Compliance
This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.
The Affordable Care Act (ACA) requires fully insured Small Group medical plans to offer an annual one-month Special Open Enrollment (SOE) Window. This period, which runs from November 15 to December 15 annually, allows eligible Small Group employers to enroll in medical coverage without needing to meet the usual contribution or participation requirements. Group coverage obtained during the SOE ...
Legislation signed into law by California Governor Gavin Newsom on September 24, 2024 will subject commercial debt collectors to new compliance requirements starting in 2025.
The IRS has announced new 401(k) contribution limits for 2025. In its release Friday, the agency increased the employee deferral limit to $23,500, up from $23,000 in 2024. The change applies to workplace plans, including 401(k)s, 403(b)s and most 457 plans, along with the federal Thrift Savings Plan. The IRS also unveiled 2025 catch-up contribution limits for savers age ...
The federal hospital price transparency rules adopted in 2021 have been doing more to cut prices than to spur the cheapest hospitals to raise their rates, according to analysts at Turquoise Health.
On October 22, 2024, the Internal Revenue Service (IRS) released Revenue Procedure 2024-40, which increases the health flexible spending account (FSA) salary reduction contribution limit to $3,300 for plan years beginning in 2025, an increase of $100 from 2024. Thus, for health FSAs with a carryover feature, the maximum carryover amount is $660 (20% of the ...
The California legislative season drew to a close September 30th, with Governor Newsom signing several Senate and Assembly Bills that increase the benefits fully insured health plans in California must cover, focusing on maternal healthcare, preventive care, and AI protections.
The U.S. Supreme Court plans to look at states’ ability to regulate pharmacy benefit managers this term. Glen Mulready, Oklahoma’s insurance commissioner, is trying to overturn an appeals court ruling that found that the Employee Retirement Income Security Act of 1974 benefits rule uniformity provisions preempts state efforts to regulate PBMs when the PBMs are serving ...
The proposed rule comes after the CMS reported a growing number of complaints about ACA health plan applications submitted by brokers.
The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. The Centers for Medicare & Medicaid Services (CMS) has required hospitals to post the prices for numerous ...
Employers offering prescription drug benefits to their employees have an important annual duty: by October 14th each year, they must notify Medicare-eligible employees and their Medicare-eligible dependents whether their plan’s drug coverage is "creditable" or "non-creditable" as compared to a standard Medicare Part D drug plan.