Benefit Buzz - May 2021

Zywave, Inc • May 10, 2021

Benefit tips brought to you by MFC Benefits, LLC

Learn more about the ARPA COBRA Subsidy Model Notices and Consolidated Appropriations Act:

DOL ISSUES ARPA COBRA SUBSIDY MODEL NOTICES, FAQS

On April 7, 2021, the Department of Labor (DOL) issued FAQs and model notices for the COBRA premium assistance provisions of the American Rescue Plan Act (ARPA). The ARPA provides a 100% subsidy for employer-sponsored group health coverage continued under COBRA and similar state continuation coverage programs for eligible individuals. The subsidy applies from April 1 through Sept. 30, 2021. The notices and the FAQs appear on a new DOL webpage dedicated to the ARPA COBRA subsidy.

Model Notices
The DOL released the following new model notices:
- Model General Notice and COBRA Continuation Coverage Election Notice: Word | PDF
- Model Notice in Connection with Extended Election Period: Word | PDF
- Model Alternative Notice: Word | PDF
- Model Notice of Expiration of Premium Assistance: Word | PDF
- Summary of COBRA Premium Assistance Provisions under the American Rescue Plan Act of 2021: Word | PDF

Please download the PDF copy at the bottom of this page, in order to click on the model notice links.

Plans may use these DOL model notices to meet their notice obligations under the ARPA COBRA subsidy provisions.

FAQs
The DOL guidance contains 21 FAQs on topics such as eligibility, elections, notice requirements and duration of the subsidy. Notably, the FAQs state that prior federal COVID-19-related relief for plan deadlines does not apply to notice or election periods set forth in the ARPA provisions about the COBRA subsidy. However, an individual may elect COBRA from an earlier qualifying event if the individual is eligible to make that election, including under the extended time frames provided under that relief.

CONSOLIDATED APPROPRIATIONS ACT AND MENTAL HEALTH PARITY FAQS

The Consolidated Appropriations Act, 2021 (CAA) amended the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to provide additional protections. On April 2, 2021, the DOL, Health and Human Services (HHS) and the Treasury jointly issued FAQs to clarify these amendments.

In particular, the CAA requires group health plans and health insurance issuers to conduct comparative analyses of the nonquantitative treatment limitations (NQTLs) used for medical and surgical benefits as compared to mental health and substance use disorder (MH/SUD) benefits. The comparative analyses, and certain other information, must be made available upon request to applicable agencies beginning Feb. 10, 2021 .

The FAQs address the following:
- When plans and issuers must make their NQTL comparative analyses available;
- What information plans and issuers must make available;
- Reasons why documentation of comparative analyses of NQTLs might be insufficient;
- What types of documentation should be made available; and
- What actions the Departments might take for noncompliance.

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© 2021 Zywave, Inc. All rights reserved

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Benefit Buzz - May 2024

By MFC Benefits, LLC • May 15, 2024

Learn more about the Prescription Drug Report due date and the Court Ruling on Free Preventive Care. PRESCRIPTION DRUG REPORT IS DUE BY JUNE 1, 2024 Group health plans must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the "prescription drug data collection," or the "RxDC report." The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023. Employers should confirm they are taking steps to comply with this reporting deadline, such as providing information to third-party vendors on a timely basis. The RxDC report is comprised of several files, including those that require specific plan-level information, such as plan year beginning and end dates and enrollment and premium data. It also includes files that require detailed information about medical and pharmacy benefits. RxDC reports must be submitted through an online portal maintained by the Centers for Medicare and Medicaid Services (CMS). CMS'RxDC website includes updated reporting instructions and other reporting resources. Employers commonly use third parties, such as issuers, third-party administrators (TPAs) and pharmacy benefit managers (PBMs), to submit RxDC reports on behalf of their health plans. Employers using third parties to submit RxDC reports must ensure that this reporting responsibility is reflected in a written agreement with the third party. Employers may work with multiple third parties to complete the RxDC report for their health plans. For example, a self-insured employer may use both its TPA and PBM to submit different portions of the RxDC report. A health plan's submission is considered complete if CMS receives all required files, regardless of who submits them. COURT RULING EXPECTED SOON ON FREE PREVENTIVE CARE The 5th U.S. Circuit Court of Appeals is expected to issue a decision within the next few months regarding the constitutionality of the Affordable Care Act's (ACA) preventive care mandate. The ACA requires non-grandfathered health plans and health insurance issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles. In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA's preventive care mandate. More specifically, the court ruled that the preventive care coverage requirements based on an A or B rating y the U.S. Preventive Services Task Force on or after March 23, 2010, violate the U.S. Constitution. The Biden administration appealed the District Court's decision to the 5th Circuit. A ruling by the 5th Circuit is expected soon, likely followed by an appeal to the U.S. Supreme Court. It is uncertain whether the 5th Circuit will reverse or uphold the District Court's ruling. However, for now, non-grandfathered health plans and issuers must continue to cover, without cost sharing, the full range of preventive car services required by the ACA. If the 5th Circuit rules that a key component of the ACA's preventive care mandate is unconstitutional, employers will want to consult with their issuers or TPAs to assess the impact on their health coverage. Provided to you by MFC Benefits, LLC © 2024 Zywave, Inc. All rights reserved Download the PDF copy here. Link: http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://content.zywave.com/file/b6f7a224-b3a3-4409-a8f2-953f0994d66a/Benefits%20Buzz%20Newsletter%20January%202024.docx Link: http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://content.zywave.com/file/b6f7a224-b3a3-4409-a8f2-953f0994d66a/Benefits%20Buzz%20Newsletter%20January%202024.docx