In this episode, Chase Cannon and Suzanne Spradley discuss the recent revival of vendor-promoted pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment. Chase leads off with a brief description of these programs and their purported claims on employment tax savings for both employees …

In this episode, Suzanne Spradley and Chase Cannon review the current state and federal regulation of pharmacy benefit managers (PBMs), focusing on litigation surrounding recent state-enacted PBM rules. Suzanne starts off with a high-level description of PBMs and the role they play in the group health plan context. Suzanne and Chase discuss the ple…

In this episode, Suzanne Spradley and Chase Cannon discuss the US importation policies and rules aimed at lowering domestic prescription drug costs. Suzanne walks through the legalities of drug importation generally and then outlines the specific programs by which states can develop importation plans. Chase and Suzanne discuss several state importa…

In this episode, Chase Cannon and Suzanne Spradley remind employers about important ACA employer mandate reporting deadlines with the IRS, including a change in electronic reporting in 2024 for smaller employers. Chase also outlines some updated numbers relating to the federal poverty line (FPL), ACA affordability calculations and ACA penalty amoun…

In this episode, Suzanne Spradley and Chase Cannon give an overview of the No Surprises Act (NSA) — a consumer health protection law that places certain requirements on providers and payers (insurers and group health plans). Suzanne describes the main requirements under the NSA and introduces the Independent Dispute Resolution (IDR) process, which …

In this episode, Chase Cannon and Suzanne Spradley discuss employer compliance with the HIPAA privacy and security rules via lessons learned from three new HHS HIPAA settlement announcements. Chase leads off with a high-level review of the HIPAA rules for both fully and self-insured plans and the importance of safeguarding protected health informat…

In this episode, Suzanne Spradley and Chase Cannon discuss a recent circuit-level decision relating to employee termination and its interaction with a participant lawsuit based on ERISA Section 510 (which prohibits an employer’s interference with a plan participant’s right to benefits). Suzanne provides background on ERISA 510 and how it applies to…

In this episode, Chase Cannon and Suzanne Spradley take a tour across the nation as they review several new regulatory developments in six states that could impact employers with employees or fully insured plans in those states. Chase outlines new or recently effective paid family leave rules in New York, Oregon, and Maine. Chase and Suzanne delve …

In this episode, Suzanne Spradley and Chase Cannon address a recent appellate-level court case that addresses ERISA preemption of a recently enacted Oklahoma state law regulating pharmacy benefit managers (PBM). Suzanne begins by laying the groundwork and history of ERISA and ERISA preemption. Suzanne and Chase discuss the Oklahoma state PBM law an…

In this episode, Chase Cannon and Suzanne Spradley discuss recent enforcement on MHPAEA. Chase jumps in with a description of DOL’s enforcement approach, including working through TPAs to identify plans that have or had ABA therapy exclusions. Suzanne and Chase discuss the administrative challenges with reprocessing ABA exclusion claims, which the …

In this episode, Suzanne Spradley and Chase Cannon review several new pieces of proposed federal legislation coming out of the House. Suzanne discusses the Transparency in Billing Act, which requires hospitals to have better and more accurate billing practices, policies and procedures with respect to outpatient departments. Suzanne and Chase dive i…

In this episode, Chase Cannon and Suzanne Spradley discuss a recent IRS memo on wellness benefit payments via employer-funded fixed indemnity plans. Chase outlines the various iterations and structure of vendor-promoted wellness programs, which usually purport huge employment tax savings for employers. Chase and Suzanne outline the relevant tax rul…

In this episode, Suzanne Spradley and Chase Cannon review the CAA’s prohibition on gag clauses in TPA and service provider contracts, as well as the employer’s obligation to attest to the removal of gag clauses (due December 31, 2023, for the first time). Suzanne outlines the challenges employers and plans face when working with TPAs, and explores …

In this episode, Chase Cannon and Suzanne Spradley discuss updates on the ACA preventive care mandate litigation, including a stay issued by the Fifth Circuit Court of Appeals. HSA contribution limits become a topic of discussion, as the IRS recently published updated numbers. Chase and Suzanne also discuss a common problem for employers filing For…

In this episode, Suzanne Spradley and Chase Cannon have a look at the national debt and debt ceiling and how they impact employers and their group health plans. Suzanne leads off with a discussion on the national debt and how Congress sets the debt ceiling. Suzanne and Chase go in depth on what a failure to raise the debt ceiling and/or default on …

In this episode, Chase Cannon and Suzanne Spradley review several recent HIPAA violation settlements from the HHS Office for Civil Rights. Chase starts off by reviewing the general HIPAA obligations of fully and self-insured plans, including the importance of a HIPAA risk assessment. Chase and Suzanne discuss three real-life scenarios outlining way…

In this episode, Suzanne Spradley and Chase Cannon discuss a recent Texas court ruling that invalidates a portion of the ACA’s preventive services coverage requirement. Suzanne provides a background of the plaintiffs and their arguments, including a Constitutional problem with the way the government appointed officers under the ACA and a religious …

In this episode, Chase Cannon and Suzanne Spradley address recent IRS guidance that mandates electronic filing of certain tax forms – including Forms 1095-C – for smaller employers. Chase describes the background from Congress and the IRS and explains what it means now that any employer filing 10 or more forms (previously, this was 250) will be req…

In this episode, Suzanne Spradley and Chase Cannon discuss potential activity at the federal and state level relating to PBM transparency. Suzanne begins the discussion by outlining a few proposals from Congress that attempt to hold PBMs accountable for unfair and deceptive practices that may be driving up prescription drug costs. Suzanne then addr…

In this episode, Beth Allen and Chase Cannon look at several new developments for plan compliance in 2023. The two start with the recent announcement on the end of the COVID-19 public health emergency, which impacts the outbreak period and extension of timeframes for certain compliance deadlines. Chase then dives in on the CAA 2023 extension of rel…

In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take effect in 2023. Suzanne and Chase discuss state comp…

In this episode, Suzanne Spradley and Chase Cannon discuss several recent COBRA cases. Suzanne starts by outlining several class action lawsuits filed against employers and plan sponsors relating to deficiencies in an employer health plan’s COBRA election notice. Suzanne and Chase discuss the use of the DOL’s Model Election Notice and how that usag…

In this episode, Chase Cannon and Suzanne Spradley discuss three recent court rulings—all at the district court level. Chase outlines the first case relating to a COBRA election notice failure, including takeaways for employers to enhance their notice distribution procedures. Chase and Suzanne dive into an ACA-related case challenging gender-affirm…

In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health services, such as required behavioral health monitoring for …

In this episode, Chase Cannon and Suzanne Spradley discuss the benefits provisions of the recently-enacted Inflation Reduction Act. Chase walks through the extension of premium tax credit expansions through 2025, and the impact on employers with respect to the employer mandate penalties. Next, Chase and Suzanne discuss Medicare prescription drug co…

In this episode, Chase Cannon and Suzanne Spradley recap the past few weeks’ guidance relating to Post-Dobbs considerations on employer coverage and reimbursement of abortion-related services. Chase starts by comparing the approaches of two different states – Texas and New Jersey – with respect to the legality of abortion services. New laws and dev…

In this episode, Suzanne Spradley and Patrick Myers discuss recent guidance concerning the interaction between FMLA and mental health conditions. Suzanne provides some context for this guidance and a brief refresher on FMLA itself. Suzanne and Patrick then discuss how mental health conditions can apply in a FMLA context, including when a mental hea…

In this episode, Suzanne Spradley and Chase Cannon discuss hospital prices and their impact on employer group health plans. Suzanne describes this issue as it relates to the new transparency in coverage rules. Suzanne and Chase review a recent study that reviews hospital prices nationwide, including Medicare-certified, short-stay and other facility…

In this episode, Chase Cannon and Suzanne Spradley look at the recent rise in so-called “point solution programs.” These add-on programs enhance or expand on a group health plan offering and have benefits such as mental health, musculoskeletal, life coaching and fertility. Chase explains some of the compliance challenges that arise from offering th…

In this episode, Suzanne Spradley and Chase Cannon update us on employer compliance obligations under the Transparency in Coverage (TIC) rules. Suzanne begins with an overview of the TIC rules and how they are meant to address consumerism and rising health care costs. Suzanne and Chase then hone in on the actual requirements, including posting of p…

In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on Ma…

Join NFP’s own Head of Innovation, Mark Rieder, as he discusses what innovation looks like at NFP and how to start your own innovation journey with Naviant’s Ema Roloff on their “Digital Transformation Talks” podcast series. Discussion points include: • How to engage a team in innovation• How to support continual education within an organization • …

In this episode, Patrick Myers and Suzanne Spradley review recent litigation and administrative action brought under the Mental Health Parity and Addiction Equity Act (MHPAEA). Suzanne begins the discussion by providing background on the requirements imposed on plans by MHPAEA, with a particular focus on non-quantitative treatment limitations (NQTL…

In this episode, Chase Cannon and Suzanne Spradley outline a few explanations on recently-asked benefits compliance questions. First, Chase describes the challenges relating to the requirement to provide a Medicare Part D creditable disclosure to CMS and individuals. Chase and Suzanne then dig into HSA eligibility where an employee has a spouse or …

In this episode, Suzanne Spradley and Chase Cannon discuss the ACA provider nondiscrimination rules — the idea that individuals have the right to access health services from the full range of providers licensed and certified in their state. Suzanne leads off with a background on why Congress felt it necessary to include the provider nondiscriminati…

In this episode, Chase Cannon and Suzanne Spradley break down the recent Supreme Court decision relating to the vaccine mandates for large employers and healthcare workers. Chase starts by outlining the large employer vaccine mandate, including the OSHA emergency temporary standard, or ETS rule, that was challenged in the courts. Next, Chase and Su…

Join Mark Reider, NFP's own Head of Innovation, as he discusses the future of the ever-changing insurance marketplace with Denise Garth, Chief Strategy Officer at Majesco on their "The Future of Insurance: Industry Leaders" podcast.Discussion points include:• How employers can utilize innovative thinking to boost employee retention• What emerging t…

In this episode, Chase Cannon and Suzanne Spradley break down the recent OSHA guidance (emergency temporary standard, or ETS) relating to the employer COVID-19 vaccine and testing mandate. Chase outlines the general requirement for employers with 100 or more employees to ensure employees are vaccinated or tested regularly. Suzanne and Chase discuss…

In this episode, Suzanne Spradley and Patrick Myers discuss the growing trend of HIPAA breaches, particularly those that involve ransomware attacks and employee errors. Suzanne points out how the pandemic and the increased use of telehealth encouraged a growing reliance on electronic transmission and data. Suzanne and Patrick discuss HIPAA privacy …

In this episode, Kim Bell, EVP, Head of Health and Benefits and Dale Sagen, VP and Leader of Group Captive Solutions focus on NFP’s newest launch, our Medical Stop Loss Captive, sharing an overview of our captive practice, and the benefits of leveraging this type of program.By NFP's Insights from the Experts

In this episode, Chase Cannon and Patrick Myers provide an update on vaccine mandates and surcharges, including some helpful governmental guidance on HIPAA wellness program rule application to vaccine surcharges. Chase then digs in on some end-of-year and open enrollment considerations for pandemic-related compliance obligations. Chase and Patrick …

In this episode, Chase Cannon and Suzanne Spradley discuss the history of, and legal challenges to, OSHA's Emergency Temporary Standards (ETS), the format for the Biden administration’s recently announced vaccine mandate and COVID-19 testing alternative for employers. Suzanne begins with an overview of the likely legal challenges to the use of the …

In this episode, Chase Cannon and Suzanne Spradley outline the Biden administration’s recently announced vaccine mandate and COVID-19 testing alternative for employers. Chase begins with an overview of the mandate, the testing alternative and which employers are impacted by the requirements. The two spend the rest of the podcast issue spotting for …

In this episode, Chase Cannon and Suzanne Spradley discuss the compliance angle of employer-initiated vaccine mandates and incentives. Chase begins by outlining the ADA and EEOC rules relating to vaccine mandates, while Suzanne jumps in for a discussion on reasonable accommodations for those that have legitimate medical or religious objections to t…

In this episode, Chase Cannon and Suzanne Spradley review and discuss three upcoming mid-summer compliance obligations with a July 31 due date: Form 5500 (an oldie), PCOR Fee (a revival) and ARPA COBRA subsidy tax credits (a newbie). Chase outlines the requirements, forms and challenges relating to those obligations as Suzanne relays some frequentl…

In this episode, Chase Cannon and Patrick Myers discuss the interim final rules relating to the federal No Surprise Billing Act. Patrick begins with an explanation for the need for these rules. Patrick and Chase then look at how the rules address the problem of balance billings. Patrick closes with a discussion of the interaction between the rules …

In this episode, Suzanne Spradley and Patrick Myers discuss the Supreme Court’s ruling in the latest challenge to the ACA. Suzanne begins with a history of legal challenges to the ACA, and then discusses the Supreme Court’s recent opinion. Patrick and Suzanne then look at how the Supreme Court’s decision impacts employers and what we can expect fro…

In this episode, Suzanne Spradley and Chase Cannon discuss rising prescription drug costs as a challenge for employers and consumers. Suzanne begins with an overview of the issue at a federal and state level, and then digs into state proposals addressing drug price transparency and affordability review boards. Chase and Suzanne then look at drug im…

In this episode, Chase Cannon and Suzanne Spradley discuss the recently published IRS FAQ guidance on ARPA COBRA premium subsidies. Chase gives an overview of six steps employers need to take to ensure compliance. Chase and Suzanne discuss IRS FAQs addressing what constitutes a reduction in hours or involuntary termination, including employment con…

In this special episode, Suzanne Spradley and Chase Cannon discuss the COBRA subsidies that are a big part of the recently-enacted ARPA. Suzanne starts the discussion with a history of past COBRA subsidies, including in 2002 and 2008/09, comparing them to the ARPA subsidies. Suzanne then answers Chase’s rapid fire questions on the ARPA COBRA subsid…