Nothing written by SPBA is legal advice.
Prescription Drug Reporting (RxDC)
Articles and Materials
Official Source Documents
RxDC Reporting Instructions(2/27/23)
RxDC Interim Final Rule Text(2/27/23)
RxDC Reporting FAQs(2/27/23)
Independent Dispute Resolution
Articles and Materials
Official Source Documents
Hospital Transparency
Articles and Materials
Transparency Documentary Trailer(6/5/12)
Sharing Hospital Transparency(7/12/11)
Hospital Transparency(6/3/11)
Security - Cybersecurity and HIPAA
Articles and Materials
NAIC Adopts Cybersecurity Model Law(11/28/17)
OCR Cyber-Awareness Update(6/1/16)
DHS Cyber Alert on Ransomware(4/6/16)
Cybersecurity Act of 2015(1/29/16)
HHS Releases Final HIPAA Rule(1/24/13)
HHS Issues Breach Notification Rules(9/10/09)
HHS Breach Notification Rules(9/8/09)
HIPAA Security Rules: Overview(12/8/06)
HIPAA Security Standards Addendum(10/26/04)
Security Plan Document Amendment(10/16/04)
Official Source Documents
2016 - 2017 HIPAA Audits Industry Report(12/21/20)
HIPAA Audit Phase 2(11/30/16)
Additional Clarification Regarding Phishing Email Alert Audits of Business Associates Are Underway(11/30/16)
Cyber Threat Information-Sharing(9/30/16)
HIPAA Audit Protocol 2016(9/22/16)
OCR Announces Initiative to More Widely Investigate Breaches Affecting Fewer than 500 Individuals(8/30/16)
Do You Know Who Your Employees Are?(8/30/16)
HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents.(7/21/16)
NIST Cybersecurity Framework(1/28/16)
Technology Service Partner
SPBA Board of Directors
SPBA Board of Directors Application(1/29/24)
Board of Director's Role Description(7/11/17)
DOL
Articles and Materials
Plan Asset Regulations(1/24/24)
DOL Makes Claims Records Relevant(7/15/21)
Claim Regulations Raises Fees Issue(12/8/06)
Official Source Documents
DOL Disclosure Rules(4/6/09)
New SPD Requirements Under HIPAA(12/8/06)
Plan Assets
Articles and Materials
Plan Asset Regulations(1/24/24)
SPBA Organizational Information
SPBA Dues Structure for 2024(1/11/24)
SPBA Staff(5/29/22)
SPBA Digital Graphics(11/11/20)
SPBA Code of Ethics(9/17/14)
SPBA Mission & Vision Statement(12/17/13)
Why Doesn't SPBA Do ___???(1/5/12)
A Reality Check of SPBA's Role(11/13/09)
Deciding if a firm is eligible to join SPBA and if it would be a worthwhile investment for you(11/3/09)
What Makes SPBA Tick(10/20/09)
CEO, COO, CFO Insight(10/20/09)
Hints for senior contacts(10/20/09)
Important Warnings(10/20/09)
Members' Bad Office Habits(10/20/09)
Report on SPBA Meeting Planning(10/20/09)
SPBA Association Description(10/20/09)
SPBA History and Customs(10/20/09)
SPBA No Go to Court(10/20/09)
A Brief History of SPBA(5/1/09)
Articles and Materials
SPBA Code of Ethics(9/8/14)
Regulatory & Legislative Issues
Articles and Materials
Cafeteria Plans
Articles and Materials
Future Meetings
Future Meetings (Click Here)(11/1/23)
Plan Transparency
Articles and Materials
Machine‑Readable Rx Files Enforcement (10/26/23)
TinC 2.0 Complexity and HR 3561 Impact (7/14/23)
Sales Tool & Opportunity(2/9/12)
Official Source Documents
Directory of TPAs, Stop-Loss & Service Partners
Wellness
Articles and Materials
EEOC Wellness Proposed Rule Article(4/28/15)
Official Source Documents
HHS FAQs on Wellness April 2015(4/28/15)
Wellness
Articles and Materials
Proposed EEOC Regulation - Application to GINA Title II to Wellness Programs (PPT 12-17-15)(3/16/16)
EEOC Wellness Proposed Rule Article(4/28/15)
Wellness - Developing as a Strategy(11/16/09)
TPA Success in Wellness(11/5/08)
Wellness Education Program(10/22/07)
Plan Incentives for Healthy Behavior(5/11/07)
Official Source Documents
Medicare
Official Source Documents
Designing Plans for Older Workers(5/23/08)
CMS Clarifies Notification Deadlines(12/8/06)
Medicare Wrap Arounds(12/8/06)
Articles and Materials
CMS Clarifies Payment in HRAs(12/8/06)
Medicare Part D
Official Source Documents
CMS Medicare Part D(8/17/11)
MHPAEA
Mental Health Parity & Addiction Equity Act (MHPAEA)
Official Source Documents
2021 MHPAEA Enforcement: Fact Sheet(1/26/22)
2022 MHPAEA Report to Congress(1/26/22)
Final Rule: Mental Health Parity Act(11/12/13)
Articles and Materials
MHPAEA Provisions in CAA(2/2/21)
New MHPAEA FAQs Released(5/10/12)
MHPAEA Overview(2/16/10)
2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert)(2/2/10)
MHPAEA Interim Final Regulations(2/17/10)
MHPAEA Request for Information(5/7/09)
HHS
Official Source Documents
Articles and Materials
IRS
Articles and Materials
2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert)(2/2/10)
Official Source Documents
IRS Notice 2019-63(12/2/19)
IRS ACA Webpages(7/31/13)
IRS - FAQs for Same Sex Couples(10/7/19)
2010 Excise Tax Requirements(2/2/10)
1099 - IRS IIR Request(1/26/07)
IRS Issues Debit Card Transition Relief(12/15/06)
IRS Notice on Debit Card Relief(12/15/06)
1099 - IRS Hints(12/8/06)
Allowable Plan Reserves(12/8/06)
Allowable Plan Reserves(12/8/06)
IRS on HMOs(12/8/06)
Proposed Revisions to the 5500 Form(12/8/06)
Reserves Reminder(12/8/06)
1099 - IRS Letter(12/8/94)
Financial
Audited Financial Statements 2020(11/19/21)
2019 Audited Financial Statements(1/13/21)
Advisor for SPBA Investments(1/12/21)
Auditor/CPA Information(1/12/21)
Resolution for Bank Account(6/20/19)
2018 Audited Financial Statements(5/15/19)
Dues Structure Approved Through 2020(11/4/15)
Dues Structure Board Action(11/3/15)
History on Dues & "Contacts"(11/12/09)
Safeguard Procedures for SPBA Audit(3/20/07)
Lobbying Accounting Explanation(5/1/05)
FAQs Implementation
Official Source Documents
DOL EBSA Webpage of FAQs(8/1/23)
Lobbying & Government Relations Policy
IRS Technical Guide on 501(c)(6) (7/27/23)
General Positions* of SPBA as Board guidance of how SPBA approaches & proceeds with govt. issues.(11/13/09)
A Reality Check of SPBA's Role(11/13/09)
Strategy
Federal Guidance
Articles and Materials
CMS Releases Vaccine Set of Toolkits(12/30/20)
EEOC Issues Vaccination Guidance(12/30/20)
OCR COVID - 19 Webinar Available Now(4/29/20)
EEOC Releases FAQs and Webinar on ADEA and Antidiscrimination Issues on COVID-19 and Pandemic(4/8/20)
EEOC Response to COVID-19(3/20/20)
Official Source Documents
CDC - ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020 (4/7/20)
IRS FAQs on Tax Credits(4/1/20)
State Licensing
TPA License Change For Michigan (7/5/22)
Articles and Materials
2022 TPA License Corrections (10/11/22)
Official Source Documents
Kansas TPA Act; SB22(4/27/17)
Board of Directors Contact Info (Cell & Direct Dial)
Stop Loss
Articles and Materials
2024 SPBA Stop-Loss Application(5/30/23)
Self-Funding: Myths vs. Facts(9/2/14)
Official Source Documents
Minnesota Stop-Loss(2/1/17)
Stop-Loss Model Act(8/8/12)
Stop-Loss Summit Issues(3/9/11)
ERISA Follows the Plan Money(12/8/06)
STOP-LOSS Fraud(12/8/06)
Who Owns Stop-Loss Policy(12/8/06)
Disclosure Form Background & Explanation(10/31/06)
Cafeteria Plans - Explanation and Commentary
Articles and Materials
$2,500 Health FSA Limit Guidance(7/17/12)
5500 Forms and Cafeteria Plans(12/8/11)
Cafeteria Plan Elections(11/16/09)
Cafeteria Plan Election Changes(12/8/06)
Debit Cards(10/24/06)
Health Savings Accounts
Articles and Materials
IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan(1/3/20)
IRS Retirement Plan News(10/1/09)
HSA Contribution Limits for 2020(1/3/20)
HSA 2018 Contribution Limits(4/24/18)
HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP(4/17/07)
All About HSAs(12/8/06)
FSA Interaction with HSAs(12/8/06)
HSA Opportunities for TPAs(12/8/06)
HSAs and ERISA(12/8/06)
Learn How to Make HSA Decisions(12/8/06)
Teaching Tools Power Point(11/8/04)
Everything You Wanted to Know about HSAs (and then some) - HIckman & Gillihan, Alston & Bird LLP(10/21/04)
Official Source Documents
IRS Notice 2004-2(11/14/14)
IRS Notice 2004-50(7/30/10)
Custodial Account Form(7/10/08)
DOL FAB 2004-01(12/8/06)
DOL FAB 2006-02(12/8/06)
Final HSA Comparability Rules(12/8/06)
Treasury Guidance on Preventive Care(1/19/06)
Notice 2005-8 - 2% Shareholders(8/5/05)
Statistics/Numbers
Official Source Documents
2022 Milliman Medical Index (5/23/23)
2021 Milliman Medical Index(4/22/22)
Minutes of Board Meetings
Articles and Materials
2023-Apr-6: SPBA Board Call Minutes(5/19/23)
2023-Mar-2: SPBA Board Call Minutes(5/19/23)
2023-Feb-2: SPBA Board Call Minutes(5/19/23)
2023-Jan-5: SPBA Board Call Minutes(5/19/23)
2021-Dec-2: SPBA Board Call Minutes(11/3/22)
2021-Nov-4: SPBA Board Call Minutes(11/3/22)
2021-Oct-7: SPBA Board Call Minutes(11/3/22)
2021-Sep-2: SPBA Board Call Minutes(11/3/22)
2021-Aug-4: SPBA Board Call Minutes(11/3/22)
2021-Jul-1: SPBA Board Call Minutes(11/3/22)
2021-May-6: SPBA Board Call Minutes(11/3/22)
2021-Apr-1: SPBA Board Call Minutes(11/3/22)
2021-Mar-4: SPBA Board Call Minutes(11/3/22)
2021-Feb-4: SPBA Board Call Minutes(11/3/22)
2021-Jan-7: SPBA Board Call Minutes(11/3/22)
2020-Oct-1: SPBA Board Call Minutes(5/27/21)
2020-May-20: SPBA Board Call Minutes(5/27/21)
2020-Apr-2: SPBA Board Call Minutes(5/27/21)
4/4/2018 - Spring - 2018 - April 4, 2018(11/26/18)
6/22/2018 Board Minutes & Resolution(7/18/18)
Surprise Billing
Official Source Documents
Rx Reporting IFR (8/15/22)
Surprise Billing Model Notice(10/18/21)
No Surprises Act Bill Text(2/4/21)
Articles and Materials
COVID-19 Resource Center
Articles and Materials
Basic Board Policy
Founding Purposes of SPBA(11/11/09)
Medicaid
Official Source Documents
Medicaid Recovery FAQ from CMS(12/14/17)
CMS Cover Letter to Medicaid Directors(12/29/06)
CMS Qs and As on Medicaid Recovery(12/29/06)
Articles and Materials
CMS Letter to States(12/29/06)
State Medicaid Compliance(9/25/06)
Preventive Services
Articles and Materials
Preventive Services FAQ Part XXVI(5/28/15)
Religious Contraceptive Issue(1/30/14)
Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans(4/17/13)
Comments Sought on Plan Design(1/21/11)
Preventive Services: Issues Abound(1/21/11)
Official Source Documents
Essential Health Benefits
Articles and Materials
HHS Has Released the Essential Health Benefits Bulletin: How Does it Affect Group Health Plans?(12/20/11)
Announcement of IHB IOM Report(10/7/11)
Essential Health Benefits(1/21/11)
Essential Health Benefits(1/14/11)
Official Source Documents
Analysis & Articles
Articles and Materials
COVID-19 Fact Sheet for Employees(7/28/21)
What You Should Know About COVID-19 and the ADA, the Rehabilitation Act and other EEOC Laws (LINK(7/28/21)
CPT Codes for Vaccines Released(11/24/20)
Coronavirus Scammer Alert(3/10/20)
COVID-19 and Group Health Plans(3/10/20)
Health Reform Law
Articles and Materials
Official Source Documents
ERISA, Fiduciary Issues, and Types of Plans
Section 1557 Nondiscrimination
Articles and Materials
Medicare Secondary Payer
Articles and Materials
MSP Mandatory Reporting Penalties(12/1/15)
Official Source Documents
GHP User Guide 2020(8/7/20)
SSN Model Collection Form(3/4/11)
Alert on Obtaining SSNs(3/4/11)
MSP Reporting and HRAs(6/10/10)
Cafeteria Plans - Agency Guidance
Articles and Materials
Official Source Documents
2015 Health FSA Dollar Limits(11/15/14)
125 Elections & MarketPlace Coverage(9/19/14)
$500 Rollover Guidance(11/20/13)
IRS Notice on FSA Carryover(10/31/13)
2001 Regulations on Election Changes(5/28/10)
2000 Regulations on Election Changes(5/28/10)
Debit Card IRS Revenue Ruling(12/8/06)
PCORI
Articles and Materials
IRS Releases Updated PCORI Fee (11/15/22)
Updated PCORI Fee Released(6/8/20)
PCORI Fees Due on July 31, 2017(6/26/17)
PCORI Fee - IRS Notice 2016-64(11/30/16)
PCORI Fee(2/29/16)
Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014)(5/29/14)
PCORI Questions from SPBA Members(6/27/13)
PCORI: Q&As(5/21/13)
Updated PCORI Released (11/30/20)
IRS Notice 2018-85: PCORI Fee(11/6/18)
IRS Releases Adjusted PCORTF Fee(11/6/18)
PICORI Fees(6/29/18)
Official Source Documents
PCORI Fee IRS Notice 2017-61(10/20/17)
IRS Webpage on PCORI(1/5/17)
PCORI Fee - IRS Notice 2016-64(11/29/16)
PCORI Fee for 2015- 2016(11/2/15)
SPBA Insurance
Insurance Policy Overview(11/4/22)
Crime(11/1/22)
Commercial Umbrella(10/3/18)
General Liability(10/3/18)
D & O(10/3/18)
Nondiscrimination - HIPAA/GINA
September 2009 GINA Regs(10/2/09)
Genetic Nondiscrimination Act(6/6/08)
Plan Incentives for Healthy Behavior(5/11/07)
Reducing Benefits for Active Workers(10/26/05)
Articles and Materials
Americans with Disabilities Act
Articles and Materials
ADA Amendments Act of 2008(8/15/19)
ADA Speech Handout(8/15/19)
Questions and Answers on the Notice of Proposed Rulemaking for the ADA Amendments Act of 2008(8/15/19)
EEOC
Articles and Materials
EEOC Releases New COVID Rules (9/7/22)
COVID-19 Fact Sheet for Employees(7/28/21)
What You Should Know About COVID-19 and the ADA, the Rehabilitation Act and other EEOC Laws (LINK(7/28/21)
EEOC Nonbinary (7/5/22)
Official Source Documents
Nondiscrimination
Nondiscrimination - HHS
HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)
Nondiscrimination in Health Programs & Activities Proposed Rule: News Release + Fact Sheet + FAQs(9/9/15)
Official Source Documents
Franciscan-Alliance v. Burwell(1/5/17)
Articles and Materials
HIPAA and Privacy
Official Source Documents
HIPAA Audit Protocol 2016(9/22/16)
HIPAA Privacy in Emergency Situations(11/18/14)
HIPAA Security Guidance - HHS(4/17/07)
Articles and Materials
HIPAA Privacy Opioid Guidance(11/28/17)
New HIPAA Business Associate Agreements (8/27/14)
Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans(4/17/13)
HHS Releases Final HIPAA Rule(1/24/13)
HHS Issues Breach Notification Rules(9/10/09)
4 Timely Alerts(2/8/07)
Authorization Sample Form(12/8/06)
Complaint Sample Form(12/8/06)
Does HIPAA Privacy prohibit insurers or HMOs from releasing claims experience due to HIPAA Privacy?(12/8/06)
Flowchart Brainstorming Tools(12/8/06)
HIPAA PRIVACY: Overview for TPAs(12/8/06)
Sample Amendment to Plan Documents(12/8/06)
Abortion
EDI/HIPAA Administrative Simplification
Articles and Materials
ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)
ICD-10 Stop-Loss Disclosure Paper (9/15/15)
HHS Provides Feedback on NPI(12/8/06)
Kansas Terminates Digital Healthcare(12/8/06)
TPA Websites for Providers and EDI(12/8/06)
Official Source Documents
ICD-10 - Testing with CMS(7/29/15)
Disclosure of Fees
Investment Statements
October 2021 Investment Statement(11/12/21)
Surprise Billing (see Transparency/Surprise Billing Resource Center on the homepage)
Official Source Documents
Surprise Billing Model Notice(10/18/21)
No Surprises Act Bill Text(2/4/21)
Articles and Materials
Air Ambulance
Articles and Materials
Air Ambulance Letter to Senate(8/8/18)
Congressional Activity
Articles and Materials
Official Source Documents
COBRA
Official Source Documents
1999 and 2001 Final COBRA Regs(8/16/09)
Articles and Materials
FAQ 32 COBRA(8/15/19)
FAQ 32 COBRA(6/29/16)
Is a Spouse Entitled to COBRA when the Covered Employee Drops Coverage after Enrolling in Medicare?(1/3/20)
COBRA Tax Audits(8/16/19)
IRS on Family and Single COBRA Rates(8/16/19)
COBRA Model Notices(8/16/19)
Gillihan's COBRA Presentation(11/3/05)
Schedule J
Official Source Documents
Articles and Materials
Executive Order Impact(1/31/17)
2016 Year in Review (12/29/16)
DOL 5500 Form and Schedule J (12/5/16)
5500 Forms
Official Source Documents
Articles and Materials
Contacts - Technology
SPBA Technology Contacts(1/13/21)
Grandfathered Plans
Articles and Materials
Agency Grandfather Table(8/2/10)
Official Source Documents
Expendable Grandfather(8/17/10)
Marketing TPA Services + PR
Why Use a TPA?(10/13/20)
Choosing & Evaluating TPA Services(6/25/19)
What Brokers Should Seek in A TPA(2/13/12)
Hints on Marketing to TPAs(11/3/09)
TPA Cost Value(10/20/09)
Your TPA Firm as a Leading "Good Guy"(10/20/09)
Canada Issues: Admin Costs: US vs Canada(10/20/09)
Congratulations & Press Tips(10/20/09)
Luring Your Clients Away(10/20/09)
Outsourcing & Offshore Considerations(10/20/09)
Responses to Anti TPA Propaganda(10/20/09)
"Stung" or Risk Averse?(10/20/09)
Articles and Materials
IRS Retirement Plan News(10/1/09)
Size and Role of TPA Market + Stop Loss
"Biggest" and "Independent" TPAs(11/8/11)
What's Allowable Error Rate?(12/8/06)
Articles and Materials
Cautions
Read All Your Contracts(10/12/20)
More & Broader Privacy Expected(12/21/10)
Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims(4/1/09)
Bank Failures and Dumping TPAs(11/7/08)
When You Overpay a Provider(11/5/08)
ERISA Fiduciary: Beware % Payments(12/8/06)
Funding: To: Employers & Plans Having Trouble Fully Funding their ERISA Employee Benefit Plan(12/8/06)
My Attorney Says....(12/8/06)
Articles and Materials
SPBA 2020 Fall Virtual Meeting
J. Hospital Price Transparency Rule(9/13/20)
Sponsorship
Webinars
Fraud
Official Source Documents
Specialty Drugs
Articles and Materials
State Guidance
Official Source Documents
New Mexico: Insurance Superintendent Guarantees Free COVID-19 Testing & Treatment for New Mexicans(4/6/20)
Nebraska: Insurer Accommodation to Policyholders or Claimants Developed in Response to COVID-19(4/6/20)
Texas: COVID-19 Emergency Rules(4/6/20)
Connecticut: 60-Day Grace Period for Insurance Premium Payments Due to Disruption Caused by COVID-19(4/2/20)
Massachusetts: Administration of Prescription Drug Benefits during COVID-19 Public Health Crisis(4/1/20)
Massachusetts: Flexibility in the Issuance & Administratration of Insurance during COVID-19 Crisis(4/1/20)
Utah: Coverage for COVID-19(4/1/20)
Utah: Guidance for Business Interruption Claims Related to COVID-19 or the March 18 Earthquake(4/1/20)
Washington: Telemedicine(4/1/20)
Missouri: Executive Order(4/1/20)
New York: Continuing Temporary Suspensiopn & Modification of Laws Relating to the Disaster Emergency(4/1/20)
Alaska: Requirements for Cost Sharing & Coverage Related to Respiratory Illnesses Including COVID-19(4/1/20)
Indiana: Indiana COVID-19 Bulletin(3/30/20)
Louisiana: Louisana Emergency Rule(3/30/20)
Articles and Materials
State Responses to COVID-19(4/7/20)
Stop-Loss
Liberty Mutual - IRONSHORE(3/30/20)
Crum & Forster(3/27/20)
Tokio Marine HCC(3/27/20)
American Fidelity(3/24/20)
US Benefits Insurance Services, LLC(3/24/20)
Employer Shared Responsibility
Official Source Documents
IRS Letter on Calculating ESR Liability(11/13/17)
Play or Pay 2013 IRS Q&As(1/2/13)
Articles and Materials
Marketplace Appeal Letters(8/30/16)
Documentation of Coverage Offer(9/29/14)
Non-Major Medical Plan and MEC(10/24/13)
FMLA (Family Medical Leave Act)
Health Reimbursement Arrangements
Official Source Documents
HRA - IRS Notice 2002-45(12/8/06)
HRA - IRS Revenue Ruling 2002-41(12/8/06)
Articles and Materials
CMS Clarifies Payment in HRAs(12/8/06)
Reporting
Official Source Documents
IRS Notice 2019-63(12/2/19)
IRS Extends Due Date for 1095-C(12/22/17)
2016 Form 1095-C(1/23/17)
2016 Form 1094-C(1/23/17)
IRS Notice 2012-32(6/11/12)
IRS Notice 2012-33(6/11/12)
Articles and Materials
ACA Information Reporting Delayed(11/30/16)
Reporting Offers of Coverage(1/29/16)
COBRA and 1095-C Reporting(12/1/15)
No Offer, But Still Report(6/27/15)
Good Faith Effort Reporting Relief(6/27/15)
IRS Proposed Rules on MEC Reporting(8/30/16)
IRS ACA Reporting Corrections ppt(6/29/16)
Webinar
Administrative Simplification
Official Source Documents
ICD-10 - Testing with CMS(7/29/15)
HPID Manual(10/31/14)
HPID Quick Guide 9/2014(10/8/14)
Articles and Materials
HPID: For Your Information(7/31/14)
Health Plan Identifier (HPID)(2/27/14)
New Rules on EDI(7/12/11)
Special Types of Plans & Situations
Articles and Materials
Leasing Do's & Don'ts(1/10/95)
ERISA Q&As (DOL, ABA & JCEB)(1/7/13)
Self-Funding: Why Use Self-Funding?(5/27/11)
Self-Funding: Why Use Self-Funding?(5/27/11)
EEOC Changes Retiree Benefits(12/8/06)
Most* Medical Provider Network Entities that Contract Directly with Employers are Currently Illegal(12/8/06)
VA Complaints about Fiduciary Duty(12/8/06)
Official Source Documents
States
Articles and Materials
Texas Prompt-Pay Law(2/29/16)
Official Source Documents
Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions(11/5/18)
Nevada: Revised Statutes(10/24/17)
Minnesota Stop-Loss(2/1/17)
Georgia - OCGA § 33-30-13.1(11/5/08)
Indiana & Maine(11/5/08)
Kentucky 806 (pdf)(11/5/08)
Kentucky 846(11/5/08)
New Mexico(11/5/08)
Oklahoma - Section 4512(11/5/08)
South Dakota(11/5/08)
Texas - HB 2015 Amended(11/5/08)
Texas - HB 2015 Enrolled Version(11/5/08)
Virginia(11/5/08)
Wisconsin (pdf)(11/5/08)
Bill Number: TX80RHB 2015(10/11/07)
Massachusetts Health Care Reform(10/11/07)
State Health Care Reform(10/11/07)
Texas Loss Experience Legislation(10/11/07)
Additional Questions on the NYHCRA(12/8/06)
New York Surcharge Impacts Employers(12/8/06)
NJ Law Turns Lemons to Lemonade(12/8/06)
Strategies on Massachusetts(12/8/06)
Third Party Administrator Statute(12/8/06)
Domestic Partners
IRS - FAQs for Same Sex Couples(10/7/19)
U.S. v. Windsor(11/1/12)
Fiduciary Issues
Fidelity Bonding Under ERISA(4/9/09)
Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims(4/1/09)
Status of New Types of Plans(2/2/09)
When You Overpay a Provider(11/5/08)
Letter to Brokers, Clients and Friends of TPAs on the Disclosure of Commissions and Payments(7/8/08)
The ERISA NEED to Have a TRUST(6/5/08)
Don't Be ERISA Jailbait(5/8/08)
Don't weasel on claims(12/8/06)
ERISA Fiduciary Reminder(12/8/06)
ERISA Fiduciary: Beware % Payments(12/8/06)
ERISA Follows the Plan Money(12/8/06)
Funding: To: Employers & Plans Having Trouble Fully Funding their ERISA Employee Benefit Plan(12/8/06)
Medical fraud/fiduciary explaination(12/8/06)
Performance standards(12/8/06)
PTE 84-24 (Keeping Commissions)(12/8/06)
PTE 84-24: A Sample Form(12/8/06)
STOP-LOSS Fraud(12/8/06)
TPAs Taking on Fiduciary Duty?(12/8/06)
What's Allowable Error Rate?(12/8/06)
Medical letter(2/1/91)
Articles and Materials
2016 Year in Review (12/29/16)
Official Source Documents
Defense of Marriage Act (DOMA)
Supreme Court Decides DOMA(8/17/19)
DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans(8/16/19)
U.S. v. Windsor: A CMS Update(10/4/13)
U.S. v. Windsor: DOMA Opinion(6/26/13)
U.S. v. Windsor(11/1/12)
Official Source Documents
COBRA-ARRA
COBRA Model Notices(8/16/19)
COBRA Subsidy Extension(2/24/10)
COBRA Subsidy Extension Signed into Law(12/28/09)
CMS COBRA Denial Application(5/8/09)
DOL COBRA Denial Application(5/8/09)
COBRA Expanded for TAA Individuals(4/27/09)
ARRA COBRA Subsidy: Phase II(4/16/09)
ARRA Second Chance Election(4/9/09)
COBRA Premium Update(2/23/09)
AHP (Association Health Plans)
AHP Comment Letter on Behalf of SPBA(8/15/19)
Official Source Documents
CHIPRA
Employer CHIP Notices(8/15/19)
CHIP DOL Release(8/15/19)
Model CHIP Notice(2/4/10)
CHIPRA Notice Requirements(4/27/09)
Access/Protection
National Medical Support Notice(8/15/19)
USA PATRIOT Act Update(8/15/19)
Insurer Duties Under USA PATRIOT Act(8/15/19)
Articles and Materials
AHPs (Association Health Plans)
Official Source Documents
Associated Health Plans & DOL (Case)(3/29/19)
AHP: ERISA Compliance Assistance(10/22/18)
Prescription Drugs
Medicare for All
Articles and Materials
Minimum Essential Coverage
Official Source Documents
Rev. Proc. 2019-29(7/22/19)
IRS Final Regs MEC(11/26/14)
Articles and Materials
Non-Major Medical Plan and MEC(10/24/13)
Portability - HIPAA
Articles and Materials
Special Enrollment Period Change(12/8/06)
VA Coverage is Creditable Coverage(12/8/06)
Final HIPAA Portability Rules(1/18/05)
Official Source Documents
Reference-Based Pricing
Webinar: Reference-Based Pricing(1/3/19)
Preemption and MEWA
MEWA 2018: Form M-1 + 10 Tips for Filing(12/11/18)
MEWA 2010 M-1 Form(1/31/11)
Articles and Materials
MEWA Plan Contacts(1/20/16)
Double Warning on Employment Status(8/28/08)
A Wishful Thinking MEWA Mindset(5/1/03)
Leasing Do's & Don'ts(1/10/95)
Official Source Documents
FSAs
Articles and Materials
Official Source Documents
Board Elections & Orientation
Board Orientation Powerpoint(7/9/18)
Board of Director's Role Description(7/11/17)
Board Interview Evaluation Form(8/3/15)
Board Nominee Orientation Letter(11/11/11)
Newly Elected Board Orientation(11/11/09)
Criteria for Board Candidates(11/11/09)
New Member Applications and Anti-Trust(11/11/09)
HSAs (Health Savings Accounts)
Specific Issues
Leave Behind on AHP(4/2/18)
Leave Behind on Opioid(4/2/18)
Leave Behind on Transparency(4/2/18)
Leave Behind on SPBA(4/2/18)
TPA Cost Value(11/2/07)
Articles and Materials
Operations + Ownership Tips
Successful Mergers & Acquisitions(11/16/09)
Starting a TPA(11/2/07)
Buy/Sell: Advice on Buying TPA firms(3/14/07)
Buy/Sell: Buying & Selling TPAs(12/8/06)
Buy/Sell: TPA Buy/Sell Advice(12/8/06)
Cadillac Tax
Cadillac Tax Delay(1/29/18)
Articles and Materials
Cadillac Tax Delayed Until 2020(5/17/17)
Excise Tax Comments from SPBA(5/21/15)
Official Source Documents
Education & Outreach
ACA Repeal & Replace Talking Points(1/17/17)
Articles and Materials
Self-Funding: Myths vs. Facts(9/2/14)
Health Reform Emails 2017
Tax Reform: A look “the morning after”.(12/20/17)
Tax Reform: A Taxing Mental Exercise(12/12/17)
Tax Reform Tangle – Special Report (11/13/17)
Cures Act
Cost Sharing
Articles and Materials
Cost Sharing Limits Plan Year 2018 (11/17/17)
Link to the Minimum Value Calculator(8/16/13)
Official Source Documents
HRAs (Health Reimbursement Accounts)
Official Source Documents
HRA Annual Limit Waiver Guidelines(10/4/13)
Technical Release 2013-03 (10/4/13)
Articles and Materials
Deductible Caps on Small Business (4/26/13)
Nondiscrimination Rules - IRS
Articles and Materials
Official Source Documents
TPA Forecasts and Reports
What's the Future for Insurers?(7/27/11)
Boom time for TPAs is Starting(7/12/11)
Mid-2005 TPA Industry Report(11/3/09)
Planning Your Firm'$ Future(12/8/06)
Pollyanna Predictions?(7/14/05)
TPA Competition Rollercoaster - Ongoing(12/14/04)
How to Shape Legislative Proposals & Govt. Policy
Key Health Policy Committee Members (8/7/17)
General Strategies
Health Reform Legislative Process(6/18/09)
How to Contact Your Member of Congress(10/11/07)
Articles and Materials
Meeting Handouts
Workshop B: Cafeteria Plans(3/20/17)
F. ACA Employer Plan Reporting(3/20/17)
D. Anti-Trust Training for Members(3/20/17)
C. Schedule J(3/20/17)
R. Cybersecurity Liability Insurance(10/14/16)
Q. PBM Insights(10/14/16)
N. Workshop G: Stop-Loss Training on ACA(10/14/16)
M. Workshop E: Free Market Health Care(10/14/16)
H. Lowering the Heat on Cyber Risk(10/13/16)
G. HIPAA Audits - Preparing for Them(10/13/16)
F. Reference-Based Pricing(10/13/16)
D. Specialty Drugs(10/13/16)
C. Innovative Plan Designs to Create Efficiences & Strategies to Avoid Compliance Challenges(10/13/16)
Ashley Gillihan - ALE/MEC Information Reporting Presentation + Examples from 2015 Spring Meeting(4/1/15)
G. Specialty Pharmacy(3/27/15)
C. The ADA: Voluntary Wellness Programs & Health Insurance Issues + Pregnancy Discrimination(3/27/15)
A. Agenda (for reference purposes)(3/27/15)
Stop-Loss
ACA Replace Legislation and Papers
Official Source Documents
Transgender
Articles and Materials
Transitional Reinsurance Program
Health Reform Emails 2016
Claims
Mental Health Parity
Summary of Benefits & Coverage
Clinical Trials
Articles and Materials
Clinical Trials(5/28/13)
Tax on Plans
Official Source Documents
Articles and Materials
Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014)(5/29/14)
PCORI Questions from SPBA Members(6/27/13)
Transitional Reinsurance 2013-28610(11/26/13)
Program Integrity Rule(11/1/13)
Final Rule(10/28/13)
Reinsurance Fees Comment Letter(1/4/13)
Health Reform Emails 2015 (Alerts Since Passage)
Tips for SPBA Members
AHIP Specialty Drug Issue Brief(12/10/15)
Auto Enrollment
Same-Sex
Official Source Documents
Stop-Loss Activity
Dependent Coverage
Official Source Documents
Articles and Materials
Minimum Value
Exchanges
IRS Revenue Procedure 2015-15(1/30/15)
FAQs: Payment Process for January 2014(10/23/13)
Penalties for Noncompliance(9/11/13)
Employer Coverage Tool(8/1/13)
CMS Navigator Assistance Roles(8/1/13)
Department of Labor Releases Exchange Notice (Exchange Notices, Guidance & COBRA Election Notice)(5/9/13)
Exchange News(5/3/13)
SHOP and Exchanges Update(4/26/13)
CCIIO Letter to Exchanges(4/8/13)
Marketplace Individual Questionnaire(3/25/13)
Marketplace: FA Paper Application(3/25/13)
Exchange Rules(2/1/13)
Exchange Notice Delayed(1/28/13)
Exchange Enrollment Process(1/14/13)
Exchange Rules Released (3/13/12)
Comments on Exchanges(10/5/11)
Fate of State Exchanges(7/12/11)
Exchanges as 1st Priority(8/17/10)
Articles and Materials
Official Source Documents
CLASS
Articles and Materials
Tax Credits for Premiums
W-2s
Official Source Documents
W-2 Health Value Reporting IRS FAQs Link(11/24/14)
IRS W-2 Guidance in 2012(2/3/12)
Articles and Materials
ACA IRS W-2 Presentation(3/6/12)
W-2 Reporting and Controlled Groups(2/29/12)
History on W-2 Health Value Reporting(10/25/10)
No Tax on Benefits $ on W-2(8/20/10)
W-2 Health Care Cost Reporting(8/20/10)
Health Reform Emails 2014 (Alerts Since Passage)
Health Reform: Today's (November 17, 2014) Insights + SPBA Membership Renewal Notices in Mail(11/17/14)
Shared Responsibility
Important
Official Source Documents
DOL Compliance Assistance Guide(11/20/14)
Articles and Materials
PPACA Reg Writers Answer SPBA Questions(10/29/10)
Excepted Benefits
Self-Funding
Articles and Materials
Self-Funding: Myths vs. Facts(9/2/14)
90-Day Waiting Period
Articles and Materials
90 Day Waiting Period Final Rules(8/27/14)
New Rules on 90-Day Waiting Period(2/24/14)
Official Source Documents
NAIC Resources
TPAs Impact NAIC Vote(12/5/12)
Official Source Documents
NAIC ERISA Working Group FAQs(10/18/12)
Articles and Materials
Health Reform emails 2013 (Alerts Since Passage)
Forecasting ACA's Future(6/6/13)
Terrorism and War Prep(4/17/13)
NAIC News
Articles and Materials
SPBA 2013 NAIC Press Release(12/16/13)
Official Source Documents
SPBA Testifies at NAIC on Stop-Loss(8/13/12)
Medical Loss Ratio
Official Source Documents
Articles and Materials
Penalties
Articles and Materials
Claims and Appeals/External Review
Revised Model Notice of Final Internal Adverse Benefit Determination - Revised as of 6-22-11(6/23/11)
States with Consumer Assistance Programs under PHS Act Section 2793 - Current as of 5-23-11(6/23/11)
Regulations for Internal Claims & Appeals Effective Date Extended + Technical Release 2011-01(3/18/11)
Articles and Materials
Official Source Documents
Over the Counter Drugs (OTC)
Mini-Med Waivers
Articles and Materials
Annual Limit Waivers Filing Due(10/31/12)
Mini-Meds and the Waiver Program(8/17/10)
Official Source Documents
Guidance: Exemption for Health Reimbursement Arrangements that are Subject to PHS Act Section 2711(8/24/11)
Waiver Application Form(12/13/10)
Waiver Guidance November 2010(11/16/10)
Student Health Insurance
Articles and Materials
Official Source Documents
SCOTUS
Cases
Articles and Materials
Official Source Documents
Health Reform Impacts and Trends
Articles and Materials
Vouchers
Articles and Materials
Free Choice Vouchers(11/23/11)
Early Retiree Reinsurance Program
Articles and Materials
ERRP New Guidance(8/17/11)
ERRP Clarification(8/17/11)
ERRP Application(8/18/10)
Official Source Documents
ERRP Update(12/21/10)
HHS Reinsurance Fact Sheet(4/8/10)
Self-Funded Reports
Self Funded Report to Congress(7/27/11)
Self Insured Health Benefit Plans(7/27/11)
Opt-Out
Official Source Documents
Articles and Materials
HIPAA Opt Out
ACOs (Accountable Care Organizations)
Official Source Documents
Sample Speeches
Is PPACA Rationing?(2/14/11)
Rescissions
Articles and Materials
Retroactive Rescission(12/21/10)
Anti-Fraud
Articles and Materials
Health Care Reform Anti-Fraud Sleepers(12/21/10)
Dental Plans
Articles and Materials
Dental Plans and Health Care Reform(11/3/10)
Annual and Lifetime Limits
Articles and Materials
Official Source Documents
Model Notices
Official Source Documents
Model notice of Opportunity to Enroll in Connection with Extension of Dependent Coverage to Age 26(6/29/10)
Model Notice on Patient Protections(6/29/10)
FTC (Federal Trade Commission)
Mandated Claims Appeals
Articles and Materials
Mandated Claims Appeals Processes(4/27/10)
Relations with ACL, Inc.
ACL, Inc. Management Agreement(4/26/10)
Michelle's Law
Articles and Materials
Opt-Out from Michelle's Law(2/19/10)
Michelle’s Law: Questions Remain(2/19/10)
Other Issues & Explanations
Why the No-Commercialism Policy?(11/13/09)
The Image & PR of the TPA Industry(10/1/99)
"White Paper" on Meetings(10/1/94)
Self Regulation for TPAs?(12/27/89)
Incoming Chair & Sec/Treas Orientation
Membership Eligibility & Trends
USERRA/Veterans
USERRA Final Regulations: Overview(12/8/06)
USERRA: Final Regulations(12/8/06)
Articles and Materials
Value Driven Initiatives
Articles and Materials
Privacy - GLBA
Articles and Materials
Subrogation
Articles and Materials
Supreme Court Case: Sereboff(12/8/06)
Understanding Government Role & Perspective
Stop-Loss Relations
90-Day Waiting Period
Articles and Materials
90 Day Waiting Period Final Rules (8/27/14)
New Rules on 90-Day Waiting Period (2/24/14)
Official Source Documents
Abortion
Basic Board Policy
Founding Purposes of SPBA (11/11/09)
Congressional Activity
Articles and Materials
Official Source Documents
Directory of TPAs, Stop-Loss & Service Partners
Fiduciary Issues
DOL Proposed Rule on TPA Fee Disclosure (10/7/19)
Fidelity Bonding Under ERISA (4/9/09)
Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims (4/1/09)
Status of New Types of Plans (2/2/09)
When You Overpay a Provider (11/5/08)
Letter to Brokers, Clients and Friends of TPAs on the Disclosure of Commissions and Payments (7/8/08)
The ERISA NEED to Have a TRUST (6/5/08)
Don't Be ERISA Jailbait (5/8/08)
Don't weasel on claims (12/8/06)
ERISA Fiduciary Reminder (12/8/06)
ERISA Fiduciary: Beware % Payments (12/8/06)
ERISA Follows the Plan Money (12/8/06)
Funding: To: Employers & Plans Having Trouble Fully Funding their ERISA Employee Benefit Plan (12/8/06)
Medical fraud/fiduciary explaination (12/8/06)
Performance standards (12/8/06)
PTE 84-24 (Keeping Commissions) (12/8/06)
PTE 84-24: A Sample Form (12/8/06)
STOP-LOSS Fraud (12/8/06)
TPAs Taking on Fiduciary Duty? (12/8/06)
What's Allowable Error Rate? (12/8/06)
Medical letter (2/1/91)
Articles and Materials
2016 Year in Review (12/29/16)
What's Payable by ERISA Plan Assets? (8/1/15)
Official Source Documents
General Strategies
Health Reform Legislative Process (6/18/09)
How to Contact Your Member of Congress (10/11/07)
Articles and Materials
Educating Your Members of Congress (6/6/17)
Independent Dispute Resolution
Articles and Materials
Official Source Documents
Stop Loss
Articles and Materials
2024 SPBA Stop-Loss Application (5/30/23)
Self-Funding: Myths vs. Facts (9/2/14)
Official Source Documents
Minnesota Stop-Loss (2/1/17)
California Stop-Loss Legislation Stalled (8/29/12)
Stop-Loss Model Act (8/8/12)
Stop-Loss Summit Issues (3/9/11)
ERISA Follows the Plan Money (12/8/06)
STOP-LOSS Fraud (12/8/06)
Who Owns Stop-Loss Policy (12/8/06)
Disclosure Form Background & Explanation (10/31/06)
ACA Replace Legislation and Papers
Official Source Documents
Analysis & Articles
Articles and Materials
COVID-19 Fact Sheet for Employees (7/28/21)
What You Should Know About COVID-19 and the ADA, the Rehabilitation Act and other EEOC Laws (LINK (7/28/21)
COVID-19 Vaccine Rollout and Payment (2/2/21)
CPT Codes for Vaccines Released (11/24/20)
Coverage for Testing of COVID-19 without Cost-Sharing + Request to SPBA Stop-Loss Partners (3/13/20)
Coronavirus Scammer Alert (3/10/20)
COVID-19 and Group Health Plans (3/10/20)
Board of Directors Contact Info (Cell & Direct Dial)
Plan Transparency
Articles and Materials
Machine‑Readable Rx Files Enforcement (10/26/23)
TinC 2.0 Complexity and HR 3561 Impact (7/14/23)
Escape the Fire (Health Care) Trailer (3/28/13)
Sales Tool & Opportunity (2/9/12)
Official Source Documents
Transparency in Coverage Final Rule (8/6/21)
SPBA 2020 Fall Virtual Meeting
J. Hospital Price Transparency Rule (9/13/20)
Special Types of Plans & Situations
Articles and Materials
Leasing Do's & Don'ts (1/10/95)
ERISA Q&As (DOL, ABA & JCEB) (1/7/13)
Self-Funding: Why Use Self-Funding? (5/27/11)
Self-Funding: Why Use Self-Funding? (5/27/11)
EEOC Changes Retiree Benefits (12/8/06)
Most* Medical Provider Network Entities that Contract Directly with Employers are Currently Illegal (12/8/06)
Payment Demands from Military Hospitals (12/8/06)
VA Complaints about Fiduciary Duty (12/8/06)
Official Source Documents
Specific Issues
Leave Behind on AHP (4/2/18)
Leave Behind on Opioid (4/2/18)
Leave Behind on Transparency (4/2/18)
Leave Behind on SPBA (4/2/18)
Far More Happening Than Health Reform (9/29/09)
Unspoken Secrets of Health Reform (2/2/09)
TPA Cost Value (11/2/07)
Articles and Materials
Statistics/Numbers
Official Source Documents
2022 Milliman Medical Index (5/23/23)
2021 Milliman Medical Index (4/22/22)
Access/Protection
National Medical Support Notice (8/15/19)
USA PATRIOT Act Update (8/15/19)
USA Patriot Act: TPAs Hit With OFAC Regs (8/15/19)
Insurer Duties Under USA PATRIOT Act (8/15/19)
Limited Use of Social Security Numbers (8/15/19)
Articles and Materials
Board Elections & Orientation
Board Orientation Powerpoint (7/9/18)
Board of Director's Role Description (7/11/17)
Board Interview Evaluation Form (8/3/15)
Board Nominee Orientation Letter (11/11/11)
Newly Elected Board Orientation (11/11/09)
Criteria for Board Candidates (11/11/09)
New Member Applications and Anti-Trust (11/11/09)
Cautions
Read All Your Contracts (10/12/20)
More & Broader Privacy Expected (12/21/10)
Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims (4/1/09)
Bank Failures and Dumping TPAs (11/7/08)
When You Overpay a Provider (11/5/08)
ERISA Fiduciary: Beware % Payments (12/8/06)
Funding: To: Employers & Plans Having Trouble Fully Funding their ERISA Employee Benefit Plan (12/8/06)
My Attorney Says.... (12/8/06)
Articles and Materials
Important
Official Source Documents
Federal Register: November 26 2014 (ACA) (12/2/14)
DOL Compliance Assistance Guide (11/20/14)
Articles and Materials
PPACA: Health Reform Questions & Answers (9/12/12)
PPACA Reg Writers Answer SPBA Questions (10/29/10)
Surprise Billing
Official Source Documents
Rx Reporting IFR (8/15/22)
Surprise Billing Model Notice (10/18/21)
No Surprises Act Bill Text (2/4/21)
Articles and Materials
TPA Forecasts and Reports
What's the Future for Insurers? (7/27/11)
Boom time for TPAs is Starting (7/12/11)
Mid-2005 TPA Industry Report (11/3/09)
Planning Your Firm'$ Future (12/8/06)
Pollyanna Predictions? (7/14/05)
TPA Competition Rollercoaster - Ongoing (12/14/04)
Webinars
AHP (Association Health Plans)
AHP Comment Letter on Behalf of SPBA (8/15/19)
Official Source Documents
Definition of "Employer" under Section 3(5) ERISA - Association Health Plans (Proposed Rule) (8/15/19)
Association Health Plans - Final Rule (8/15/19)
Contacts - Technology
SPBA Technology Contacts (1/13/21)
Federal Guidance
Articles and Materials
CMS Releases Vaccine Set of Toolkits (12/30/20)
EEOC Issues Vaccination Guidance (12/30/20)
OCR COVID - 19 Webinar Available Now (4/29/20)
EEOC Posts Additional FAQs on COVID-19 (4/20/20)
EEOC Releases FAQs and Webinar on ADEA and Antidiscrimination Issues on COVID-19 and Pandemic (4/8/20)
EEOC Response to COVID-19 (3/20/20)
Official Source Documents
COVID-19 Timeline Extension Final Rule (4/29/20)
CDC - ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020 (4/7/20)
IRS FAQs on Tax Credits (4/1/20)
Health Reform Law
Articles and Materials
Official Source Documents
Hospital Transparency
Articles and Materials
Transparency Documentary Trailer (6/5/12)
Sharing Hospital Transparency (7/12/11)
Hospital Transparency (6/3/11)
Marketing TPA Services + PR
Why Use a TPA? (10/13/20)
Choosing & Evaluating TPA Services (6/25/19)
What Brokers Should Seek in A TPA (2/13/12)
Hints on Marketing to TPAs (11/3/09)
TPA Cost Value (10/20/09)
Your TPA Firm as a Leading "Good Guy" (10/20/09)
Canada Issues: Admin Costs: US vs Canada (10/20/09)
Congratulations & Press Tips (10/20/09)
Luring Your Clients Away (10/20/09)
Outsourcing & Offshore Considerations (10/20/09)
Responses to Anti TPA Propaganda (10/20/09)
Rewards for TPAs in Government Complicance (10/20/09)
"Stung" or Risk Averse? (10/20/09)
Articles and Materials
IRS Retirement Plan News (10/1/09)
ACOs (Accountable Care Organizations)
Official Source Documents
Air Ambulance
Articles and Materials
Air Ambulance Letter to Senate (8/8/18)
Financial
Dues Structure Approved Through 2024 (8/4/23)
Audited Financial Statements 2020 (11/19/21)
2019 Audited Financial Statements (1/13/21)
Advisor for SPBA Investments (1/12/21)
Auditor/CPA Information (1/12/21)
Resolution for Bank Account (6/20/19)
2018 Audited Financial Statements (5/15/19)
Dues Structure Approved Through 2020 (11/4/15)
Dues Structure Board Action (11/3/15)
History on Dues & "Contacts" (11/12/09)
Safeguard Procedures for SPBA Audit (3/20/07)
Lobbying Accounting Explanation (5/1/05)
Operations + Ownership Tips
Frequently Asked Questions about TPAs (3/21/11)
Successful Mergers & Acquisitions (11/16/09)
Starting a TPA (11/2/07)
Buy/Sell: Advice on Buying TPA firms (3/14/07)
Buy/Sell: Buying & Selling TPAs (12/8/06)
Buy/Sell: TPA Buy/Sell Advice (12/8/06)
Reference-Based Pricing
Webinar: Reference-Based Pricing (1/3/19)
State Guidance
Official Source Documents
New Mexico: Insurance Superintendent Guarantees Free COVID-19 Testing & Treatment for New Mexicans (4/6/20)
Nebraska: Insurer Accommodation to Policyholders or Claimants Developed in Response to COVID-19 (4/6/20)
Tennessee: Request for Flexibility (4/6/20)
Texas: Coverage for COVID-19 Testing (4/6/20)
Texas: COVID-19 Emergency Rules (4/6/20)
Connecticut: 60-Day Grace Period for Insurance Premium Payments Due to Disruption Caused by COVID-19 (4/2/20)
Massachusetts: Administration of Prescription Drug Benefits during COVID-19 Public Health Crisis (4/1/20)
Massachusetts: Flexibility in the Issuance & Administratration of Insurance during COVID-19 Crisis (4/1/20)
Louisiana: Declaration of Emergency (4/1/20)
Wisconsin: COVID-19 Coverage Request (4/1/20)
Utah: Coverage for COVID-19 (4/1/20)
Utah: Guidance for Business Interruption Claims Related to COVID-19 or the March 18 Earthquake (4/1/20)
Washington: Telemedicine (4/1/20)
Vermont: Prescription Drug Refills (4/1/20)
Vermont: Access to COVID-19 Testing (4/1/20)
North Carolina: Insurance Directive (4/1/20)
Montana: Guidance & Recommendations (4/1/20)
Missouri: Executive Order (4/1/20)
New York: Continuing Temporary Suspensiopn & Modification of Laws Relating to the Disaster Emergency (4/1/20)
Alaska: Requirements for Cost Sharing & Coverage Related to Respiratory Illnesses Including COVID-19 (4/1/20)
Indiana: Indiana COVID-19 Bulletin (3/30/20)
Louisiana: Louisana Emergency Rule (3/30/20)
Articles and Materials
State Responses to COVID-19 (4/7/20)
Administrative Simplification
Official Source Documents
CMS-AMA ICD-10 Flexibilities Statement (7/29/15)
ICD-10 - Testing with CMS (7/29/15)
HPID Manual (10/31/14)
HPID Quick Guide 9/2014 (10/8/14)
Articles and Materials
HPID: For Your Information (7/31/14)
Health Plan Identifier (HPID) (2/27/14)
HIPAA – Administration Simplification (1/30/14)
New Rules on EDI (7/12/11)
Americans with Disabilities Act
Articles and Materials
ADA Amendments Act of 2008 (8/15/19)
ADA Speech Handout (8/15/19)
Questions and Answers on the Notice of Proposed Rulemaking for the ADA Amendments Act of 2008 (8/15/19)
Fraud
Official Source Documents
Incoming Chair & Sec/Treas Orientation
SPBA Board of Directors
SPBA Board of Directors Application (1/29/24)
Board of Director's Role Description (7/11/17)
Anti-Fraud
Articles and Materials
Health Care Reform Anti-Fraud Sleepers (12/21/10)
Cafeteria Plans
Articles and Materials
Investment Statements
October 2021 Investment Statement (11/12/21)
SPBA Organizational Information
SPBA Dues Structure for 2024 (1/11/24)
SPBA Staff (5/29/22)
SPBA Digital Graphics (11/11/20)
SPBA Code of Ethics (9/17/14)
SPBA Mission & Vision Statement (12/17/13)
Why Doesn't SPBA Do ___??? (1/5/12)
A Reality Check of SPBA's Role (11/13/09)
Deciding if a firm is eligible to join SPBA and if it would be a worthwhile investment for you (11/3/09)
What Makes SPBA Tick (10/20/09)
Why SPBA Does Not Take Formal "Positions" (10/20/09)
CEO, COO, CFO Insight (10/20/09)
Hints for senior contacts (10/20/09)
Important Warnings (10/20/09)
Members' Bad Office Habits (10/20/09)
Report on SPBA Meeting Planning (10/20/09)
SPBA Association Description (10/20/09)
SPBA History and Customs (10/20/09)
SPBA No Go to Court (10/20/09)
A Brief History of SPBA (5/1/09)
Articles and Materials
SPBA Code of Ethics (9/8/14)
Stop-Loss
Pan-American Life Insurance Company (4/1/20)
Bardon Insurance Group on COVID-19 (4/1/20)
Liberty Mutual - IRONSHORE (3/30/20)
Crum & Forster (3/27/20)
Tokio Marine HCC (3/27/20)
American Fidelity (3/24/20)
US Benefits Insurance Services, LLC (3/24/20)
Minnesota Stop-Loss (2/1/17)
Official Source Documents
Articles and Materials
AHPs (Association Health Plans)
Official Source Documents
Associated Health Plans & DOL (Case) (3/29/19)
AHP: ERISA Compliance Assistance (10/22/18)
Cafeteria Plans - Agency Guidance
Articles and Materials
Official Source Documents
2015 Health FSA Dollar Limits (11/15/14)
125 Elections & MarketPlace Coverage (9/19/14)
$500 Rollover Guidance (11/20/13)
IRS Notice on FSA Carryover (10/31/13)
2001 Regulations on Election Changes (5/28/10)
2000 Regulations on Election Changes (5/28/10)
Debit Card IRS Revenue Ruling (12/8/06)
Lobbying & Government Relations Policy
IRS Technical Guide on 501(c)(6) (7/27/23)
General Positions* of SPBA as Board guidance of how SPBA approaches & proceeds with govt. issues. (11/13/09)
A Reality Check of SPBA's Role (11/13/09)
Technology Service Partner
Service Partner Application (2024) (2/7/24)
Annual and Lifetime Limits
Articles and Materials
Official Source Documents
Cafeteria Plans - Explanation and Commentary
Articles and Materials
$2,500 Health FSA Limit Guidance (7/17/12)
5500 Forms and Cafeteria Plans (12/8/11)
Cafeteria Plan Elections (11/16/09)
New Proposed Cafeteria Plan Regulations (1/23/08)
Cafeteria Plan Election Changes (12/8/06)
Debit Cards (10/24/06)
Understanding Government Role & Perspective
Auto Enrollment
Cadillac Tax
Cadillac Tax Delay (1/29/18)
Articles and Materials
Cadillac Tax Delayed Until 2020 (5/17/17)
Excise Tax Comments from SPBA (5/21/15)
Official Source Documents
CHIPRA
Employer CHIP Notices (8/15/19)
CHIP DOL Release (8/15/19)
Model CHIP Notice (2/4/10)
CHIPRA Notice Requirements (4/27/09)
Membership Eligibility & Trends
Cases
Articles and Materials
Official Source Documents
COBRA
Official Source Documents
1999 and 2001 Final COBRA Regs (8/16/09)
Articles and Materials
FAQ 32 COBRA (8/15/19)
FAQ 32 COBRA (6/29/16)
DOL Issues FAQs and COBRA Model Notices (5/15/20)
Is a Spouse Entitled to COBRA when the Covered Employee Drops Coverage after Enrolling in Medicare? (1/3/20)
COBRA Tax Audits (8/16/19)
DOL Releases Final COBRA Notice Rules (8/16/19)
IRS on Family and Single COBRA Rates (8/16/19)
COBRA Model Notices (8/16/19)
Dependent Child Maternity under COBRA (8/16/19)
DOL Releases Updated Model COBRA Notices (8/16/19)
Gillihan's COBRA Presentation (11/3/05)
Minutes of Board Meetings
Articles and Materials
2023-Apr-6: SPBA Board Call Minutes (5/19/23)
2023-Mar-2: SPBA Board Call Minutes (5/19/23)
2023-Feb-2: SPBA Board Call Minutes (5/19/23)
2023-Jan-5: SPBA Board Call Minutes (5/19/23)
2022-Dec-1: SPBA Board Call Minutes (2/3/23)
2022-Nov-3: SPBA Board Call Minutes (2/3/23)
2022-Oct-6: SPBA Board Call Minutes (2/3/23)
2022-Sep-1: SPBA Board Call Minutes (2/3/23)
2022-Aug-4: SPBA Board Call Minutes (2/3/23)
2022-Jul-7: SPBA Board Call Minutes (2/3/23)
2022-May 5: SPBA Board Call Minutes (2/3/23)
2022-Apr: SPBA Board Call Minutes (2/3/23)
2022-Mar 3: SPBA Board Call Minutes (2/3/23)
2022-Feb-3: SPBA Board Call Minutes (2/3/23)
2022-Jan-6: SPBA Board Call Minutes (2/3/23)
2021-Dec-2: SPBA Board Call Minutes (11/3/22)
2021-Nov-4: SPBA Board Call Minutes (11/3/22)
2021-Oct-7: SPBA Board Call Minutes (11/3/22)
2021-Sep-2: SPBA Board Call Minutes (11/3/22)
2021-Aug-4: SPBA Board Call Minutes (11/3/22)
2021-Jul-1: SPBA Board Call Minutes (11/3/22)
2021-Jun: SPBA Board Strategy Meeting (11/3/22)
2021-May-6: SPBA Board Call Minutes (11/3/22)
2021-Apr-1: SPBA Board Call Minutes (11/3/22)
2021-Mar-4: SPBA Board Call Minutes (11/3/22)
2021-Feb-4: SPBA Board Call Minutes (11/3/22)
2021-Jan-7: SPBA Board Call Minutes (11/3/22)
2020-Oct-1: SPBA Board Call Minutes (5/27/21)
2020-May-20: SPBA Board Call Minutes (5/27/21)
2020-Apr-2: SPBA Board Call Minutes (5/27/21)
4/4/2018 - Spring - 2018 - April 4, 2018 (11/26/18)
6/22/2018 Board Minutes & Resolution (7/18/18)
Claims
COBRA-ARRA
COBRA Model Notices (8/16/19)
COBRA Subsidy Extension (2/24/10)
COBRA Subsidy Extension Signed into Law (12/28/09)
Frequent ARRA COBRA Subsidy Questions (7/30/09)
CMS COBRA Denial Application (5/8/09)
DOL COBRA Denial Application (5/8/09)
COBRA Expanded for TAA Individuals (4/27/09)
ARRA COBRA Subsidy: Phase II (4/16/09)
ARRA Second Chance Election (4/9/09)
COBRA Premium Update (2/23/09)
Other Issues & Explanations
Why the No-Commercialism Policy? (11/13/09)
The Image & PR of the TPA Industry (10/1/99)
"White Paper" on Meetings (10/1/94)
Self Regulation for TPAs? (12/27/89)
Claims and Appeals/External Review
Revised Model Notice of Final Internal Adverse Benefit Determination - Revised as of 6-22-11 (6/23/11)
States with Consumer Assistance Programs under PHS Act Section 2793 - Current as of 5-23-11 (6/23/11)
Regulations for Internal Claims & Appeals Effective Date Extended + Technical Release 2011-01 (3/18/11)
Articles and Materials
Official Source Documents
Defense of Marriage Act (DOMA)
Supreme Court Decides DOMA (8/17/19)
DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans (8/16/19)
U.S. v. Windsor: A CMS Update (10/4/13)
U.S. v. Windsor: DOMA Opinion (6/26/13)
U.S. v. Windsor (11/1/12)
Official Source Documents
Relations with ACL, Inc.
ACL, Inc. Management Agreement (4/26/10)
CLASS
Articles and Materials
Disclosure of Fees
SPBA Insurance
Insurance Policy Overview (11/4/22)
Crime (11/1/22)
Commercial Umbrella (10/3/18)
General Liability (10/3/18)
D & O (10/3/18)
Clinical Trials
Articles and Materials
Clinical Trials (5/28/13)
Domestic Partners
IRS - FAQs for Same Sex Couples (10/7/19)
U.S. v. Windsor (11/1/12)
Stop-Loss Relations
Cost Sharing
Articles and Materials
Cost Sharing Limits Plan Year 2018 (11/17/17)
Link to the Minimum Value Calculator (8/16/13)
Official Source Documents
DOL
Articles and Materials
Plan Asset Regulations (1/24/24)
DOL Makes Claims Records Relevant (7/15/21)
Claim Regulations Raises Fees Issue (12/8/06)
Official Source Documents
Comprehensive Guidance on the DOL Claims (10/7/19)
DOL Proposed Rule on TPA Fee Disclosure (10/7/19)
DOL Disclosure Rules (4/6/09)
New SPD Requirements Under HIPAA (12/8/06)
Strategy
Cures Act
EDI/HIPAA Administrative Simplification
Articles and Materials
ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)
ICD-10 Stop-Loss Disclosure Paper (9/15/15)
HHS Provides Feedback on NPI (12/8/06)
Kansas Terminates Digital Healthcare (12/8/06)
TPA Websites for Providers and EDI (12/8/06)
Official Source Documents
CMS-AMA ICD-10 Flexibilities Statement (7/29/15)
ICD-10 - Testing with CMS (7/29/15)
CMS Announces Contingency Plan on NPI (4/27/07)
Dental Plans
Articles and Materials
Dental Plans and Health Care Reform (11/3/10)
EEOC
Articles and Materials
EEOC Releases New COVID Rules (9/7/22)
COVID-19 Fact Sheet for Employees (7/28/21)
What You Should Know About COVID-19 and the ADA, the Rehabilitation Act and other EEOC Laws (LINK (7/28/21)
EEOC Nonbinary (7/5/22)
Official Source Documents
5500 Forms
Official Source Documents
Delinquent Filer Correction Program (2/8/21)
Articles and Materials
DOL 5500 Form & Schedule J + Comment Letter (11/26/16)
Dependent Coverage
Official Source Documents
Articles and Materials
Early Retiree Reinsurance Program
Articles and Materials
ERRP New Guidance (8/17/11)
ERRP Clarification (8/17/11)
ERRP Application (8/18/10)
Official Source Documents
ERRP Update (12/21/10)
HHS Reinsurance Fact Sheet (4/8/10)
FMLA (Family Medical Leave Act)
Employer Shared Responsibility
Official Source Documents
IRS Letter on Calculating ESR Liability (11/13/17)
Play or Pay 2013 IRS Q&As (1/2/13)
Articles and Materials
Marketplace Appeal Letters (8/30/16)
Dependent PTC and Impact on ESR Payment (6/27/15)
Documentation of Coverage Offer (9/29/14)
Non-Major Medical Plan and MEC (10/24/13)
FTC (Federal Trade Commission)
Essential Health Benefits
Articles and Materials
HHS Has Released the Essential Health Benefits Bulletin: How Does it Affect Group Health Plans? (12/20/11)
Announcement of IHB IOM Report (10/7/11)
Essential Health Benefits (1/21/11)
Essential Health Benefits (1/14/11)
Official Source Documents
Health Reimbursement Arrangements
Official Source Documents
HRA - IRS Notice 2002-45 (12/8/06)
HRA - IRS Revenue Ruling 2002-41 (12/8/06)
Administration Finalizes New HRA Rule (6/14/19)
Articles and Materials
CMS Clarifies Payment in HRAs (12/8/06)
Excepted Benefits
Articles and Materials
Amendments to "Excepted Benefits" (10/24/14)
HHS Issues Essential Health Benefit FAQs (2/24/12)
Official Source Documents
Health Savings Accounts
Articles and Materials
IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan (1/3/20)
IRS Retirement Plan News (10/1/09)
HSA Contribution Limits for 2020 (1/3/20)
HSA 2018 Contribution Limits (4/24/18)
HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP (4/17/07)
All About HSAs (12/8/06)
FSA Interaction with HSAs (12/8/06)
Health Savings Accounts - First Analysis (12/8/06)
HSA Opportunities for TPAs (12/8/06)
HSAs and ERISA (12/8/06)
Learn How to Make HSA Decisions (12/8/06)
Teaching Tools Power Point (11/8/04)
Everything You Wanted to Know about HSAs (and then some) - HIckman & Gillihan, Alston & Bird LLP (10/21/04)
Official Source Documents
2018 HSA Inflation - Adjusted Amounts (6/30/17)
IRS Notice 2004-2 (11/14/14)
IRS Notice 2004-50 (7/30/10)
Custodial Account Form (7/10/08)
DOL FAB 2004-01 (12/8/06)
DOL FAB 2006-02 (12/8/06)
Final HSA Comparability Rules (12/8/06)
Treasury Guidance on Preventive Care (1/19/06)
Notice 2005-8 - 2% Shareholders (8/5/05)
Exchanges
IRS Revenue Procedure 2015-15 (1/30/15)
FAQs: Payment Process for January 2014 (10/23/13)
Penalties for Noncompliance (9/11/13)
Employer Coverage Tool (8/1/13)
CMS Navigator Assistance Roles (8/1/13)
HHS Final Rule on Exchange Verification (7/10/13)
SPBA FAQs: State Exchange Model Notices (5/28/13)
Department of Labor Releases Exchange Notice (Exchange Notices, Guidance & COBRA Election Notice) (5/9/13)
Exchange News (5/3/13)
SHOP and Exchanges Update (4/26/13)
CCIIO Letter to Exchanges (4/8/13)
Marketplace: Non FA Paper Application (3/25/13)
Marketplace Individual Questionnaire (3/25/13)
Marketplace: Video Description and URL (3/25/13)
Marketplace: FA Paper Application (3/25/13)
Exchange Rules (2/1/13)
Exchange Notice Delayed (1/28/13)
Exchange Enrollment Process (1/14/13)
Exchange Rules Released (3/13/12)
Comments on Exchanges (10/5/11)
Fate of State Exchanges (7/12/11)
HHS Releases Proposed Rules On Exchanges (7/12/11)
Exchanges as 1st Priority (8/17/10)
Articles and Materials
Official Source Documents
HIPAA Opt Out
FAQs Implementation
Official Source Documents
DOL EBSA Webpage of FAQs (8/1/23)
HHS
Official Source Documents
Articles and Materials
FSAs
IRS Releases 2019 FSA Inflation Adjustment (11/15/18)
Articles and Materials
Official Source Documents
HIPAA and Privacy
Official Source Documents
HIPAA Audit Protocol 2016 (9/22/16)
HIPAA Privacy in Emergency Situations (11/18/14)
HIPAA Security Guidance - HHS (4/17/07)
Articles and Materials
HIPAA Privacy Opioid Guidance (11/28/17)
New HIPAA Business Associate Agreements (8/27/14)
Revised 2013 Notice of Privacy Practices (8/15/13)
Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)
HHS Releases Final HIPAA Rule (1/24/13)
HHS Issues Breach Notification Rules (9/10/09)
4 Timely Alerts (2/8/07)
Authorization Sample Form (12/8/06)
BAA: Electronic Contract Language Memo (12/8/06)
BAA: Model Electronic Contract Language (12/8/06)
Complaint Sample Form (12/8/06)
Does HIPAA Privacy prohibit insurers or HMOs from releasing claims experience due to HIPAA Privacy? (12/8/06)
Flowchart Brainstorming Tools (12/8/06)
HIPAA PRIVACY: Overview for TPAs (12/8/06)
Memo Explaining HIPAA Privacy Documents (12/8/06)
Providers Misinterpreting HIPAA Privacy (12/8/06)
Sample Amendment to Plan Documents (12/8/06)
Grandfathered Plans
Articles and Materials
Agency Grandfather Table (8/2/10)
Official Source Documents
Grandfathered Plans Interim Final Rules (6/14/10)
Expendable Grandfather (8/17/10)
IRS
Articles and Materials
Home Exercise Equipment for Obesity (8/8/23)
2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)
Official Source Documents
IRS Notice 2019-63 (12/2/19)
IRS ACA Webpages (7/31/13)
IRS - FAQs for Same Sex Couples (10/7/19)
IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)
2010 Excise Tax Requirements (2/2/10)
Congress Reworks Dependent Definition (6/26/07)
1099 - IRS IIR Request (1/26/07)
IRS Issues Debit Card Transition Relief (12/15/06)
IRS Notice on Debit Card Relief (12/15/06)
1099 - IRS Hints (12/8/06)
5500 Forms Not Needed for Certain Plans (12/8/06)
Allowable Plan Reserves (12/8/06)
Allowable Plan Reserves (12/8/06)
IRS on HMOs (12/8/06)
Proposed Revisions to the 5500 Form (12/8/06)
Reserves Reminder (12/8/06)
1099 - IRS Letter (12/8/94)
Health Reform Emails 2017
Tax Reform: A look “the morning after”. (12/20/17)
Tax Reform: A Taxing Mental Exercise (12/12/17)
Tax Reform Tangle – Special Report (11/13/17)
Medicaid
Official Source Documents
Medicaid Recovery FAQ from CMS (12/14/17)
CMS Cover Letter to Medicaid Directors (12/29/06)
CMS Qs and As on Medicaid Recovery (12/29/06)
Articles and Materials
CMS Letter to States (12/29/06)
State Medicaid Compliance (9/25/06)
Health Reform Emails 2016
After Election Insights (November 9, 2016) (11/10/16)
Medicare
Official Source Documents
Designing Plans for Older Workers (5/23/08)
CMS Clarifies Notification Deadlines (12/8/06)
Medicare Wrap Arounds (12/8/06)
New Release About Medicare Prescriptions (12/8/06)
Articles and Materials
CMS Clarifies Payment in HRAs (12/8/06)
Health Reform Emails 2015 (Alerts Since Passage)
Medicare for All
Articles and Materials
Health Reform Emails 2014 (Alerts Since Passage)
Health Reform: Today's (November 17, 2014) Insights + SPBA Membership Renewal Notices in Mail (11/17/14)
Medicare Secondary Payer
Articles and Materials
MSP Mandatory Reporting Penalties (12/1/15)
CMS Posts Model Form for Soliciting SSNs (7/22/09)
Official Source Documents
GHP User Guide 2020 (8/7/20)
SSN Model Collection Form (3/4/11)
Alert on Obtaining SSNs (3/4/11)
MSP Reporting and HRAs (6/10/10)
Health Reform emails 2013 (Alerts Since Passage)
Forecasting ACA's Future (6/6/13)
Health Reform: ACA: A Huge Train Wreck? (4/18/13)
Terrorism and War Prep (4/17/13)
Medicare Part D
Official Source Documents
CMS Medicare Part D (8/17/11)
Health Reform Impacts and Trends
Articles and Materials
Mental Health Parity
HRAs (Health Reimbursement Accounts)
Official Source Documents
HRA Annual Limit Waiver Guidelines (10/4/13)
Technical Release 2013-03 (10/4/13)
Articles and Materials
Deductible Caps on Small Business (4/26/13)
Mental Health Parity & Addiction Equity Act (MHPAEA)
Official Source Documents
2021 MHPAEA Enforcement: Fact Sheet (1/26/22)
2022 MHPAEA Report to Congress (1/26/22)
Final Rule: Mental Health Parity Act (11/12/13)
Articles and Materials
MHPAEA Provisions in CAA (2/2/21)
New MHPAEA FAQs Released (5/10/12)
MHPAEA Overview (2/16/10)
2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)
MHPAEA Regs Delayed Until January 2010 (10/3/09)
MHPAEA Interim Final Regulations (2/17/10)
MHPAEA Request for Information (5/7/09)
HSAs (Health Savings Accounts)
Michelle's Law
Articles and Materials
Opt-Out from Michelle's Law (2/19/10)
Michelle’s Law: Questions Remain (2/19/10)
Mandated Claims Appeals
Articles and Materials
Mandated Claims Appeals Processes (4/27/10)
NAIC News
Articles and Materials
SPBA 2013 NAIC Press Release (12/16/13)
Official Source Documents
SPBA Testifies at NAIC on Stop-Loss (8/13/12)
Medical Loss Ratio
Official Source Documents
Articles and Materials
Nondiscrimination
MHPAEA
Nondiscrimination - HIPAA/GINA
September 2009 GINA Regs (10/2/09)
Genetic Nondiscrimination Act (6/6/08)
Plan Incentives for Healthy Behavior (5/11/07)
Reducing Benefits for Active Workers (10/26/05)
Articles and Materials
Mini-Med Waivers
Articles and Materials
Annual Limit Waivers Filing Due (10/31/12)
Mini-Med Waiver Extension to 12/31/13 (6/20/11)
Mini-Meds and the Waiver Program (8/17/10)
Official Source Documents
Guidance: Exemption for Health Reimbursement Arrangements that are Subject to PHS Act Section 2711 (8/24/11)
Sale of New Limited Benefit Plan Guidance (12/13/10)
Waiver Application Form (12/13/10)
Waiver Guidance November 2010 (11/16/10)
Nondiscrimination Rules - IRS
Articles and Materials
Official Source Documents
Minimum Essential Coverage
Official Source Documents
Rev. Proc. 2019-29 (7/22/19)
IRS Final Regs MEC (11/26/14)
Articles and Materials
Non-Major Medical Plan and MEC (10/24/13)
Plan Assets
Articles and Materials
Plan Asset Regulations (1/24/24)
Minimum Value
Portability - HIPAA
Articles and Materials
Special Enrollment Period Change (12/8/06)
VA Coverage is Creditable Coverage (12/8/06)
Final HIPAA Portability Rules (1/18/05)
Official Source Documents
Final Rules HIPAA Portability 12/30/2004 (8/21/14)
Model Notices
Official Source Documents
Model notice of Opportunity to Enroll in Connection with Extension of Dependent Coverage to Age 26 (6/29/10)
Model Notice on Patient Protections (6/29/10)
Nondiscrimination - HHS
HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)
HHS Non-Discrimination Regulations (6/1/16)
Nondiscrimination in Health Programs & Activities Proposed Rule: News Release + Fact Sheet + FAQs (9/9/15)
Official Source Documents
Franciscan-Alliance v. Burwell (1/5/17)
Articles and Materials
Prescription Drug Reporting (RxDC)
Articles and Materials
Official Source Documents
RxDC Reporting Instructions (2/27/23)
RxDC Interim Final Rule Text (2/27/23)
RxDC Reporting FAQs (2/27/23)
Opt-Out
Prescription Drugs
HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs (8/2/19)
Off-Label & Non-Approved Drugs & Treatments (12/18/07)
Over the Counter Drugs (OTC)
Articles and Materials
FSA & HRA Debit Cards for OTC Purchases (12/29/10)
Official Source Documents
Over the Counter Drug Notice (IRS) (9/7/10)
Privacy - GLBA
Articles and Materials
PCORI
Articles and Materials
IRS Releases Updated PCORI Fee (11/15/22)
Updated PCORI Fee Released (6/8/20)
PCORI Fees Due on July 31, 2017 (6/26/17)
PCORI Fee - IRS Notice 2016-64 (11/30/16)
PCORI Fee (2/29/16)
Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014) (5/29/14)
PCORI Questions from SPBA Members (6/27/13)
PCORI: Q&As (5/21/13)
Updated PCORI Released (11/30/20)
IRS Notice 2018-85: PCORI Fee (11/6/18)
IRS Releases Adjusted PCORTF Fee (11/6/18)
PICORI Fees (6/29/18)
Official Source Documents
PCORI Fee IRS Notice 2017-61 (10/20/17)
IRS Webpage on PCORI (1/5/17)
PCORI Fee - IRS Notice 2016-64 (11/29/16)
PCORI Chart on Types of Coverage (Link) (11/1/16)
PCORI Fee for 2015- 2016 (11/2/15)
PCORI: Federal Register Final Regulations (12/10/12)
Penalties
Articles and Materials
Same-Sex
Official Source Documents
Preventive Services
Articles and Materials
COVID-19 Vaccine Rollout and Payment (2/2/21)
Preventive Services Final Regulations (7/29/15)
Preventive Services FAQ Part XXVI (5/28/15)
Religious Contraceptive Issue (1/30/14)
Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)
Preventive Services: Issues Abound (2/7/11)
Comments Sought on Plan Design (1/21/11)
Preventive Services: Issues Abound (1/21/11)
Official Source Documents
Final Rule on Women's Preventive Services regarding Religious Employers Issued - July 2, 2013 (7/8/13)
Guide to Clinical Preventive Services (5/27/10)
Section 1557 Nondiscrimination
Articles and Materials
Reporting
Official Source Documents
IRS Notice 2019-63 (12/2/19)
IRS Extends Due Date for 1095-C (12/22/17)
2016 Form 1095-C (1/23/17)
2016 Form 1094-C (1/23/17)
2016 Instruction for Forms 1094/1095-C (1/23/17)
IRS Notice 2016-70, Extension of Due Date (11/21/16)
IRS Notice 2012-32 (6/11/12)
IRS Notice 2012-33 (6/11/12)
Articles and Materials
ACA Information Reporting Delayed (11/30/16)
Reporting Offers of Coverage (1/29/16)
COBRA and 1095-C Reporting (12/1/15)
Multiemployer Plans and ALE Reporting (11/4/15)
No Offer, But Still Report (6/27/15)
Good Faith Effort Reporting Relief (6/27/15)
An Overview of Employer/Plan Reporting (6/27/15)
IRS Proposed Rules on MEC Reporting (8/30/16)
IRS ACA Reporting Corrections ppt (6/29/16)
Webinar
Schedule J
Official Source Documents
Articles and Materials
Executive Order Impact (1/31/17)
2016 Year in Review (12/29/16)
DOL 5500 Form and Schedule J (12/5/16)
DOL 5500 Form & Schedule J + Comment Letter (11/26/16)
Schedule J Proposed in New 5500 Regulations (10/27/16)
Rescissions
Articles and Materials
Retroactive Rescission (12/21/10)
Security - Cybersecurity and HIPAA
Articles and Materials
NAIC Adopts Cybersecurity Model Law (11/28/17)
OCR Cyber-Awareness Update (6/1/16)
DHS Cyber Alert on Ransomware (4/6/16)
Cybersecurity Act of 2015 (1/29/16)
HHS Releases Final HIPAA Rule (1/24/13)
HHS Issues Breach Notification Rules (9/10/09)
HHS Breach Notification Rules (9/8/09)
HIPAA Security Rules: Overview (12/8/06)
Implementing the HIPAA Security Standards for Group Health Plans - Amending Plan Documents (12/8/06)
HIPAA Security Standards Addendum (10/26/04)
Security Plan Document Amendment (10/16/04)
Official Source Documents
2016 - 2017 HIPAA Audits Industry Report (12/21/20)
HHS OCR Cybersecurity December Newsletter (12/28/17)
Reporting and Monitoring Cyber Threats (2/28/17)
HIPAA Audit Phase 2 (11/30/16)
Additional Clarification Regarding Phishing Email Alert Audits of Business Associates Are Underway (11/30/16)
Identifying DDOS Risks to ICS Environments (10/28/16)
Cyber Threat Information-Sharing (9/30/16)
HIPAA Audit Protocol 2016 (9/22/16)
OCR Announces Initiative to More Widely Investigate Breaches Affecting Fewer than 500 Individuals (8/30/16)
Do You Know Who Your Employees Are? (8/30/16)
HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents. (7/21/16)
NIST Cybersecurity Framework (1/28/16)
Sample Speeches
Is PPACA Rationing? (2/14/11)
Specialty Drugs
Articles and Materials
SCOTUS
Articles and Materials
What's Next After SCOTUS (6/28/12)
Official Source Documents
Supreme Court Opinion - June 28, 2012 (6/28/12)
State Licensing
TPA License Change For Michigan (7/5/22)
Articles and Materials
2022 TPA License Corrections (10/11/22)
Official Source Documents
Kansas TPA Act; SB22 (4/27/17)
Self-Funded Reports
Self Funded Report to Congress (7/27/11)
Self Insured Health Benefit Plans (7/27/11)
States
Articles and Materials
Texas Prompt-Pay Law (2/29/16)
Official Source Documents
Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions (11/5/18)
Nevada: Revised Statutes (10/24/17)
Minnesota Stop-Loss (2/1/17)
Georgia - OCGA § 33-30-13.1 (11/5/08)
Indiana & Maine (11/5/08)
Kentucky 806 (pdf) (11/5/08)
Kentucky 846 (11/5/08)
New Mexico (11/5/08)
Oklahoma - Section 4512 (11/5/08)
South Dakota (11/5/08)
Texas - HB 2015 Amended (11/5/08)
Texas - HB 2015 Enrolled Version (11/5/08)
Virginia (11/5/08)
Wisconsin (pdf) (11/5/08)
Bill Number: TX80RHB 2015 (10/11/07)
Massachusetts Health Care Reform (10/11/07)
State Health Care Reform (10/11/07)
Texas Loss Experience Legislation (10/11/07)
Additional Questions on the NYHCRA (12/8/06)
New York Surcharge Impacts Employers (12/8/06)
NJ Law Turns Lemons to Lemonade (12/8/06)
Strategies on Massachusetts (12/8/06)
Third Party Administrator Statute (12/8/06)
Self-Funding
Articles and Materials
Self-Funding: Myths vs. Facts (9/2/14)
Administrative Fix for Policy Cancelations (11/15/13)
Shared Responsibility
Official Source Documents
Individual Responsibility Q and A (Link) (1/31/13)
Articles and Materials
Transition Relief for 2014 (7/10/13)
Multiemployer Plans Transition Relief (5/29/13)
ACA Premium Tax Credit Affordability (2/1/13)
Subrogation
Articles and Materials
Supreme Court Case: Sereboff (12/8/06)
Student Health Insurance
Articles and Materials
CMS Issues Final Rules on the Affordable Care Act Requirements for Student Health Policies (7/17/12)
Official Source Documents
Surprise Billing (see Transparency/Surprise Billing Resource Center on the homepage)
Official Source Documents
Surprise Billing Model Notice (10/18/21)
No Surprises Act Bill Text (2/4/21)
Articles and Materials
Summary of Benefits & Coverage
Articles and Materials
Uniform Summary of Benefits and Coverage (7/12/11)
Official Source Documents
SBC Calculator Correction (7/27/12)
Transgender
Articles and Materials
Tax Credits for Premiums
Official Source Documents
Premium Tax Credits - Proposed Reg (8/12/11)
Articles and Materials
ACA Premium Tax Credit Affordability (2/1/13)
USERRA/Veterans
USERRA Final Regulations: Overview (12/8/06)
USERRA: Final Regulations (12/8/06)
Articles and Materials
Tax on Plans
Official Source Documents
PCORI: Federal Register Final Regulations (12/10/12)
Articles and Materials
Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014) (5/29/14)
PCORI Questions from SPBA Members (6/27/13)
Transitional Reinsurance 2013-28610 (11/26/13)
Program Integrity Rule (11/1/13)
Final Rule (10/28/13)
Reinsurance Fees Comment Letter (1/4/13)
Value Driven Initiatives
Articles and Materials
Transitional Reinsurance Program
Wellness
Articles and Materials
Wellness Final Rules under ADA Title I (7/22/16)
Proposed EEOC Regulation - Application to GINA Title II to Wellness Programs (PPT 12-17-15) (3/16/16)
EEOC Wellness Proposed Rule Article (4/28/15)
EEOC Wellness Proposed Rule Article (4/28/15)
Wellness - Developing as a Strategy (11/16/09)
TPA Success in Wellness (11/5/08)
Wellness Education Program (10/22/07)
Plan Incentives for Healthy Behavior (5/11/07)
Official Source Documents
DOL-IRS-HHS Wellness FAQ - April 2015 (4/28/15)
HHS FAQs on Wellness April 2015 (4/28/15)
Vouchers
Articles and Materials
Free Choice Vouchers (11/23/11)
W-2s
Official Source Documents
W-2 Health Value Reporting IRS Chart Link (12/24/14)
W-2 Health Value Reporting IRS FAQs Link (11/24/14)
IRS W-2 Guidance in 2012 (2/3/12)
Articles and Materials
ACA IRS W-2 Presentation (3/6/12)
W-2 Reporting and Controlled Groups (2/29/12)
Article on IRS W-2 Guidance in 2012 (2/3/12)
W-2 Health Care Value Reporting Updated (1/27/12)
History on W-2 Health Value Reporting (10/25/10)
No Tax on Benefits $ on W-2 (8/20/10)
W-2 Health Care Cost Reporting (8/20/10)
Sponsorship
2020 Webinar Sponsorship Opportunities (5/18/20)
Future Meetings
Future Meetings (Click Here) (11/1/23)
Meeting Handouts
Workshop B: Cafeteria Plans (3/20/17)
M. Designing Compliant Wellness Programs (3/20/17)
F. ACA Employer Plan Reporting (3/20/17)
D. Anti-Trust Training for Members (3/20/17)
C. Schedule J (3/20/17)
B. Prospects for Health Reform Changes (3/20/17)
R. Cybersecurity Liability Insurance (10/14/16)
Q. PBM Insights (10/14/16)
N. Workshop G: Stop-Loss Training on ACA (10/14/16)
M. Workshop E: Free Market Health Care (10/14/16)
J. Breakout 2 TPA Auditing Standards (SOC) (10/14/16)
I. Breakout 1 - ACA Employer Plan Reporting (10/13/16)
H. Lowering the Heat on Cyber Risk (10/13/16)
G. HIPAA Audits - Preparing for Them (10/13/16)
F. Reference-Based Pricing (10/13/16)
D. Specialty Drugs (10/13/16)
C. Innovative Plan Designs to Create Efficiences & Strategies to Avoid Compliance Challenges (10/13/16)
A. 2016 Fall Meeting Agenda (For Reference) (10/13/16)
Ashley Gillihan - ALE/MEC Information Reporting Presentation + Examples from 2015 Spring Meeting (4/1/15)
G. Specialty Pharmacy (3/27/15)
C. The ADA: Voluntary Wellness Programs & Health Insurance Issues + Pregnancy Discrimination (3/27/15)
A. Agenda (for reference purposes) (3/27/15)
Education & Outreach
ACA Repeal & Replace Talking Points (1/17/17)
Articles and Materials
Educating Your Members of Congress (6/6/17)
Self-Funding: Myths vs. Facts (9/2/14)
ERISA, Fiduciary Issues, and Types of Plans
NAIC Resources
TPAs Impact NAIC Vote (12/5/12)
Official Source Documents
NAIC ERISA Working Group FAQs (10/18/12)
Articles and Materials
COVID-19 Resource Center
Articles and Materials
How to Shape Legislative Proposals & Govt. Policy
Key Health Policy Committee Members (8/7/17)
Regulatory & Legislative Issues
Articles and Materials
Preemption and MEWA
MEWA 2018: Form M-1 + 10 Tips for Filing (12/11/18)
MEWA 2010 M-1 Form (1/31/11)
Articles and Materials
MEWA Plan Contacts (1/20/16)
Double Warning on Employment Status (8/28/08)
A Wishful Thinking MEWA Mindset (5/1/03)
Leasing Do's & Don'ts (1/10/95)
Official Source Documents
Size and Role of TPA Market + Stop Loss
"Biggest" and "Independent" TPAs (11/8/11)
Frequently Asked Questions About TPAs (7/26/11)
What's Allowable Error Rate? (12/8/06)
Articles and Materials
Stop-Loss Activity
Tips for SPBA Members
AHIP Specialty Drug Issue Brief (12/10/15)