Three Group Insurance Issues You May Have Missed – Employment and HR – United States – Mondaq News Alerts
United States:
Three Group Insurance Issues You May Have Missed
03 February 2022
Masuda, Funai, Eifert & Mitchell, Ltd.
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In late 2021 and early 2022, three issues affecting group health
insurance became law. To ensure you remain in compliance, we have
summarized them below:
A New Group Health Plan Disclosure Notice in
Illinois: Effective August 27, 2021, the Consumer Coverage
Disclosure Act (the “CCDA”) became law in Illinois. The
CCDA requires all companies that provide group health insurance to
employees in Illinois to provide all employees who are eligible for
group health insurance coverage a written list of all covered
benefits included in the company’s group health insurance plan
in a format that easily compares the plan’s covered benefits
with the essential health insurance benefits required of individual
health insurance coverage regulated by the State of Illinois. The
Illinois Department of Labor website includes a disclosure
template. The required disclosure must be provided upon hire,
annually thereafter, and upon request from an employee.
Importantly, the new disclosure notice does not require a
company’s group insurance plan to provide all the essential
health insurance benefits listed. Instead, companies must provide
the disclosure simply for comparison purposes. The CCDA is enforced
by the Illinois Department of Labor via civil penalties. Although
this is an employer notice requirement and not an insurance company
notice requirement, companies with employees in Illinois should
seek assistance from their insurance company, broker, or
third-party administrator to develop the comparison.
Brokers and Consultants Must Disclose Direct and
Indirect Compensation: On December 30, 2021, the U.S.
Department of Labor issued a temporary enforcement policy related
to group health insurance plan brokers and consultants. In short,
all brokers and consultants that provide services to an
ERISA-covered group health plan who reasonably expect to receive
$1,000 or more in direct or indirect compensation in connection
with providing such services must disclose their compensation in
advance of the parties entering into the agreement. This new
compensation disclosure requirement, which applies to all insured
and self-insured group health plans regardless of size, is intended
to provide plan fiduciaries with sufficient information to assess
(1) the reasonableness of compensation to be received by their
broker or consultant, and (2) any potential conflicts of interest
that may exist because the broker or consultant is receiving
indirect compensation from other sources other than the plan or the
plan sponsor. The new compensation disclosure requirement applies
to all contracts of agreement for services which are entered,
extended, or renewed on or after December 27, 2021.
Over-the-Counter COVID-19 Tests Covered by Health Plans
Without Attending Physician: On January 10, 2022, the
Departments of Labor, Health and Human Services and Treasury issued
a Q&A clarifying that individuals who purchase over-the-counter
COVID-19 home tests, without the test first being ordered by a
health care provider, can seek reimbursement from their insurance
plans. This new Q&A replaces guidance issued in June 2020,
which required the self-tests or at-home tests to be ordered by an
attending physician. As such, employees should submit claims for
self-tests or at-home tests to the company’s insurance
carrier.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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