Posts Categorized: Health Benefits

Updated SBC Templates Apply for 2018 Open Enrollment

in Affordable Care Act, Health Benefits

The new SBC templates released last year are required for open enrollment periods beginning on and after April 1, 2017.  For health plans and employers with calendar year plans, this means the updated SBC templates and related requirements apply to 2018 open enrollment occurring this Fall. Given the current House and Senate “repeal and replace” ACA legislation, many employers are wondering if they need to take the time to revise their SBCs to comply with the new template and requirements.  The short answer is use of the new SBC templates are still required.  Both the House-passed legislation and the current… Continue Reading

Eating Disorders and Information Requests under the MHPAEA

in Health Benefits, Welfare Benefits

On June 16, a new FAQ was released and additional steps were taken towards increasing disclosures to participants with respect to mental health/substance abuse benefits.  The FAQ confirms that eating disorders are a mental health condition and, therefore, the treatment of eating disorders is a mental health benefit under MHPAEA.  The Departments also requested comments on whether additional clarification is needed on how MHPAEA applies to this treatment. Perhaps of more consequence to plan administrators, the Departments also released a draft form that can be used by participants and their authorized representatives to request information regarding available mental health/substance abuse… Continue Reading

Ninth Circuit Issues Shocking Opinion Concerning Health Care Provider ERISA Claims

in Court Cases, Health Benefits

The Ninth Circuit Court of Appeals is not known for being employer-friendly.  So, when the Ninth Circuit issued its latest opinion on health care provider ERISA claims, most thought it would be against employer-sponsored health plans.  But, in a shocking opinion, the Ninth Circuit dealt health care providers a serious (and possibly fatal) blow to their recent crusade to use ERISA to pursue claims for reimbursement against employer-sponsored health plans. In DB Healthcare v. Blue Cross Blue Shield of Arizona, Inc. and Advanced Women’s Health Center, Inc. v. Anthem Blue Cross Life and Health Insurance Co., the Ninth Circuit affirmed… Continue Reading

An Employer-Centric Summary of the American Health Care Act

in Affordable Care Act, Health Benefits

Updated on March 13, 2016 Unless you recently were stranded on an uninhabited island, or do not own a mobile phone, computer or television, you likely have not heard that the House released the Affordable Care Act repeal and replace bill. This new bill is referred to as the American Health Care Act (“AHCA”).  While there is much to discuss, at this point, we are only focusing on those provisions that affect employers.  Further, we know that this draft will not be the final legislation, and so overly debating its pros and cons is not practical at this point. In… Continue Reading