PPI Benefit Solutions

Healthcare Reform

CMS Issues 2021 Notice of Benefit and Payment Parameters

On May 14, 2020, CMS released the Final Benefit and Payment Parameters for 2021, along with an accompanying fact sheet. The regulations are primarily directed at health insurers and the marketplace, but include important information that also affects large employers and self-insured group health plans. The effective date is July 13, 2020.

As background, these annual parameters specify the uniform standards for health plans subject to the ACA. Related regulatory and reporting issues are also prescribed. Accordingly, the guidance can serve as a useful planning tool for insurers and employers.

Overall, the 2021 regulations minimize regulatory changes in an effort to promote a more stable and predictable regulatory market. The guidance provides the updated plan cost-sharing limits and addresses the application of prescription drug coupons towards such limits. There are new annual reporting requirements with respect to state mandates for benchmark plans. Other highlights include amendments to the medical loss ratio (MLR) calculation and new notice obligations for non-federal government sponsors of excepted benefit health reimbursement arrangements (EBHRAs).

For 2021, the out-of-pocket maximum applicable to insured and self-funded plans is $8,550 for self-only coverage and $17,100 for family coverage. This limit is distinct from the 2021 IRS out-of-pocket maximum applicable to HSA-compatible high deductible health plans (HDHPs), which is $7,000 for self-only coverage and $14,000 for family coverage.

The guidance also clarifies that, to the extent consistent with state law, plans will be permitted, but not required, to count drug manufacturer coupons or discounts towards enrollees’ annual out-of-pocket limits. (The prior 2020 rule permitted the exclusion of coupons towards the cost-sharing limits only if the drug has a generic equivalent available.) However, the 2021 parameters do not address concerns regarding the applicability of drug coupons to an HSA-compatible HDHP. Accordingly, absent new guidance, these plans should continue to disregard the discounts in determining whether the HDHP statutory deductible has been satisfied.

The ACA requires non-grandfathered health plans in the individual and small group health plans to cover 10 essential health benefits (EHBs). States may require benefits in addition to the EHBs that are incorporated in the state benchmark plans. Beginning in 2021, states will be required to annually notify HHS of any such additional state-required benefits in a form and manner specified by HHS. The change is intended to ensure states are defraying the costs of additional required benefits for those advanced premium tax credits.

In an effort to lower premium amounts, the guidance amends the MLR regulations to require issuers to deduct prescription drug rebates and any other price discounts received by the issuer (or any entity providing pharmacy benefit management services to the issuer) from the incurred claim amount. This change is effective for the 2022 MLR reporting year. Additionally, issuers must report expenses for outsourced services in the same manner as expenses for non-outsourced services, to ensure that the full benefit of prescription drug rebates is reflected in premiums and not offset by outsourcing expenses.

For the benefit of employees, non-federal governmental plan sponsors that offer EBHRAs will now be required to provide a notice that includes the eligibility requirements, annual or lifetime benefit limits, and a summary of benefits generally consistent with ERISA requirements. The notice requirement was designed to ensure that employees received clear information about their excepted benefit offer regardless of whether the arrangement was subject to ERISA.

Employers may find this annual guidance helpful in designing their plan benefit offerings.

HHS Benefit and Payment Parameters Final Rule »
Final Benefit and Payment Parameters Fact Sheet »

Federal Updates

IRS Announces 2021 HSA and HDHP Limits

On May 20, 2020, the IRS released Revenue Procedure 2020-32, which provides the 2021 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2021 annual HSA contribution limit will increase to $3,600 for individuals with self-only HDHP coverage, up $50 from 2020, and to $7,200 for individuals with anything other than self-only HDHP coverage (family or self + 1, self + child(ren), or self + spouse coverage), up $100 from 2020.

For qualified HDHPs, the 2021 minimum statutory deductibles remain at $1,400 for self-only coverage and $2,800 for individuals with anything other than self-only coverage (the same as for 2020). The 2021 maximum out-of-pocket limits will increase to $7,000 for self-only coverage (up $100 from 2020) and up to $14,000 for anything other than self-only coverage (up $200 from 2020). For reference, out-of-pocket limits on expenses include deductibles, copayments and coinsurance, but not premiums. Additionally, the catch-up contribution maximum remains $1,000 for individuals aged 55 years or older (this is a fixed amount not subject to inflation).

The 2020 limits may impact employer benefit strategies, particularly for employers coupling HSAs with HDHPs. Employers should ensure that employer HSA contributions and employer-sponsored qualified HDHPs are designed to comply with 2021 limits.

Rev. Proc. 2020-32 »

IRS Clarifies When Expenses Can Be Reimbursed Under Dependent Care FSA

On March 31, 2020, the IRS issued information letter Number 2020-0002 that addressed a question concerning whether a dependent care FSA under a Section 125 plan could reimburse an employee for expenses incurred before they became a participant in the plan.

The IRS reminded the employer that expenses incurred before an employee becomes a participant in the plan are not eligible for reimbursement under the plan. The plan can only pay or reimburse for substantiated expenses incurred on or after the date the employee enrolls in the plan.

Information letters are not legal advice and cannot be relied upon for guidance. Taxpayers needing binding legal advice from the IRS must request a private letter ruling. While the letter does not provide any new guidance, this letter does provide general information that may be helpful to employers with questions on this particular topic.

Letter No 2020-0002 »

Retirement Update

DOL Finalizes New Electronic Distribution Safe Harbor for Retirement Plans

On May 21, 2020, the DOL finalized the electronic distribution safe harbor rule, which expands the options for electronic delivery of required retirement plan disclosures. As background, on October 23, 2019, the DOL proposed this rule, following Executive Order 13847, which instructed the DOL to determine whether regulatory actions could be taken to improve the effectiveness of participant disclosures and reduce their cost to employers. After review and consultation with other regulatory agencies, the DOL set forth a new “notice and access” safe harbor under which ERISA retirement plan disclosures could be made available on a website following specified notice. We wrote about the proposed rule in the October 31, 2019 edition of Compliance Corner.

As proposed, the new safe harbor permits required disclosures for retirement plans (including multi-employer plans) to be posted online following notice to covered individuals, who can then access the documents continuously using an internet-connected device. Covered individuals are participants, beneficiaries and any other individuals entitled to documents who have provided the plan administrator (or designee) with an electronic address, such as email address or smartphone number.

The DOL received many comments on the proposed rule. However, the finalized rule mainly adopts the provisions of the proposed rule, with minor changes. Among other changes, those minor changes include the following:

While an employer can provide notices through the use of phone numbers, the employer will have to take steps to confirm with participants and beneficiaries that the phone is a smartphone or other mobile phone that will allow the individual to receive and inspect written messages.
While employers can continue to use an electronic address provided by the employer, the electronic address can no longer be assigned only for the purpose of providing covered documents. Instead, the employer-provided electronic address has to have an employment-related purpose other than just complying with this safe harbor. Also, employers cannot assign electronic addresses for nonemployee spouses or other beneficiaries.
The IRS clarified the covered documents to include all disclosures required under Title 1 of ERISA, with the exception of documents that must be furnished only upon request (such as the plan document).
A brief description of the covered document is only required in addition to the name of the document when the name would not reasonably convey the nature of the covered document.
The Notice of Internet Availability (NOIA) can utilize hyperlinks instead of just website addresses.
Employers are only required to keep documents available online for a year from posting. Because of this, the NOIA must include a warning or reminder that covered documents may not always be available online.
The NOIA must be written in a manner calculated to be understood by the average plan participant, but plan administrators may look to the DOL’s SPD regulations for guidance on the meaning of “written in a manner calculated to be understood by the average plan participant” instead of having to comply with the additional guidelines that were mentioned in the proposed rule.
The term “website,” which dictates where the employer must post the covered documents, can include a mobile app as long as covered individuals have been provided reasonable access.
If participants or beneficiaries want a paper copy of certain covered documents, only one copy of a specific document must be provided free of charge.
While participants and beneficiaries must be given the opportunity to opt-out of receiving documents electronically, the employer can require a global opt-out. This means the employer can (but does not have to) require an all-or-nothing opt-out, instead of allowing participants and beneficiaries to opt-out document-by-document.

Notably, the DOL still declined to extend the final rule to welfare benefit plans. However, they did indicate an intention to review whether a similar rule should be provided for welfare benefit plans.

Employers who are seeking an alternative electronic delivery method for retirement plan disclosures may choose to adopt this safe harbor. Although it is officially effective as of 60 days after the publishing of this final rule in the Federal Register, the rule made it clear that the DOL will not seek enforcement against any employer that adopts the rule before the effective date.

Default Electronic Disclosure by Employee Pension Plans under ERISA Final Rule »

Announcements

COVID-19-Related Benefits Compliance Resources Available

The Benefits Compliance team has provided a number of resources that are available for assistance during the COVID-19 crisis. Information presented through our resources is subject to change pending additional guidance from the DOL, IRS, or other state or federal regulatory agencies.

FAQs on Benefits Compliance and COVID-19 »
Families First Coronavirus Response Act (FFCRA) Flowchart »
COVID-19 State Quick Reference Chart »
DOL Issues COVID-19 Relief via Certain Notice Extensions for Employee Benefit Plans »
IRS Announces New Guidance for Section 125 Cafeteria Plans and Related High Deductible Health Plans, and IHCRAs »
COVID-19 – State Leave Provisions: New York »
COVID-19 – State Leave Provisions: New Jersey »

FAQ

What are a plan’s options regarding COBRA continuation coverage during a qualified beneficiary’s election and initial premium grace period?

The COBRA regulations normally provide a qualified beneficiary with a minimum 60 day period to elect COBRA and a minimum 45 day grace period following such election to make the first premium payment.

However, under recent COVID-19 IRS/DOL joint guidance, the election and grace periods have been significantly extended. Specifically, in determining an election or payment deadline, the timeframe from March 1, 2020, to 60 days following the declared end of the COVID-19 National Emergency (which is not yet known) must be disregarded (or tolled). The COBRA administrator should communicate these extended timeframes to qualified beneficiaries (by providing, for example, a supplement provided with the election notice).

The IRS COBRA rules provide that during the interim election and premium grace periods, the plan could do one of the following:

Provide the COBRA continuation coverage and retroactively cancel it if the election or payment is not timely made
Cancel the coverage and retroactively reinstate it once the election or payment is timely made

The COBRA election notice should specify the plan’s chosen policy during the grace period.

In either situation, the plan would need to explain the status of the COBRA-qualified beneficiary to any health care provider seeking to confirm coverage during the interim period. So, if the plan’s policy was to provide the coverage and retroactively cancel it, the plan would need to inform a provider to alert them of the possibility of a retroactive termination that could result in claims not being covered. Some plans may continue to pay claims during this interim, but then retroactively deny the claims and seek reimbursement if a timely COBRA election and payment is not made.

Similarly, if the plan cancels but retroactively reinstates coverage, then the plan must inform the provider that the qualified beneficiary currently does not have coverage but will retroactively if the election or payment is made. During the interim period, some plans take the approach of denying claims, but later reprocessing these if a timely election and payment is received. Other plans may hold or “pend” the claims. However, given the current extended deadlines, pending claims may be particularly challenging if in-network provider contracts require payments within a certain timeframe.

For a fully insured plan, it is imperative that the employer consult with the carrier regarding the approach, as well as any third-party COBRA administrators. If the plan policy is to provide coverage and retroactively cancel it, the carrier may require the employer to pay the COBRA premium for the interim period. A self-insured plan should confer with the stop loss carrier and any other service providers. Given the additional administrative challenges presented by the extended deadlines, coordinated efforts and consistent, clear communications to qualified beneficiaries are essential.

Finally, an employer should consult with counsel regarding any liability concerns with respect to COBRA administration, including those relating to the extended election and payment deadlines.

State Updates

Arkansas

May 27, 2020

Coronavirus-Related Bulletins Issued

On May 11, 2020, the Commissioner Mcclain released a series of coronavirus (COVID-19) bulletins. These included Bulletins 20-2020, 21-2020, 23-2020, and 24-2020.

As background, on March 11, 2020, a public health emergency was declared in the state due to the COVID-19 crisis. Following the declaration, the commissioner issued numerous related bulletins to insurers, health care providers, pharmacy managers and other interested parties in the state. The May 11, 2020, bulletins include rescissions of certain prior orders, as well as new emergency relief measures.

Bulletin 20-2020 rescinds certain prior COVID-19-related bulletins. Bulletin 21-2020 announces a 45-day cancellation moratorium on personal lines, life and health policies for certain state residents affected by the COVID-19 emergency. This premium nonpayment relief is available to policyholders who, since March 11, 2020, have been diagnosed with or positively tested for COVID-19 or have been terminated, laid off or, if self-employed, experienced a cessation of work due to the COVID-19 emergency.

In a further effort to assist residents affected by the outbreak and remove impediments to their receipt of health care, Bulletin 23-2020 was issued to insurers, health maintenance organizations and other interested parties. This bulletin suspends payment audits of hospitals and health care providers for the 45-day period that began on May 5, 2020. However, such audits can be performed retroactively. The bulletin also directs health insurers to toll the time limit on overpayment recovery for the 45-day period. Finally, the bulletin encourages provides to maximize the use of telemedicine services in accordance with state laws to mitigate the spread of COVID-19 in the state.

Similarly, Bulletin No. 24-2020 recognizes that pharmacists are also an integral part of the COVID-19 health response. Accordingly, this bulletin suspends random audits of pharmacies (except where fraud is suspected) for the above referenced 45-day period. Additionally, this directive reminds pharmacy benefit managers of the ban on price gouging and their responsibility to monitor drug pricing to ensure consumers have access to products during the emergency.

Although the bulletins are primarily directed at insurers and health care providers, employers may want be aware of these developments.

Bulletin 20-2020 »
Bulletin 21-2020 »
Bulletin 23-2020 »
Bulletin 24-2020 »

Illinois

May 27, 2020

Chicago Enhances Paid Sick Leave Ordinance

On May 20, 2020, the Chicago City Council approved Substitute Ordinance 2020-2343. In addition to protecting employees from adverse employment action in response to the COVID-19 public health crisis, the ordinance also revises Chicago’s Paid Sick Leave Ordinance (PSLO) that is effective July 1, 2020.

As background, employers must provide employees with paid sick leave (PSL) to care for themselves (or a family member) if they work at least 80 hours within any 120-day period (eligible for use by the 180th day of employment). PSLO amendments were previously enacted in December 2019 to take effect July 1, 2020. The Substitute Ordinance 2020-2343 redefines employees for purposes of paid sick leave to include certain categories that were erroneously left out, such as an outside salesperson, member of a religious corporation/organization, a student at and employed by an accredited Illinois college or university, and motor carriers regulated by the US Secretary of Transportation or the State of Illinois.

Further, changes to Chicago’s paid sick leave rules require employers to provide covered employees with an individual paid sick leave notice along with their first paycheck subject to the PSLO (and annually thereafter), among other requirements such as a workplace posting and new recordkeeping procedures.

The ordinance applies to all employers with at least one covered employee. Employers with employees in Chicago should be aware of the new requirements and ensure compliance with the PSLO and revised paid sick leave rules effective July 1, 2020.

Substitute Ordinance 2020-2343 »
Chicago Minimum Wage and Paid Sick Leave Rules »
Paid Sick Leave Notice »

Maryland

May 27, 2020

Coverage for Pediatric Autoimmune Neuropsychiatric Disorders

Effective for health insurance policies issued on or after January 1, 2021, SB 475 requires coverage for medically necessary diagnosis, evaluation and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Coverage must be provided for intravenous immunoglobulin therapy. Coverage is not required for Rituximab unless the US FDA approves the use of Rituximab for this purpose.

SB 475 »

Massachusetts

May 27, 2020

COVID-19 Testing Guidance Updated

On May 18, 2020, Commissioner Anderson released Bulletin 2020-16, which updates the Division of Insurance’s guidance on COVID-19 testing. The bulletin updates Bulletin 2020-02, and reiterates the division’s expectations of insurance carriers. Specifically, the division expects carriers to:

Establish dedicated help lines to respond to calls about COVID-19.
Relax prior approval requirements and procedures.
Eliminate prior approval requirements for antigen and polymerase chain reaction (PCR) testing for COVID-19.
Relax out-of-network requirements and procedures when access to testing or urgent treatment is unavailable in-network.
Forego any cost sharing for medically necessary COVID-19 testing, counseling and vaccinations when in-network coverage is unavailable.
Cover PCR or antigen tests designed to detect the presence of the novel coronavirus when a covered patient has any symptoms or has been exposed to COVID-19.
Cover antibody tests when such tests are being conducted consistent with Department of Public Health and CDC guidance.

This guidance does not provide any compliance obligations for employers, but they should familiarize themselves with the directive.

Bulletin 2020-16 »

Exchange Special Enrollment Period Extended

On May 21, 2020, Commissioner Anderson released Bulletin 2020-18, extending the special enrollment period on the Commonwealth Health Insurance Connector. Now, uninsured Massachusetts residents can enroll in coverage on the Connector through June 23, 2020.

Employers with employees in Massachusetts should be aware of this option should employees need to enroll in a plan on the exchange due to the termination of their employment or eligibility under the employer’s plan.

Bulletin 2020-18 »

Michigan

May 27, 2020

Telehealth Services Encouraged

On May 14, 2020, Gov. Whitmer issued Executive Order 2020-86 expanding the use of telehealth services in light of the COVID-19 public health emergency. Highlights of the order’s requirements include:

Authorizing and encouraging all health care providers to utilize telehealth services when medically appropriate with patient consent (which can be verbal).
In-person examination is not required to be conducted by the physician before prescribing medication (except for methadone).
Healthy Michigan and private insurers are encouraged to reimburse for telehealth services.

While the above primarily applies to insurers and health care providers, employers should be aware of this development.

Executive Order 2020-86 »

Missouri

May 27, 2020

Extension of Telehealth Services

On May 15, 2020, the Missouri Department of Commerce and Insurance issued Insurance Bulletin 20-15, which extends the applicability of prior Bulletin 20-07 through June 15, 2020. As mentioned in our prior Compliance Corner March 31, 2020, article “COVID-19 and Health Insurance Coverage: Executive Orders and Insurance Bulletins,” Bulletin 20-07 strongly encourages Missouri residents to access health care services via telehealth for all services provided through telehealth, including mental health services (not just testing for COVID-19). Further, the department reminds health insurers of the requirement to cover telehealth services in the same manner as they would provide coverage for in-person services. Originally expiring May 15, 2020, Bulletin 20-07 is now extended through June 15, 2020, in light of the continued COVID-19 public health crisis.

Employers should be aware of these developments.

Insurance Bulletin 20-15 »

New Hampshire

May 27, 2020

Employer Guidelines During COVID-19

On May 1, 2020, Gov. Sununu issued Emergency Order #40 (extending a previous closure of non-essential businesses and stay-at-home order), which includes Exhibit B that provides guidelines in light of the COVID-19 public health crisis to New Hampshire employers who remain open (or who are reopening) and their employees. While the guidelines largely provide guidance on employment law matters – such as developing screening processes, allowing employees to telework as appropriate, updating illness policies – employers are reminded of the requirements under the FFCRA to provide paid sick leave as applicable. In addition, the guidelines include requirements for employees, such as practicing social distancing, staying home when ill and wearing a face mask (among other requirements).

New Hampshire employers should be aware of these guidelines and communicate with employees accordingly.

Emergency Order #40 Exhibit B »
Emergency Order #40 »

New Jersey

May 27, 2020

Coronavirus Testing Requirements Updated

On May 13, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-24, updating the requirement for insurers to waive all cost-sharing payments for the screening and testing for COVID-19. This bulletin updates the guidance found in Bulletin No. 20-03 (discussed in the March 17, 2020, edition of Compliance Corner). This bulletin supplements the prior bulletin by expanding carrier required coverage without cost sharing or any SARS-COV-2 molecular test authorized by the New Jersey Department of Health Standing Order. Carriers must treat any such test authorized by the DOH Standing Order as medically appropriate for the individual. Additionally, carriers must not require a prescription or prior authorization, or employ any other medical management, for any SARS-COV-2 molecular test administered pursuant to the DOH standing order.

Employers can notify their plan participants who may need to receive testing that the testing will be provided without cost sharing.

Bulletin No. 20-24 »

New York

May 27, 2020

Essential Workers Receive Temporary Cost-Sharing Relief for Mental Health Services

On May 2, 2020, the Department of Financial Services (DFS) amended the state’s Insurance Regulation 62 to provide essential workers with temporary relief from cost sharing for mental health services. The amendment pertains to all policies or contracts delivered or issued for delivery in the state.

Following the declaration of a public emergency in the state on March 7, 2020, the coronavirus (COVID-19) pandemic has significantly impacted all New Yorkers, but especially essential workers who have directly interacted with the public and exposed themselves and their families to health risks. The amendment recognizes the emotional and psychological toll on these essential workers by alleviating cost they would otherwise incur for seeking in-network mental health services.

Specifically, insurers and health maintenance organizations that provide comprehensive coverage for hospital, surgical or medical care are prohibited from imposing copayments, coinsurance or annual deductibles for mental health services rendered by in-network providers on an outpatient basis for essential workers. The amendment excepts high deductible health plans as defined in Code Section 223(c) (2) that may be required under federal law to subject a service to the plan’s annual deductible.

Additionally, the amendment requires an insurer to provide written notification, which may be by email, to in-network outpatient mental health providers that they shall not collect any deductible, copayment or coinsurance from an essential worker. The notice must include the definition of an essential worker.

For purposes of the amendment, essential workers are defined to include individuals who are or were employed as health care workers, first responders, or in any position within a nursing home, long-term care facility or other congregate care setting during the state of emergency declared in the state on March 7, 2020. Furthermore, the definition includes individuals employed as essential workers who interact with the public, such as transit workers, retail workers at essential businesses, delivery workers, food service workers, funeral service workers and security guards.

Although the amendment is primarily directed at issuers, employers may want to be aware of this emergency relief measure.

Insurance Regulation 62 Amendment »

Texas

May 27, 2020

Prior Authorizations Extended

On May 11, 2020, the Department of Insurance issued Bulletin B-0025-20. The bulletin encourages insurers licensed by the department to extend prior authorizations for elective procedures that were authorized before Gov. Abbott postponed those procedures in an emergency order issued on March 22, 2020. Since the governor has eased those restrictions in an order issued on April 17, 2020, by allowing them under certain circumstances, the bulletin encourages insurers to minimize delays in providing procedures by considering such things as automatically extending prior authorizations previously granted, extending referrals to specialists, and providing both consumers and providers with written notice of updated authorizations.

Employers with health plans licensed in Texas should be aware of this development.

Bulletin B-0025-20 »

Virginia

May 27, 2020

12-Week Short-Term Disability Benefits for Childbirth

On April 9, 2020, Gov. Northam signed SB 567 into law. The new law requires group short-term disability policies to pay benefits for at least 12 weeks for a disability related to childbirth. The requirement is effective for policies issued or renewed on or after July 1, 2021.

SB 567 »

No Prior Authorization for Newborn Hospital Transfer

On April 9, 2020, Gov. Northam signed SB 718 into law. The new law prohibits group health insurance policies issued on or after January 1, 2021 from requiring prior authorization for the interhospital transfer of a newborn experiencing a life-threatening emergency condition or the hospitalized mother to accompany the newborn.

SB 718 »

West Virginia

May 27, 2020

12-Month Supply of Contraceptive Drugs

All health insurance policies that provide coverage for contraceptive drugs are required by HB4198 to allow for a 12-month refill supply of such drugs effective for policies issued or renewed on or after January 1, 2021. Additionally, the insured must be allowed to receive the drugs on-site at the health provider’s office. For this purpose, the term contraceptive drugs means all drugs approved by the US FDA that are used to prevent pregnancy, including, but not limited to hormonal drugs administered orally, transdermally and intravaginally.

HB4198 »

Revised Coverage Requirements Related to Mental Health and Substance Use Disorder

Effective for health insurance policies issued on or after January 1, 2021, SB 291 revises the coverage requirements related to mental health and substance use disorder. Previously, if an insurer could demonstrate its total anticipated costs for treatment for mental illness would exceed 2% of the total costs for such plan in any experience period, then the insurer could apply necessary cost containment measures, including limitations on inpatient and outpatient benefits, to maintain costs below 2% of the total costs for the plan. The new legislation removes this provision and more closely matches the state’s requirements with those under the ACA.

Insurers are required to provide coverage for the prevention of, screening for, and treatment of behavioral health, mental health and substance use disorder (including autism) that is no less extensive than the coverage provided for any physical illness. Treatment must be in parity in with nonquantitative treatment limitations, financial requirements and quantitative treatment limitations.

Coverage must include screening for unhealthy alcohol use for adults, substance use for adults and adolescents, and depression screening for adolescents and adults.

SB291 »

Wisconsin

May 27, 2020

COVID-19 Coverage Requirements

On May 19, 2020, the Wisconsin Office of the Commissioner of Insurance (OCI) issued a notice to insurers that summarizes the federal requirements of the FFCRA and CARES Act in light of the COVID-19 public health crisis. The notice highlights that testing for COVID-19 should be provided without any out-of-pocket costs (no cost sharing). In addition, the notice explains that the CARES Act includes a broader range of services that must be covered without cost-sharing requirements, prior authorization or other medical management requirements, and requires coverage of preventative services and immunizations (when applicable) related to COVID-19.

Further, a press release dated May 19, 2020, encourages individuals to discuss with their insurer if they have received any bills with costs associated with COVID-19 testing so that those services are covered without cost sharing.

While the notice is directed towards insurers, employers should be aware of this notice and communicate with employees accordingly.

Notice to Insurers »
Press Release »

This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI^®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.

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Healthcare Reform

CMS Issues 2021 Notice of Benefit and Payment Parameters

Federal Updates

IRS Announces 2021 HSA and HDHP Limits

IRS Clarifies When Expenses Can Be Reimbursed Under Dependent Care FSA

Retirement Update

DOL Finalizes New Electronic Distribution Safe Harbor for Retirement Plans

Announcements

COVID-19-Related Benefits Compliance Resources Available

FAQ

What are a plan’s options regarding COBRA continuation coverage during a qualified beneficiary’s election and initial premium grace period?

State Updates

Arkansas

May 27, 2020

Illinois

May 27, 2020

Maryland

May 27, 2020

Massachusetts

May 27, 2020

Michigan

May 27, 2020

Missouri

May 27, 2020

New Hampshire

May 27, 2020

New Jersey

May 27, 2020

New York

May 27, 2020

Texas

May 27, 2020

Virginia

May 27, 2020

West Virginia

May 27, 2020

Wisconsin

May 27, 2020

FAQ

PPI in the News Compliance Corner - May 28, 2020 Archive
You are here: Home / PPI in the News / Compliance Corner - May 28, 2020 Archive