July 23, 2020

Required Contribution Percentage Adjustment

The IRS announced (in Rev. Proc. 2020-36) the 2021 indexing adjustment to the Affordable Care Act’s (ACA’s) required contribution percentage. Applicable Large Employers (ALEs) subject to the ACA’s shared responsibility (pay or play) provisions use this percentage to determine whether the coverage they offer is affordable. The 2021 percentage is 9.83% up from 9.78% in… Continue Reading

July 10, 2020

SCOTUS Expands Exemption for Contraceptive Coverage

On July 8th, 2020, the Supreme Court of the United States (SCOTUS) upheld expanded exemptions to the Affordable Care Act’s (ACA) contraceptive coverage mandate (Mandate). In a 78 page opinion, SCOTUS details history of the litigation surrounding the Mandate. In a nutshell, SCOTUS stated that though the ACA’s Mandate has existed for nine years, there… Continue Reading

MLR Reporting and Rebates Deadline Extended due to COVID-19

The Centers for Medicare and Medicaid Services (CMS) have extended the deadline for insurers to report Medical Loss Ratio (MLR) annual reports and rebates from July 31 to August 17, 2020. The MLR reflects the portion of insurance premium revenue spent by the insurer for enrollee health services related to the total premium revenue. If… Continue Reading

June 29, 2020

FAQs Part 43: Additional Health Plan Guidance Re: COVID-19 Regulations

On June 23, 2020, the Departments of Labor, HHS, and Treasury (Departments) published additional guidance on how the Families First Coronavirus Response Act (the FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) apply to health plans. Under the FFCRA, plans and issuers must provide benefits for certain items and services… Continue Reading

June 25, 2020

“PrEP Test” to be required as Preventive Service for Persons at risk of HIV Acquisition

On June 11, 2019, the The United States Preventive Services Task Force (USPTF) added pre-exposure prophylaxis (“PrEP”) for persons at high risk of HIV acquisition as a “preventive care” service health plans must provide. Under the ACA, non-grandfathered health plans are required to provide coverage for preventive care at 100% without cost sharing. Health plans… Continue Reading

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