Legal Alerts

A Cautionary Tale: Self-Funded Plan Administrators Must Meaningfully and Effectively Communicate With Plan Participants and Their Providers on Appeal

By Stacy Barrow - January 9, 2024

Sponsors of self-funded ERISA plans have fiduciary obligations to plan participants, which includes the obligation to provide a full and fair review of claims and effectively and meaningfully communicate or engage with plan participants regarding claims denials. One district court recently clarified that this obligation may include the need for the plan administrator, which is [Read More]

The Crucial Role of Comparative Analyses Under the Mental Health Parity Proposed Rule and Technical Guidance

By Stacy Barrow - December 4, 2023

On July 25, 2023, the agencies released an extensive proposed rule related to the Mental Health Parity and Addiction Equity Act (the “Proposed Rule”) as well as a Technical Release requesting comments on certain proposed data requirements for nonquantitative treatment limitations (“NQTLs”) and the potential for an enforcement safe harbor if certain data requirements are [Read More]

IRS Adjusts Health Flexible Spending Account and Other Benefit Limits for 2024

By Stacy Barrow - November 13, 2023

On November 9, 2023, the Internal Revenue Service (IRS) released Revenue Procedure 2023-34, which increases the health flexible spending account (FSA) salary reduction contribution limit to $3,200 for plan years beginning in 2024, an increase of $150 from 2023.  Thus, for health FSAs with a carryover feature, the maximum carryover amount is $640 (20% of [Read More]

Agencies Issue Additional FAQs Regarding the Transparency in Coverage Final Rules

By Stacy Barrow - October 12, 2023

On September 27, 2023, the DOL, IRS, and HHS released FAQs About Affordable Care Act Implementation Part 61 (“FAQ Part 61”) which addresses lingering questions about enforcement of the Transparency in Coverage Final Rules (TiC Final Rules), specifically the provisions of the TiC final rules requiring plans and carriers to post machine-readable files for in-network [Read More]

Tenth Circuit Court of Appeals Hands Down a Big Win for ERISA Preemption

By Stacy Barrow - August 31, 2023

After several failed attempts by pharmacy benefit managers (“PBM”) to challenge state laws regulating PBMs, the 10th Circuit Court of Appeals (in Pharmaceutical Care Management Association v. Mulready) handed down a big win for PBMs and, by extension, self-funded ERISA plans, when it held that provisions under an Oklahoma insurance law that established strict network [Read More]

IRS Issues Affordability Percentage Adjustment for 2024

By Stacy Barrow - August 25, 2023

The Internal Revenue Service (IRS) has released Rev. Proc. 2023-29, which contains the inflation-adjusted amounts for 2024 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable Care Act’s (ACA) employer-shared responsibility provisions and premium tax credit program. As shown in the table below, for plan years beginning in 2024, the affordability [Read More]

Agencies Release Proposed Regulations on Fixed Indemnity Insurance, Seek Comments on Level Funded Plans

By Stacy Barrow - July 27, 2023

On July 12, 2023, the IRS, DOL and HHS (collectively, “the Agencies”) released proposed regulations that modify the conditions for hospital indemnity and other fixed indemnity insurance to be considered an “excepted benefit.” Maintaining “excepted benefit” status is important for fixed indemnity plans, as it exempts them from having to comply with the ACA’s insurance [Read More]

FICA Reduction Redux – IRS Issues Guidance on Wellness Indemnity Payments

By Stacy Barrow - June 28, 2023

On June 9, 2023, the IRS released OCC Memo 202323006, which advises that wellness indemnity payments under a fixed indemnity insurance policy are wages for purposes of Federal Insurance Contributions Act (FICA) taxes, Federal Unemployment Tax Act (FUTA) taxes, and federal income tax withholding (FITW) (collectively, “employment taxes”) if the employee has no unreimbursed medical [Read More]

IRS Releases 2024 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits

By Stacy Barrow - May 26, 2023

In Rev. Proc. 2023-23, the IRS released the inflation-adjusted amounts for 2024 relevant to Health Savings Accounts (HSAs) and high deductible health plans (HDHPs). The table below summarizes those adjustments and other applicable limits.   2024 2023 Change Annual HSA Contribution Limit (employer and employee) Self-only: $4,150 Family: $8,300 Self-only: $3,850 Family: $7,750 Self-only: +$300 [Read More]