and labor-intensive task. In

Employer-sponsored health plans would be required to cover over-the-counter contraception, including condoms and emergency contraception, without a prescription and without cost sharing under newly proposed Affordable Care Act (ACA) regulations.

Background

Section 1557 is the non-discrimination provision of the Affordable Care Act (ACA).  Section 1557, which has been in effect since 2010, is intended to prevent discrimination in certain health programs or activities that receive federal financial assistance.   In May of 2024, the Department of Health and Human Services’ (HHS)

Once again, the U.S. Departments of Labor, Health and Human Services, and the Treasury have issued guidance on the Affordable Care Act’s (ACA) required coverage of contraception without cost sharing, clarifying the permitted use of reasonable medical management techniques to set coverage limitations on contraceptive care.

Under the Affordable Care Act (ACA), applicable large employers (ALEs) — i.e., those with, on average, fifty (50) or more full-time or full-time-equivalent employees in the preceding year — must offer in the following year affordable, minimum value group health plan coverage to their full-time employees and those employees’ dependents

Employers, at least for now, may have some relief from some of the Affordable Care Act (ACA) requirements to cover preventive care services without cost sharing under a nationwide injunction issued March 30, 2023, by a federal judge in Texas.

The Consolidated Appropriations Act, 2023 (CAA 2023) holds some welcome news for employers that offer a high deductible health plan (HDHP) option paired with a health savings account (HSA).

The Consolidated Appropriations Act (CAA) adopted a new prescription drug reporting mandate on November 12, 2021. The mandate requires group health plans and group health insurers to submit prescription drug and health care spending reports to the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (“the agencies”) on annual basis. Under the CAA, the following information must be reported to the agencies by December 27, 2022:

The Patient-Centered Outcomes Research Institute (“PCORI”) is an independent nonprofit research organization that funds comparative clinical research, among other things.  PCORI is funded through annual fees — provided for in the Affordable Care Act — paid by insurers of fully-insured health plans and sponsors of self-insured health plans, including health