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News & Updates

CMS Releases Updated Guidance on Creditable Coverage Determination for 2026

  • On April 14, 2025
On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized instructions regarding changes to the Medicare Part D program that take effect in 2026. These updates, stemming from the Inflation Reduction Act of 2022, affect how employer-sponsored prescription drug plans will be evaluated for “creditable coverage” status. What is Creditable Coverage? Employers offering prescription […]
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MMO: COSE Benefit & Balanced Solutions Plans Will No Longer Include MedMutual Pet™–Powered by Wagmo

  • On April 9, 2025
Topic: Benefits | Applies to: COSE Benefit Plan (1-50) and Balanced Solutions (10-50) Effective at the group’s next renewal, COSE Benefit Plan (1-50) & Balanced Solutions (10-50) plans will no longerinclude the pet wellness benefit, MedMutual Pet™ – Powered by Wagmo. This change impacts groups renewingon or after May 1, 2025. Medical Mutual will notify impacted […]
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Understanding the Summary Plan Description (SPD) Requirements under ERISA

  • On April 7, 2025
When employees become participants in a health benefits plan governed by the federal Employee Retirement Income Security Act (ERISA), they must automatically receive an important document: the Summary Plan Description (SPD). However, many employers find themselves confused about this critical ERISA requirement, which could lead to legal and financial risks. Consequences of Non-Compliance with SPD […]
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MMO: Midsize 51-99 Product Portfolio Enhanced with New Additions

  • On April 1, 2025
Topic: Marketing | Applies to: Mid-size Group Business (51-99) Medical Mutual is excited to announce enhancements to the 51-99 standard portfolio of benefits available to quote beginning April 1, 2025, for effective dates beginning July 1, 2025. ** R22 refers to the current standard portfolio and R19 refers to the old standard portfolio. Click here to […]
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15 Drastic Cost Containment Policies for Employers in a Fiscal Emergency

  • On March 31, 2025
It is no secret that the Trump Administration has cut government funding grants for a vast array of organizations. Many employers that relied upon these grants to finance their operations are now left reeling amidst an unexpected shortage of capital. Under circumstances such as these, it may be advisable for affected organizations to consider more drastic […]
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Litigation Surrounding Tobacco Use Premium Surcharges

  • On March 24, 2025
A number of class-action lawsuits have been filed against employers, claiming that premium surcharges for tobacco use violate federal regulations. These suits have been brought by current and former employees of large U.S. companies, including PepsiCo, Walmart, Target, and Whole Foods, who argue that their health plan premiums were higher due to their tobacco use, […]
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MMO: Ohio House Bill 315 Covers Hearing Aids, Equivalent Copays for Certain Therapies

  • On March 18, 2025
Topic: Broker Relations | Applies to: All Groups Effective April 3, 2025, Ohio House Bill 315 will require insurance carriers to cover hearing aids (and related services) at no member cost-sharing and mandate equivalent copays for physical therapy, occupational therapyand chiropractic services compared with primary care physician copays. The law applies to all fully insured individual […]
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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 […]
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HR Insight: Navigating the Changing Landscape of Employment Laws: What HR Leaders Need to Know in 2025

  • On March 17, 2025
As we step into 2025, HR leaders face a rapidly evolving regulatory environment. With shifts in government priorities and an increasingly complex labor market, staying ahead of changes in employment laws is critical. From new legislation to wage and hour regulations, worker protections, and compliance requirements, HR professionals must be prepared for the challenges and […]
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