Benefits - ACA

Enhanced subsidies for individual health insurance under the Affordable Care Act (ACA) are set to expire on December 31, 2025, unless the U.S. Congress agrees to retain them. This change could make recruiting and retention more difficult in 2026 for employers filling jobs that do not come with emplo

The Centers for Medicare and Medicaid Services (“CMS”) “60-Day” overpayment rule (“60-Day Rule”) was established as part of the Affordable Care Act (“ACA”) in 2010. [i] In a nutshell, Section 1128J(d) [ii] of the ACA provides that a person who has received an overpayment shall report and return the

Last month, in Faulk Company, Inc. v. Xavier Becerra, et al. 4:24-CV-00609-P (April 10, 2025) , the U.S. District Court for the Northern District of Texas granted an employer’s challenge to employer shared responsibility penalties assessed by the Internal Revenue Service (“IRS”) and ordered IRS to r

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, a

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

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 employee

Congress recently passed the Employer Reporting Improvement Act and the Paperwork Burden Reduction Act (the Acts), which are now awaiting President

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 .

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

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 Hu

In 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage Final Rules (TiC Final Rules) which, among other things, require non-grandfathered group health plans to post on a public website certain plan pricing information in machine-readable files (MRFs) by Jul

The Supreme Court of the United States, on April 28, 2022, held that emotional distress damages are not available for private discrimination claims under the federal Rehabilitation Act of 1973 and the Affordable Care Act (ACA).

The U.S. Supreme Court ruled that emotional distress damages are not recoverable in private actions to enforce statutes authorized by the Spending Clause of the U.S. Constitution. Cummings v. Premier Rehab Keller, P.L.L.C. , No. 20-219 (Apr. 28, 2022).

Plan participants can be hit with surprise medical bills when they receive care from out-of-network providers. Sometimes, this happens when participants do not know that the care they are receiving is from an out-of-network provider, like when they have surgery at an in-network facility only to find

A federal court ruling staying key parts of new Affordable Care Act (ACA) regulations in light of the landmark Supreme Court of the United States ruling on sexual orientation and gender identity will provide little certainty to employers about how federal discrimination law applies to their health p