ACA’s Contraceptive Coverage: New FAQs Guide

Wendy Lopez

On January 22, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a fresh set of Frequently Asked Questions (FAQs), shedding light on the Affordable Care Act (ACA)’s imperative for non-grandfathered medical plans to include specific preventive services, notably contraceptives, without imposing any cost-sharing on individuals. The aim of these FAQs is to address concerns from stakeholders, facilitating a better understanding of the contraceptive coverage mandate and encouraging compliance through an alternative method. For detailed insights and further information, download the PDF below. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

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Updated No Surprises Act and IDR Guidance

Wendy Lopez

Recent developments in healthcare legislation have brought changes to the No Surprises Act’s independent dispute resolution (IDR) process. Issued by the Departments of Labor, the Treasury, and Health and Human Services (HHS), FAQ Part 62 provides essential updates regarding the qualifying payment amount (QPA) calculation methodology and the disclosure requirements for out-of-network (OON) air ambulance services. Moreover, the federal IDR portal has reopened, streamlining the resolution of billing disputes. The No Surprises Act Overview The No Surprises Act, a part of the Consolidated Appropriations Act, 2021, aims to protect patients from surprise medical bills. It places limits on out-of-network cost-sharing and bans balance billing in various situations, such as emergency… Read More

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Court Vacates Coupon Cost-Sharing Rule

Wendy Lopez

On September 29, 2023, a significant legal development occurred that could affect how health insurance carriers and group health plans handle manufacturer coupons for prescription drugs. The District Court for the District of Columbia vacated a rule issued by the Department of Health and Human Services (HHS) that allowed, but did not mandate, the inclusion of manufacturer coupons in calculating the cost-sharing for health plans. In this blog post, we’ll explore the background of this issue, the 2019 HHS rule, and the subsequent legal decisions that have led to this recent development. HHS’s 2019 Rule In 2019, HHS issued a rule to clarify this matter. The rule stated that plans… Read More

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