Legal Update HeaderOn Aug. 17, 2020, a federal district court granted an injunction blocking a Department of Health and Human Services (HHS) regulation that would have allowed health care and insurance discrimination based on sex stereotyping, gender identity and pregnancy-related conditions.

ACA Section 1557 Regulations

Under Section 1557 of the Affordable Care Act (ACA), discrimination on the “basis of sex” is prohibited in “any health program or activity” that receives federal funds or is administered by a federal agency.

Annual Open Enrollment ChecklistOpen enrollment can be an extremely positive and rewarding experience for you and your employees.

During this unprecedented time, it’s important to review and modify employee benefits to enhance their physical, mental and financial health. Consider the following suggestions to help you prepare for a successful open enrollment period this year.

 

Know Your Benefits HeaderThe health care system in the United States can be intricate and confusing. By understanding some of the factors that affect the care you receive and knowing how to navigate the increasingly complex health care system, you can make better decisions and ultimately receive better care.

Traditional Health Care vs. Managed Care Historically, the United States health care system consisted of a large number of independent health care providers who owned their own practices. These were either solo practices or joint practices owned by multiple physicians who practiced together in a group setting. In addition, most communities had independent, not-for-profit hospitals.

Open enrollment following the COVID-19 pandemic will be unlike any other in recent memory.

Many organizations are still trying to recover from extended closures and maintain safe working environments—open enrollment is the last thing on their minds. Yet, procrastinating on enrollment planning can actually cause more issues than it solves. This article explains what employers can expect this enrollment period and how to prepare.

Open enrollment fairs are a great way for employers and benefits providers to help employees understand and enroll in the benefits programs that meet their needs.

These fairs are typically done in person, and they allow employees to learn about available benefits and discuss offerings with providers. Just as the COVID-19 pandemic may be changing what employees need for benefits, the format of open enrollment events should change, too. With open enrollment season around the corner and many organizations extending work-from-home policies, a virtual open enrollment fair may be necessary. This article explores benefits and best practices for organizations moving their open enrollment events online.

To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2021. Employers should review their plan documents to confirm that they include these required changes.

In addition, any changes to a health plan’s benefits for the 2021 plan year should be communicated to plan participants through an updated summary plan description (SPD) or a summary of material modifications (SMM).