Can Employers Offer Different Benefits to Different Groups of Employees?

On March 17, 2025

The Health Insurance Portability and Accountability Act (HIPAA) prohibits group health plans and group health insurance issuers from discriminating against individuals regarding eligibility, premiums, or coverage based upon a health status-related factor. The HIPAA nondiscrimination provisions set forth eight “health factors” that may not be used to discriminate in health coverage among individuals: Similarly Situated Individuals While […]

On March 10, 2025

The Trump administration has released another executive order (EO) with the potential to impact employers. It is titled “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This EO, intended to increase enforcement of price transparency requirements, orders the Department of Labor, Treasury, and Department of Health and Human Services […]

On March 3, 2025

The HIPAA nondiscrimination rule states that an employer cannot “refuse to provide benefits because an individual is not actively at work on the day that individual would become eligible for benefits.” Yet, actively-at-work clauses, which require an individual to be actively at work on the day their benefits become effective, remain....

On February 10, 2025

Employer-sponsored health plans that offer prescription drug coverage to Medicare-eligible individuals must meet an important annual reporting requirement: submitting the Disclosure to CMS Form to confirm whether their prescription drug coverage is creditable or non-creditable compared to Medicare Part D. With the deadline approaching, plan sponsors should ensure they file their disclosure on time to avoid compliance issues. Below […]

On January 27, 2025

Over the last several years, many states have passed mandatory paid leave laws allowing employees to continue to receive at least partial wages when they cannot work due to injury, illness, or disability to themselves or covered family members. While these state laws provided clear guidance on when and how much leave could be taken, […]

On January 6, 2025

On Dec. 27, 2024, the U.S. Department of Health and Human Services (HHS) released a proposed rule that would modify the HIPAA Security Rule to strengthen cybersecurity protections for electronic protected health information (ePHI). Although the changes are substantial, they are only in proposed form at this point. Employers with self-insured health plans and those […]

On December 30, 2024

The Employee Retirement Income Security Act of 1974 (ERISA) governs employee benefit plans maintained by private-sector employers. ERISA requires that employer-sponsored welfare benefit plans, such as group health plans, be described in a written plan document. Employers must also provide participants with a Summary Plan Description (SPD) that explains the plan’s terms. Note, however, that […]

On December 23, 2024

On Saturday, December 21, 2024, President Biden signed the American Relief Act of 2025 (ARA) into law, averting a federal government shutdown. After intense negotiations, Congress reached a deal Saturday just in time for the holidays, opting to fund the government at current levels through March 14. Failing to reach a deal would have resulted in the […]

On December 16, 2024

Update as of 12/24/2024: President Biden has signed the Paperwork Reduction Act and the Employer Reporting Improvement Act into law. Congress passed the Paperwork Reduction Act and the Employer Reporting Improvement Act, each of which would modify the ACA’s provisions on 1094 and 1095 tax form reporting. President Biden is expected to sign both acts […]

On December 10, 2024

The Affordable Care Act created an annual assessment of health insurance carriers and self-insured group health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). Often referred to as the PCORI fee, health insurance carriers pay it on behalf of their fully insured group health plan clients. However, employers who offer self-funded and level-funded […]

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Can Employers Offer Different Benefits to Different Groups of Employees?

White House Releases New Executive Order on Healthcare Price Transparency

Take a Closer Look at the HIPAA Nondiscrimination Rule’s Prohibition of Actively-at-Work Clauses

Reminder: Employer-Sponsored Health Plans to Report Medicare Part D Information to CMS

The IRS Provides Much-Needed Guidance on Federal Tax Treatment of State Paid Leave Laws

HHS Issues Proposed Rule Aimed at Strengthening HIPAA Security Compliance

Revisiting ERISA Plan Documents and SPDs in the New Year

No Telehealth Flexibility Extension for HSAs in Funding Bill

Congress Passes Two Laws Intended to Ease Employer ACA Reporting

IRS Releases 2024-2025 PCORI Fees