| Society of Professional Benefit Administrators

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Contacts - Technology

SPBA Technology Contacts(11/21/24)

Board Elections & Orientation

Board of Directors Application(11/20/24)

Board Orientation Powerpoint(7/9/18)

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)

Articles and Materials

Board of Director's Role Description(7/11/17)

Financial

Audited Financial Statements 2023(11/15/24)

Accounting Services Wendroff Business Engagement Letter (9/30/24)

Bank Contacts(8/2/24)

Dues Structure Approved Through 2024(8/4/23)

Audited Financial Statements 2020(11/19/21)

Oversight of Money into/from SPBA and Office Money Handling Processes(5/13/21)

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)

Showing Overhead Charges for Association Major Activities for IRS Reporting Purposes(11/12/09)

History: Dues & Contacts Worksheet Approved for 2008(11/12/09)

History on Dues & "Contacts"(11/12/09)

SPBA, Money + Management + Board Perks Philosophy History(11/12/09)

Safeguard Procedures for SPBA Audit(3/20/07)

Lobbying Accounting Explanation(5/1/05)

Board of Directors Contact Info (Cell & Direct Dial)

JUNE 2024 - MAY 2025 SPBA BOARD, PAST CHAIRMEN & STAFF E-MAIL ADDRESSES(11/14/24)

June 2024 - May 2025 SPBA Board of Directors Contact Info.(11/14/24)

Future Meetings

Future Meetings (Click Here)(11/1/23)

Lobbying & Government Relations Policy

IRS Technical Guide on 501(c)(6) (7/27/23)

What Percent of SPBA Activities are "lobbying" in IRS eyes?(11/13/09)

General Positions* of SPBA as Board guidance of how SPBA approaches & proceeds with govt. issues.(11/13/09)

Lobbying Disclosure vs Lobbying Non-Deductible(3/11/96)

Articles and Materials

A Reality Check of SPBA's Role(11/13/09)

Strategy

2023 Strategy Meeting(7/6/23)

2022 Strategy Meeting(7/6/23)

Strategic Planning Options(1/31/14)

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)

Prescription Drug Reporting (RxDC)

Prescription Drug and Healthcare Cost Reporting 10/25 @ 1PM ET (10/11/22)

Prescription Drug and Healthcare Spending(2/8/22)

Articles and Materials

House Subcommittee Holds Hearing to Examine Abusive PBM Practices (4/29/25)

PBM Executives Face Bipartisan Scrutiny at House Hearing(8/30/24)

CAA Prescription Drug Reporting Deadline is Looming (3/22/24)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year (3/27/23)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year(3/27/23)

Agencies Release Good Faith Relief on RxDC Reporting (12/27/22)

Agencies Release Interim final Rule - Prescription Drug and Health Care Spending(11/18/21)

TPA Client Newsletter: Agencies Release Interim Final Rule - Prescription Drug and Health Care Spending(11/18/21)

Official Source Documents

RxDC Reporting Instructions(2/27/23)

RxDC Interim Final Rule Text(2/27/23)

RxDC Reporting FAQs(2/27/23)

Webinar

Webinar: RxDC Reporting: What You Need To Know (5/1/24)

Prescription Drugs

FDA Guidance on Importing Drugs from Canada (6/10/22)

Emerging Issues for Prescription Drugs in 2021(12/3/20)

Articles and Materials

Specialty Drug Section & Drug Importation in this Presentation(9/12/24)

PBM Executives Face Bipartisan Scrutiny at House Hearing(8/30/24)

President Signs Executive Orders on Prescription Drug Costs(7/27/20)

FDA issues Proposed Rules on Importing Prescription Drugs from Canada(12/31/19)

Administration Released Limited Prescription Drug Importation Proposal(12/30/19)

HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs(8/2/19)

Medicare-for-all!!! Happy talk that lets everyone mislead themselves.(1/30/19)

Off-Label & Non-Approved Drugs & Treatments(12/18/07)

Canada Issues: Importing Drugs - Canada Drug Warning (again) (Nov 2003)(12/8/06)

Investment Statements

October 2021 Investment Statement(11/12/21)

SPBA 2020 First Quarter Investor Holdings Report(4/3/20)

Independent Dispute Resolution

No Surprises Act Regulations Part II - Independent Dispute Resolution (Webinar)(10/13/21)

Articles and Materials

IRS Releases Guidance on Calculating 2024 QPA Payments (3/21/24)

No Surprises Act Independent Dispute Resolution Process Proposed Rule (12/15/23)

Calculating the QPA in the Aftermath of the Texas Medical Association et al. Case (10/31/23)

Overview Highlights of the SPBA Spring Meeting Session:  “The No Surprises Act Independent Dispute Resolution Process”(5/1/23)

Independent Dispute Resolution: Status Update(3/10/23)

H. The No Surprises Act Independent Dispute Resolution Process from the Date of Service to the Decision of the IDR Entity - Scott Bennett(3/28/22)

Federal IDR Portal Stakeholder Testing Round Table(2/25/22)

Federal Judge Strikes Down Pieces of No Surprises Act Independent Dispute Resolution IFR(2/24/22)

SPBA Submits Comment Letter on No Surprises Act Independent Dispute Resolution Process(12/15/21)

No Surprises Act and Transparency Effective Date Chart(10/19/21)

No Surprises Act Regulations - Part II Released(10/4/21)

Official Source Documents

Fact Sheet: No Surprises Act Independent Dispute Resolution Process Proposed Rule (11/3/23)

ACA FAQ Part 62 on QPA Post Court Decision in TMA III (10/20/23)

Payment Disputes Between Providers and Health Plans (9/19/23)

IDR Disputing Parties Guidance for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022(4/24/23)

Guidance for IDR Entities for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022(4/24/23)

Webinar

Webinar: New Proposed Federal IDR Process, Court Decision, New FAQ and AI Compliance Tools (12/5/23)

Surprise Billing

No Surprises Act - First Set of New Regulations (Webinar)(7/20/21)

Articles and Materials

Progress Toward Advanced Explanation of Benefits (AEOB) Rulemaking and Implementation (12/16/24)

No Surprises Act – Determining Cost-Sharing and Payment Amounts to Providers(12/13/24)

National Emergency or Public Health Emergency Declaration (9/2/22)

SPBA Reviews the Administration's Executive Order(7/15/21)

Future Rollout of Federal Guidance Planned(7/7/21)

Administration Releases Interim Final Rule on the No Surprises Act(7/2/21)

Advanced Explanation of Benefits in the No Surprises Act(5/28/21)

SPBA Submits Comments on No Surprises Act Regulations(5/26/21)

F. New Federal No Surprises Act & Related Transparency Requirements(4/7/21)

End of Year Spending and COVID Stimulus Package: A Summary(2/4/21)

No Surprises Act - Section by Section Summary(2/4/21)

Official Source Documents

HHS Progress-AEOB-Rulemaking-Implementation-1 April 2024 (12/16/24)

HHS Progress on AEOB Rulemaking Update-2 December-2024 (12/16/24)

Interim Final Rule - Requirements Related to Surprise Billing Part II(4/24/23)

Guidance for IDR Entities for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022(4/24/23)

Requirements Related to Surprise Billing - Final Rules (8/2022)(4/24/23)

Rx Reporting IFR (8/15/22)

Surprise Billing Model Notice(10/18/21)

Interim Final Rule - Requirements Related to Surprise Billing; Part I (8/6/21)

No Surprises Act Bill Text(2/4/21)

Surprise Billing (see Transparency/Surprise Billing Resource Center on the homepage)

No Surprises Act - First Set of New Regulations (Webinar)(7/20/21)

Articles and Materials

No Surprises Act – Determining Cost-Sharing and Payment Amounts to Providers(12/13/24)

SPBA Reviews the Administration's Executive Order(7/15/21)

Future Rollout of Federal Guidance Planned(7/7/21)

Administration Releases Interim Final Rule on the No Surprises Act(7/2/21)

Advanced Explanation of Benefits in the No Surprises Act(5/28/21)

SPBA Submits Comments on No Surprises Act Regulations(5/26/21)

F. New Federal No Surprises Act & Related Transparency Requirements(4/7/21)

End of Year Spending and COVID Stimulus Package: A Summary(2/4/21)

No Surprises Act - Section by Section Summary(2/4/21)

Official Source Documents

Surprise Billing Model Notice(10/18/21)

Requirements Related to Surprise Billing; Part II - IFR (Fact Sheet)(10/4/21)

Requirements Related to Surprise Billing; Part II pdf (Federal Register IFR)(10/4/21)

No Surprises Act Bill Text(2/4/21)

SPBA 2020 Fall Virtual Meeting

L. HIPAA Administration - Prior Authorization & Referrals (278) Rule Making(9/13/20)

J. Hospital Price Transparency Rule(9/13/20)

I. Extexive New Plan Disclosures in Transparency Coverage Proposed Rule(9/13/20)

H. Social Hour with "World Piano Man' Martyn Lucas's Song List(9/13/20)

G. TPA/Self-Administrators & Stop-Loss Partnering(9/13/20)

F. Stopping Losses - Coordinating with Stop-Loss in a COVID-19 Era(9/13/20)

K. Social Hour - "Mixin' It Up with Ben" - Recipes(9/13/20)

C. Congressional/State Activity & Prospects for Changes Impacting Employer Sponsored Plans(9/13/20)

Sponsorship

2020 Webinar Sponsorship Opportunities(5/18/20)

Webinar Sponsorship Opportunities for 2020(5/8/20)

Webinars

Webinar: Coronavirus Preparedness and Prevention Plan by Employers (#1)(3/18/20)

Articles and Materials

Webinar: Recent Guidance on Extension of Certain Timeframes for Employee Benefit Plans (With Direct Link to Webinar)(5/8/20)

Coronavirus FAQs for Employers by Alston & Bird(3/20/20)

Minutes of Board Meetings

10/26/2018 - Fall - 2018 - September 26, 2018(12/10/18)

4/4/2018 - Spring - 2018 - April 4, 2018(11/26/18)

6/22/2018 Board Minutes & Resolution(7/18/18)

Articles and Materials

2024-June-6: SPBA Board Call Minutes(8/3/24)

2024-May-20: SPBA In-Person Board Meeting Minutes(8/3/24)

2024-May-19: SPBA Board Strategy Meeting Minutes(8/3/24)

2024-May-2: SPBA Board Call Minutes(8/3/24)

2024-Apr-4: SPBA Board Call Minutes(8/3/24)

2024-Mar-7: SPBA Board Call Minutes(8/2/24)

2024-Feb-1: SPBA Board Call Minutes(8/2/24)

2024-Jan-4: SPBA Board Call Minutes(8/2/24)

2023-Dec-7: SPBA Board Call Minutes(8/2/24)

2023-Nov-2: SPBA Board Call Minutes(8/2/24)

2023-Oct-5: SPBA Board Call Minutes(8/2/24)

2023-Sep-13: SPBA In-Person Board Meeting Minutes(8/2/24)

2023-Aug-3: SPBA Board Call Minutes(8/2/24)

2023-Jul: SPBA Board Call Minutes(8/2/24)

2023-Jun-1: SPBA Board Call Minutes(8/2/24)

2023-May-4: SPBA Board Call Minutes(8/2/24)

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)

Meeting Handouts

Workshop B: Cafeteria Plans(3/20/17)

Workshop A: How Well do You Know Your Network & It's Legal/Administrative Implications?(3/20/17)

M. Designing Compliant Wellness Programs(3/20/17)

L. Health Care Fraud 2017: Challenges & Opportunities for Benefit Admin.(3/20/17)

K. The Future of HIPAA Administrative Transactions(3/20/17)

J. Navigating the HIPAA Enforcement Landscape(3/20/17)

I. Mental Health Parity & the 21st Century Cures Act(3/20/17)

H. Section 1557: Accessing the Impact of Section 1557 on Group Health Plans(3/20/17)

G. Section 1557 of the Affordable Care Act(3/20/17)

F. ACA Employer Plan Reporting(3/20/17)

E. Recent Employee Benefit Litigation: TPA Edition(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)

A. 2017 Spring Meeting Agenda (For Reference)(3/20/17)

R. Cybersecurity Liability Insurance(10/14/16)

Q. PBM Insights(10/14/16)

P. Workshop H - Next Level of Cyber Risk Reduction Part II(10/14/16)

O. Simplifying Business Transaction to Increase TPA Cost Savings & Efficiency(10/14/16)

N. Workshop G: Stop-Loss Training on ACA(10/14/16)

M. Workshop E: Free Market Health Care(10/14/16)

L. Workshop C: Wellness Final Rules under ACA Title I(10/14/16)

K. Workshop B: Next Level of Cyber Risk Reduction (Part I)(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)

E. Top Six Affordable Care Act Issues You Should be Focused On(10/13/16)

D. Specialty Drugs(10/13/16)

C. Innovative Plan Designs to Create Efficiences & Strategies to Avoid Compliance Challenges(10/13/16)

B. Why Every TPA Website Needs Real-Life Client Success Stories(10/13/16)

A. 2016 Fall Meeting Agenda (For Reference)(10/13/16)

Tues: Social Media - The Straight Scoop for TPAs(10/15/15)

B. The Commercial Application of Bundled Payments(9/22/15)

Ashley Gillihan - ALE/MEC Information Reporting Presentation + Examples from 2015 Spring Meeting(4/1/15)

H. Wellness Programs: Operating Without EEOC Guidance(3/31/15)

G. Specialty Pharmacy(3/27/15)

F. Drafting Self-Funded Welfare Plan Documents(3/27/15)

D. Federal Enforcement of the ACA & Other Health Laws(3/27/15)

C. The ADA: Voluntary Wellness Programs & Health Insurance Issues + Pregnancy Discrimination(3/27/15)

B. Prospects for Health Reform Changes in the 114th Congress(3/27/15)

A. Agenda (for reference purposes)(3/27/15)

Employer Shared Responsibility

Issues to Consider When Designing Compliant Non-Major Medical Minimum Essential Coverage Plans (Webinar)(3/27/14)

Articles and Materials

Are ALEs Required to hold Open Enrollment Periods?(1/3/20)

IRS Extends 2019 ACA Reporting Deadlines(1/3/20)

IRS Releases ACA Affordability Rates for 2020 + Rev. Proc 2019-29(8/6/19)

Employer Shared Responsibility Penalties for 2019(2/12/19)

Marketplace Appeal Letters(8/30/16)

A Variable Hour Employee/Measurement Issues(7/25/15)

Dependent PTC and Impact on ESR Payment(6/27/15)

Documentation of Coverage Offer(9/29/14)

The SPBA Manual to the Pay or Play Rules (Updated November 26, 2014)(7/11/14)

TRANSITION RELIEF for Employer Shared Responsibility(2/27/14)

Cafeteria Plan Elections and Going to the Exchange(10/24/13)

Non-Major Medical Plan and MEC(10/24/13)

Will Changing a Plan's Renewal Date Delay Compliance with ACA?(5/31/13)

Play or Pay in 2014 (Shared Responsibility for Employers Regarding Health Coverage)(1/2/13)

Employer Penalties and Issues to Watch For(9/14/12)

Minimum Value of an Employer-Sponsored Health Plan(5/29/12)

Health Care Reform: Employer Mandate and Federal Subsidies(8/17/11)

Official Source Documents

IRS Memo on ESR Penalty Statute of Limitations(3/13/20)

ESRP Response + Employee Premium Tax Credit (PTC) Listing: Forms 14764 + 14765(12/6/17)

IRS Letter on Calculating ESR Liability(11/13/17)

IRS Notice 2015-87: Variety of ACA Related Provisions(12/17/15)

IRS Notice on Proposed Approach to Look-Back Measurement(9/19/14)

Play or Pay 2014 Final Rules (Single Column)(3/1/14)

Notice 2013-45: Transition Relief for 2014(7/10/13)

Play or Pay 2013 Rules: Federal Register Proposed Rules(1/2/13)

Play or Pay 2013 IRS Q&As(1/2/13)

IRS Notice 2012-31 on Minimum Value of Employer-Sponsored Health Plan(12/7/12)

IRS Notice 2012-58 - Determining Full-Time Employees(9/4/12)

IRS Notice 2012-59 - Guidance on 90 Day Waiting Period Limitation(9/4/12)

Relations with ACL, Inc.

ACL, Inc. Management Agreement(4/26/10)

Other Issues & Explanations

Why the No-Commercialism Policy?(11/13/09)

SPBA's Role, Government Strategies, Visibility etc. with Other Organizations(2/3/09)

The Image & PR of the TPA Industry(10/1/99)

White Paper - Oct. 1999: Answers from Spring Meeting Speakers(10/1/99)

"White Paper" on Meetings(10/1/94)

Self Regulation for TPAs?(12/27/89)

Incoming Chair & Sec/Treas Orientation

Secretary/Treasurer Invitation for Orientation(11/11/09)

Basic Board Policy

Guiding precepts, policies & priorities of the SPBA Founders & Board over the years(11/11/09)

Founding Purposes of SPBA(11/11/09)

Articles and Materials

By-Laws of the Society of Professional Benefit Administrators(2/27/23)

SPBA Non-Discrimination and Anti-Harassment Policy(10/2/14)

Membership Eligibility & Trends

The Unique Relationship & Expectations of SPBA Members(9/1/09)

Stop-Loss Relations

Reviewing the Stop-Loss / SPBA Relationship(1/10/00)

Mental Health Parity & Addiction Equity Act (MHPAEA)

Articles and Materials

Enforcement Delay of MHPAEA NQTL (5/28/25)

Report to Congress on MHPAEA Released by Federal Agencies (2/27/25)

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

Tri-Agencies Release MHPAEA Regulations and Report to Congress (7/25/23)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

MHPAEA Provisions in CAA(2/2/21)

Agencies Solicit Comments on MHPAEA, Issue Model and FAQs(6/30/17)

Final Mental Health Parity & Addiction Equity Act (MHPAEA) Regulations (article)(11/12/13)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008(11/12/13)

New MHPAEA FAQs Released(5/10/12)

New Information on Mental Health Parity & Addiction Equity Act of 2008 Implementation(2/7/11)

DOL Gives Plans Clarification on MHPAEA(7/8/10)

Comments on MHPAEA Interim Final Regulations(5/4/10)

TPAs Don't Need to Inform Their Clients About These Things(3/4/10)

MHPAEA Interim Final Regulations(2/17/10)

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)

Effective Date of Mental Health Parity Addiction Equity Act(7/30/09)

Official Source Documents

Agency Statement on Partial Non-Enforcement of Final MHPAEA Rules (5/20/25)

Biden Administration Releases New MHPAEA Regulation(8/25/23)

DOL PPT on MHPAEA NQTL Comparative Analyses(5/27/22)

2021 MHPAEA Enforcement: Fact Sheet(1/26/22)

2022 MHPAEA Report to Congress(1/26/22)

Mental Health Parity (MHPAEA) Resource Materials for NQTLs(6/30/21)

DOL Issues New FAQs on Mental Health Parity and Substance Use Disorder Rules + Fact Sheet + Proposed FAQs + Documentation Request Form(5/1/18)

Parity of Mental Health & Substance Use Benefits with Other Benefits; Using Your Employer-Sponsored Health Plan to Cover Services(6/29/16)

Warning Signs-Plan or Policy Non-Quantitative Treatment Limitations that Require Additional Analysis to Determine MHP Compliance(6/29/16)

Final Rule: Mental Health Parity Act(11/12/13)

Understanding Implementation of the MHPAEA Act of 2008 - FAQs(5/10/12)

MHPAEA Interim Final Rules - Federal Register(2/2/10)

MHPAEA Request for Information(5/7/09)

Regulatory & Legislative Issues

Articles and Materials

Enforcement Relief for Gag Clause Prohibition Compliance Attestation (4/30/25)

Unleashing Prosperity Through Deregulation (2/25/25)

Ozempic, Wegovy Among 15 Drugs Selected for Medicare Price Negotiations (2/25/25)

Legislative Update – Prospects for Telehealth Movement in the Lame Duck Session (12/17/24)

Trump Administration Implications for Healthcare: The Issues and People to Watch (12/4/24)

House Committee Tees Up Telehealth Bill (10/24/24)

Health Subcommittee Examines Proposals to Extend Telehealth Flexibilities (4/25/24)

Richard Hardin Testimony for the Record (4/12/24)

SPBA submits comment letter to the House Committee on Education and the Workforce (4/5/24)

Bipartisan Group of Senators Introduce Legislation to Reduce Employer Healthcare Reporting Requirements (11/15/23)

National Emergency or Public Health Emergency Declaration (9/7/22)

Official Source Documents

President Trump Issues Executive Order Directing Efforts to Lower Prescription Drug Prices (4/28/25)

Trump Executive Order on Transparency (2/28/25)

Plan Transparency

Articles and Materials

Enforcement Relief for Gag Clause Prohibition Compliance Attestation (4/30/25)

Departments Issue FAQ 69 on Independent Dispute Resolution and the Gag Clause (2/25/25)

CAA HB SB Gag Clause Chart (8/29/24)

Gag Clause Prohibition Compliance Attestation User Manual Updated(6/28/24)

Machine‑Readable Rx Files Enforcement (10/26/23)

TinC 2.0 Complexity and HR 3561 Impact (7/14/23)

New Requirements Under CMS' Transparency in Coverage Rule Take Effect January 1, 2024(6/30/23)

The CAA Gag Clause Prohibition Attestation (6/29/23)

New Requirements Under CMS' Transparency in Coverage Rule Take Effect January 1, 2024 (6/26/23)

Transparency in Coverage Rules….What is it and What it Requires Part 1(7/15/21)

Future Rollout of Federal Guidance Planned(7/7/21)

SPBA Transparency Summit - 3rd Session - Video Recording(6/15/21)

SPBA Transparency Summit - 2nd Session - Video Recording(3/29/21)

SPBA Transparency Summit - 1st Session - Video Recording(3/22/21)

SPBA Transparency Summit Slides - March 18, 2021(3/18/21)

Administration Finalizes Transparency in Coverage Rule(11/24/20)

SPBA Comments on CMS Transparency in Coverage Proposed Rule(2/6/20)

SPBA's Comments on Transparency Submitted to HHS (6/28/18)

Media Reports on Medical $ Transparency(4/9/13)

Escape the Fire (Health Care) Trailer(3/28/13)

Sales Tool & Opportunity(2/9/12)

Official Source Documents

Gag Clause Prohibition Compliance Attestation Annual Submission Instructions & User Manual 2024 (6/5/24)

Transparency in Coverage Final Rule(8/6/21)

Health Coverage Transparency Proposed Rule 11-2019(11/22/19)

HHS Report on Reforming America's Healthcare System Through Choice & Competition(8/1/19)

Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First(6/25/19)

Preventive Services

Articles and Materials

Supreme Court Arguments on Preventive Services Seem to Divide the Court (4/29/25)

Withdrawal of Preventive Services Proposed Rule on Non-Religious Moral Objections (2/25/25)

FAQ 68 Preventive Services and WCHRA (12/17/24)

Proposed OTC Preventive Services Regulations (12/17/24)

New FAQ 54 Addresses Preventive Services in light of Supreme Court Roe v. Wade Decision (2/2/23)

Reminder: New and Updated Women’s Preventive Health Services Guidelines Apply in 2023 (2/2/23)

COVID-19 Vaccine Rollout and Payment(2/2/21)

Supreme Court Allows for Birth Control Exemptions Based on Religious and Moral Objections(7/8/20)

Final Contraceptives Rules Include Religious and Moral Convictions Exemptions(12/19/18)

Religious Exemption & Accommodation for Certain Preventive Service Benefits(10/13/17)

Religious Exemptions and Accommodations for Coverage of Certain Preventive Services under the Affordable Care Act(10/6/17)

FAQ Part 31 Questions on Preventive and Out-of-Network Emergency Services(4/27/16)

Preventive Services Final Regulations(7/29/15)

Preventive Services FAQ Part XXVI(5/28/15)

The Supreme Court Decision on Hobby Lobby’s Contraceptive Case(7/31/14)

Religious Contraceptive Issue(1/30/14)

Final Contraceptive Rules Include TPA Role for Providing Certain Contraceptive Coverage(7/29/13)

SPBA's Comment Letter to IRS on Contraceptive Coverage(4/23/13)

Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans(4/17/13)

State Stop-Loss Legislation + HHS Issues Contraceptive Coverage Proposed Rule(2/4/13)

New Contraceptive Services Guidance Issued(9/12/12)

Contraceptives and Religious organizations: DOL seeks comments on implementing the preventive care mandate accommodation (4/18/12)

HHS Releases Interim Final Rule on Women's Preventive Services(8/2/11)

Preventive Services: Issues Abound - Companion Article: Comments Sought on Plan Design(2/7/11)

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

Withdrawal of Preventive Services Proposed Rule on Non-Religious Moral Objections (2/11/25)

Testing Price & Preventive - COVID IFC Reg (Federal Register - Nov 6, 2020)(12/1/20)

HHS Guidance: Revocation of Accommodation Notice(12/1/17)

Interim Final Rule on Certain Preventive Services under the ACA(10/6/17)

CMS New Release on 2015 released final regulations for Preventive Services(7/29/15)

Instructions for Model Notice - Accommodation Notice to HHS(8/27/14)

Proposed Rule to change definition of Eligibile Organization(8/27/14)

IFR-Notifying HHS of Accommodation Status(8/27/14)

Final Rule on Women's Preventive Services regarding Religious Employers Issued - July 2, 2013(7/8/13)

CMS & CCIIO: Contraceptive Guidance - August 15, 2012(11/1/12)

Preventive Services Covered under the Affordable Care Act(7/28/10)

Regulations Released Requiring New Health Insurance Plans to Provide Free Preventive Care(7/16/10)

Guide to Clinical Preventive Services(5/27/10)

Reporting

Articles and Materials

IRS Releases Guidance on Affordable Care Act Reporting Requirements (4/28/25)

At Long Last, Congress Passes Needed ACA Employer Reporting Relief (12/16/24)

IRS Extends Due Date for ACA Employer Reporting(12/22/17)

Early DRAFT tax form instructions the 1095B and 1095C(9/28/17)

ACA Information Reporting Delayed(11/30/16)

IRS Proposed Rules on MEC Reporting(8/30/16)

ACA Information Returns Corrections Process(8/24/16)

IRS Comments on TINs and a Good Faith Effort(7/15/16)

IRS Video on the ACA Information Returns Corrections Process(7/15/16)

ACA and US Territories: Do the individual mandate & the employer mandate apply in the US territories?(2/29/16)

Reporting Offers of Coverage(1/29/16)

Impact of Measurement Periods on 6056 Reporting(1/29/16)

Small ALEs Eligible for ACA Employer Mandate Transition Relief Must Still File for 2015(12/30/15)

Small Extension of Due Dates for ACA ALE and MEC Information Reporting(12/30/15)

COBRA and 1095-C Reporting(12/1/15)

1095-C Reporting for Employees on Medicare(11/4/15)

Multiemployer Plans and ALE Reporting(11/4/15)

HRA Integrated with Fully Insured ACA Reporting: SPBA Worked the Issue(9/25/15)

Penalty for Failure To File ACA Employer Reporting(7/25/15)

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)

Can a TPA File Form 1094-C on behalf of an Employer?(4/29/15)

Reporting for Controlled Groups on Form 1094-C(4/29/15)

Final Versions of 2014 ACA Employer/Plan Reporting Forms and Instructions(3/1/15)

IRS Releases Draft Forms for Reporting of Employee Health Coverage under ACA(7/31/14)

IRS Released Two Final Rules on Employer/Plan Reporting(3/25/14)

IRS Released Two Proposed Rules on Employer/Plan Reporting(10/24/13)

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)

Federal Register: Proposed Rule on MEC Reporting, August 2, 2016(8/23/16)

IRS ACA Reporting Corrections ppt(6/29/16)

Extension of Due Dates for ACA ALE & MEC Information Reporting(12/29/15)

IRS Notice 2015-87: Variety of ACA Related Provisions(12/17/15)

Federal Register: Final Rules Information Reporting by ALEs(12/3/14)

IRS Notice 2012-32(6/11/12)

IRS Notice 2012-33(6/11/12)

Webinar

Webinar: ACA Employer and Plan Reporting Webinar for TPAs and TPA Clients(11/20/15)

MHPAEA

Articles and Materials

Report to Congress on MHPAEA Released by Federal Agencies (2/27/25)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

Agencies Solicit Comments on MHPAEA, Issue Model and FAQs(6/30/17)

Mental Health Parity Compliance Checklist(6/29/16)

Mental Health Parity Compliance Checklist(6/29/16)

ACA FAQs (Part 31) Clinical Trials & MHPAEA(4/27/16)

MHPAEA and PPACA(9/29/10)

Official Source Documents

Biden Administration Releases New MHPAEA Regulation(8/25/23)

Parity of Mental Health & Substance Use Benefits with Other Benefits; Using Your Employer-Sponsored Health Plan to Cover Services(6/29/16)

Warning Signs-Plan or Policy Non-Quantitative Treatment Limitations that Require Additional Analysis to Determine MHP Compliance(6/29/16)

DOL MHPAEA Warning Signs: Plan or Policy NQTLs That Require Additional Analysis(6/22/16)

Determining Mental Health Parity Compliance(6/2/16)

Special Types of Plans & Situations

Articles and Materials

Reference Based Pricing Wins in California Court Case (2/25/25)

DOL Electronic Disclosure Rule + Federal Register: Electronic Disclosure by Employee Pension Benefit Plans Under ERISA(10/30/19)

Taft-Hartley/Multi-Employer/Collective-Bargain Description for Laymen(10/30/17)

Admin Fees + "Leftover" Money + Premium Tax Implications for Self-funded vs Insured Plans(7/27/11)

Self-Funding: Why Use Self-Funding?(5/27/11)

Self-Funding: Why Use Self-Funding?(5/27/11)

State and Local Government Employers Must Account for Post-Employment Health Benefits on Financial Statements Soon(8/4/08)

TRICARE: DOD Proposed Rules on TRICARE: Prohibited Financial Incentives(6/5/08)

EEOC Changes Retiree Benefits(12/8/06)

Govt. Announced New Coverage for National Guard And Reserve Members(12/8/06)

Leasing & Independent Contractor Do's & Don'ts(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)

Plans sponsored by Governmental & Religious Groups are NOT Under ERISA(12/8/06)

VA Complaints about Fiduciary Duty(12/8/06)

What's the Regulatory Status of Government & Religious Plans?(12/8/06)

Leasing Do's & Don'ts(1/10/95)

Official Source Documents

Guidance to Employee Benefit Plans on the Definition of "Spouse" and "Marriage" under ERISA & The Supreme Court Decision(9/23/13)

ERISA Q&As (DOL, ABA & JCEB)(1/7/13)

Security - Cybersecurity and HIPAA

Articles and Materials

HIPAA Security Rule will Undergo Significant Revisions in 2025 (2/25/25)

New Security Risk Assessment Nov 2024 (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HHS Finalizes New Provisions to Enhance Integrated Care and Confidentiality for Patients with Substance Use Conditions (2/26/24)

Mitigate Cyber Attacks with Industry Standard Security Protocols (11/1/22)

2022 New Security Risk Assessment Tool (7/7/22)

Cyber Alert: Updates on Ransomware and Critical VMware Vulnerability(7/15/21)

OCR Issues Audit Report on Health Care Industry Compliance with the HIPAA Rules(12/30/20)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates(6/7/19)

NAIC Adopts Cybersecurity Model Law(11/28/17)

US CERT ALERT: Malware Infecting U.S. Businesses(11/17/17)

HHS Update: International Cyber Threat to Healthcare Organizations -- (5/15/17)

Great Ideas From Fall Meeting Sessions on Cyber Security(10/28/16)

Sharing Patient Data Subject to FTC Regulations, Not Just HIPAA(10/28/16)

UPDATED: Security Risk Assessment (SRA) Tool(9/30/16)

Protecting HIPAA Private Health Information(6/29/16)

Cybersecurity: Ransomware & Recent Variants(6/1/16)

OCR Cyber-Awareness Update(6/1/16)

Security Alert Updates from OCR, US-Cert and the FBI(5/6/16)

DHS Cyber Alert on Ransomware(4/6/16)

Cybersecurity Act of 2015(1/29/16)

Security Update: Business Associates are a Priority(12/30/15)

HHS Releases Final HIPAA Rule(1/24/13)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

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)

Security Business Associate Addendum Memo(12/8/06)

HIPAA Security Compliance Strategies - Mariann Yeager, MBA, TruArx, Inc.(5/2/05)

HIPAA Security Standards Addendum(10/26/04)

Security Plan Document Amendment(10/16/04)

Official Source Documents

HIPAA Security Rule to Strengthen the Cybersecurity of ePHI NPRM (1/3/25)

HHS Office for Civil Rights Creates FAQ Webpage in Response to the Change Healthcare Cyberattack (4/22/24)

OCR Cybersecurity Newsletter: Defending Against Common Cyber-Attacks(4/28/22)

Controlling Access to ePHI: For Whose Eyes Only?(7/15/21)

2016 - 2017 HIPAA Audits Industry Report(12/21/20)

How to Manage Malicious Insider Cyber Threats(8/30/19)

Risk Analyses vs. Gap Analyses – What is the difference?(6/29/18)

HHS OCR Cybersecurity December Newsletter(12/28/17)

OCR Cybersecurity Newsletter: Insider Threats and Termination Procedures(12/1/17)

OCR April Cybersecurity Newsletter - Man in the Middle Attacks and more(4/27/17)

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 Audits Are Coming to Business Associates - NOW(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)

Cyber Incident Reporting: A Unified Message for Reporting to the Federal Government(8/30/16)

New HIPAA Ransomeware Guidance: Fact Sheet(7/21/16)

HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents.(7/21/16)

OCR Releases HIPAA Phase 2 Audit Protocols(4/8/16)

HIPAA Security Rule Crosswalk to NIST Cybersecurity Freamework(2/29/16)

NIST Cybersecurity Framework(1/28/16)

HIPAA Security Guidance for Remote Use of Electronic Health Information(2/26/07)

Mental Health Parity

Articles and Materials

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

DOL Office of Inspector General Survey on Mental Health Parity Enforcement (4/15/24)

Back to the Future: Mental Health Parity Audits(9/30/16)

Residential Treatment Exclusion Violates Mental Health Parity(2/29/16)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008(11/12/13)

New Mental Health Coverage Requirements of the Wellstone Act(8/31/09)

Official Source Documents

Final Rule: Mental Health Parity Act(11/12/13)

HIPAA and Privacy

Articles and Materials

New HIPAA Privacy Rules Following the Supreme Court Dobbs Ruling (12/16/24)

HIPAA Privacy Rule to Support Reproductive Health Care Privacy: Resources for Stakeholders and HIPAA Covered Entities or Business Associates(6/28/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes(12/30/20)

New Frequently Asked Questions on HIPAA and Health Plans Support Care Coordination and Continuity of Care(7/1/19)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates(6/7/19)

The Supreme Court, CareFirst & Data Breach Lawsuits(2/27/18)

HIPAA Privacy Opioid Guidance(11/28/17)

HHS Modifies HIPAA In An Attempt to Address Gun Violence(1/29/16)

HIPAA Business Associate Agreements (8/27/14)

Revised 2013 Notice of Privacy Practices (Clean)(8/15/13)

Revised 2013 Notice of Privacy Practices(8/15/13)

Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans(4/17/13)

BAA and Subcontractor: Business Associate Agreement and Subcontractor Agreement(4/5/13)

HHS Releases Sample Language for Updating Agreements Under HIPAA(1/30/13)

HHS Releases Final HIPAA Rule(1/24/13)

ONC To Develop Model Notice of Privacy Practices for Consumers(9/12/12)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

OCR Says Business Associates Will Not Be a Part of the Pilot Audit(2/24/12)

HHS To Conduct HIPAA Privacy and Security Audits(11/28/11)

HHS’ Office of Civil Rights Releases HIPAA Violations Report(9/27/11)

HIPAA Privacy Rule Accounting of Disclosures – COMMENTS Submitted by SPBA(8/17/11)

HHS Issues Proposed Rule on Disclosures of Electronic Medical Data(6/1/11)

HIPAA Privacy and the Model Notice of Adverse Benefit Determination(3/9/11)

The New HIPAA Privacy & Security Rules: What Is Now Required(10/1/09)

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)

Beware PHI Retained in Computers after a Client is Terminated(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)

Employee Confidentiality Agreement and Training Certification(12/8/06)

Flowchart Brainstorming Tools(12/8/06)

HIPAA Privacy Impact on Employers (Letter to use with Clients)(12/8/06)

HIPAA PRIVACY: Overview for TPAs(12/8/06)

Memo Explaining HIPAA Privacy Documents(12/8/06)

Plan Sponsor’s Certification of Compliance(12/8/06)

Providers Misinterpreting HIPAA Privacy(12/8/06)

Request for Access to Protected Health Information(12/8/06)

Request for Amendment of Protected Health Information Sample Form(12/8/06)

Request for an Accounting of Certain Disclosures of Protected Health Information(12/8/06)

Request for Confidential Communications Sample Form(12/8/06)

Request for Restrictions on Use or Disclosure of Protected Health Information(12/8/06)

Sample Amendment to Plan Documents(12/8/06)

TPA Privacy Issues Addressed at SPBA 2003 Spring Meeting(12/8/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule(5/3/06)

The HIPAA Security Standards: Practical Implementation Considerations - Dorthula Powell-Woodson(5/2/05)

SPBA Model Customer Service Scenarios(9/8/03)

Official Source Documents

HIPAA Privacy Rule to Support Reproductive Health Care Privacy - For Covered Entities and Business Associates. (6/28/24)

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet(7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

OCR Proposes Modifications to the HIPAA Privacy Rule to Empower Individuals, Improve Coordinated Care and Reduce Regulatory Burdens (Fact Sheet)(12/21/20)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (12/21/20)

HIPAA Audit Protocol 2016(9/22/16)

HIPAA Privacy Rule and National Instant Criminal Background Check System(1/28/16)

Personal Representative rights for another individual's health information(1/28/16)

Individuals' Right under HIPAA to Access their Health Information(1/28/16)

HIPAA Privacy in Emergency Situations(11/18/14)

2009 Interim Final Rules on Breach Notification(9/8/09)

HIPAA Security Guidance - HHS(4/17/07)

Cost Sharing

Articles and Materials

HHS Addresses Permissible Employee Cost Sharing under Group Health Plans(12/13/24)

New Proposed Rules on EHB and Cost Sharing for plan year 2016(1/8/15)

JCEB Meeting with Agencies on Taxation (May Meeting 2013)(8/12/13)

HHS Issues Proposed Regulations on Essential Health Benefits(12/19/12)

Official Source Documents

Standards Related to Essential Health Benefits, Actuarial Value & Accreditation; Final Rule (Federal Register)(8/16/13)

Nondiscrimination Rules - IRS

Articles and Materials

IRS Nondiscrimination Rules for Self-Funded Plans(12/10/24)

Nondiscrimination Issues: 105(h) and Issues Impacting Wellness Program; Ashley Gillihan(8/31/10)

Official Source Documents

IRS Nondiscrimination Rules for Self-Funded Plans(12/8/06)

Cafeteria Plans

Articles and Materials

2025 Health FSA Inflation-Adjusted Amounts (12/9/24)

Health FSA Inflation-Adjusted Amounts for 2024 (11/12/23)

IRS Issues Notice Expanding Some Permitted Change-in-Status Rules for Cafeteria Plans (12/1/22)

2021 COLAs for "HCP" and "Key" in Cafeteria Plans(12/1/20)

A. 2019 COLAs for "HCP" and "Key" in Cafeteria Plans(11/13/18)

B. 2018 COLAs for "HCP" and "Key" in Cafeteria Plans(11/30/17)

Official Source Documents

IRS Notice 2020-90: COVID-19 Guidance Under § 125 Cafeteria Plans and Related to High Deductible Health Plans(9/28/20)

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)

IRS Notice on FSA Distributions for Reservists(11/21/08)

Federal Register: Final Rules on Dependent Care Services(8/28/07)

Federal Register: Proposed Cafeteria Plan Regulations, August 6, 2007(8/10/07)

Debit Card IRS Revenue Ruling(12/8/06)

Preamble to Proposed Reg on Dependent Care Expenses(12/8/06)

Prop Reg § 1.21-1. Expenses for household and dependent care services necessary for gainful employment.(12/8/06)

IRS Notice on "Use-It-or-Lose-It" Grace Period(5/19/05)

SPBA Value To You

Articles and Materials

2024 SPBA Value To You (12/3/24)

2023 SPBA Value To You(12/19/23)

SPBA Board of Directors

Articles and Materials

SPBA Board of Directors Application(11/20/24)

June 2024 - May 2025 SPBA Board of Directors Contact Info.(7/19/22)

Board of Director's Role Description(7/11/17)

Self-Nominate to be a SPBA Board Candidate(4/3/13)

Annual and Lifetime Limits

Articles and Materials

Annual and Lifetime Limits: Reg Writers Provide Insights on PPACA Issues(11/15/24)

More on Annual and Lifetime Limits (Email)(1/13/24)

Prohibition on Lifetime and Annual Limits (Article)(5/13/10)

Official Source Documents

Annual and Lifetime Limits (Federal Register): Preexisting Condition Exclusions, Patient Protections (primary care physician choice, emergency services), Rescissions(6/29/10)

Fact Sheet on Patient Protection Annual Limits (Email)(6/22/10)

Directory of TPAs, Stop-Loss & Service Partners

Articles and Materials

SPBA 2024 Member Directory of TPAs, Stop-Loss, and Service Partners (11/15/24)

Specialty Drugs

Articles and Materials

B & C. Compliance Update I. Ashley Gillihan, Alston & Bird(9/24/24)

Specialty Drug Section & Drug Importation in this Presentation(9/12/24)

Specialty Drugs and Plan Design: Strategies and Compliance Issues(5/4/20)

Specialty Drug Webinar on Legal Challenges in Designing Plans - July 2016(11/10/16)

FTC (Federal Trade Commission)

Articles and Materials

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

Nondiscrimination - Section 1557

Articles and Materials

Final Regulations Regarding Section 1557 Nondiscrimination Rules Recently Released by U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) (6/26/24)

New Laws Enacted by the Consolidated Appropriations Act of 2023 (CAA23) (1/30/23)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Christian Employers Case Section 1557 (7/5/22)

Official Source Documents

Background documents HHS ACA Section 1557 Nondiscrimination(6/26/24)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

HSAs (Health Savings Accounts)

Articles and Materials

IRS Releases HSA Inflation Adjusted Amounts for 2025 (5/28/24)

Adult Dependents and HSAs(12/21/10)

Official Source Documents

IRS Rev. Proc. 2018-27 (2018 HSA Deductions)(4/27/18)

Health Savings Accounts

Articles and Materials

IRS Releases HSA Inflation Adjusted Amounts for 2025 (5/28/24)

IRS Releases HSA Inflation Adjusted Amounts for 2024 (5/26/23)

Congress Extends Telehealth Flexibility for Two Years (1/17/23)

HSA Contribution Limits for 2020(1/3/20)

IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan(1/3/20)

Treasury Releases Guidance on Additional Preventive Care Benefits Permitted by HDHP(7/18/19)

IRS Releases New Guidance on 2018 HSA Contribution Limits & IRS Rev. Proc. 2018-27(4/27/18)

HSA 2018 Contribution Limits(4/24/18)

IRS Retirement Plan News(10/1/09)

The TPA & The HSA: How Not to be Just Like the Others(10/11/07)

Full-Year Contribution for Part-Year Coverage(5/24/07)

HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP(4/17/07)

Strategies for Promoting Health Savings Accounts(4/17/07)

HSA Provisions in the "Tax Relief and Health Care Act of 2006"(1/26/07)

A New TPA Profit Center: Educating Employees about HSAs(12/8/06)

Everything You Wanted to Know about HSAs: A Crash Course in Health Care Consumerism(12/8/06)

FSA Grace Period and HSA Eligibility Guidance Offers Only Short Term Relief(12/8/06)

FSA Interaction with HSAs(12/8/06)

Health Savings Accounts - First Analysis(12/8/06)

HSA Must Be Established before Qualified Medical Expenses Can Be Incurred(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)

SPBA Seattle Meeting Panel on Health Savings Accounts(12/8/06)

Treasury Releases More HSA Guidance - IRS Notice 2004-50(12/8/06)

The President's Health Savings Account Proposals(5/3/06)

Gillihan's Overview of HSA Comparability Rules(11/3/05)

HSAs and Out-of-Pocket Maximum Carryovers(10/5/05)

Considering an HSA?. - Kathy McCormick, HSA Bank(5/2/05)

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)

More IRS/Treasury HSA Guidance Interaction with FSAs and HRAs(5/12/04)

DOL Releases Guidance on ERISA Applicability to HSAs(4/12/04)

SPBA Insights on HSA Bank/Trustee Issues(2/9/04)

Official Source Documents

IRS Notice 2004-2(11/14/14)

IRS Notice 2004-50(7/30/10)

Custodial Account Form(7/10/08)

IRS Notice 2008-59: New Q & As on HSAs(6/27/08)

IRS Notice 2007-22 on FSA and HRA Rollovers to HSAs(2/16/07)

All About HSAs(12/8/06)

DOL FAB 2004-01(12/8/06)

DOL FAB 2006-02(12/8/06)

Final HSA Comparability Rules(12/8/06)

IRS Notice 2005-86, HSA and FSA Grace Period(12/8/06)

IRS Proposed Rules on Employer Comparable Contributions(12/8/06)

Treasury Guidance on Preventive Care(1/19/06)

Notice 2005-8 - 2% Shareholders(8/5/05)

AHP (Association Health Plans)

Articles and Materials

Association Health Plans Subject to Guidance of the ACA Past (4/30/24)

Association Health Plans Proposed Regulations Released + AHP Regulation Overview(8/15/19)

Association Health Plans Regulations Under Consideration by DOL(8/15/19)

AHP Comment Letter on Behalf of SPBA(8/15/19)

Department of Labor Final Regulations Expanding ERISA's Definition of "Employer" to Provide Access to Association Health Plans + FAQs(8/15/19)

Official Source Documents

Association Health Plans: ERISA Compliance Assistance(8/15/19)

Definition of "Employer" under Section 3(5) ERISA - Association Health Plans (Proposed Rule)(8/15/19)

Association Health Plans - Final Rule(8/15/19)

EEOC

Articles and Materials

Pregnant Workers Fairness Act (4/26/24)

EEOC Releases New COVID Rules (9/7/22)

EEOC Nonbinary (7/5/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

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)

Questions for the EEOC Staff for the 2015 Joint Committee of Employee Benefits Technical Session, May 7,2015(10/7/19)

EEOC Fact Sheet: (FAQs) Domestic or Dating Violence, Sexual Assault, Stalking (Article)(10/7/17)

Official Source Documents

EEOC Guidelines on Sex & Pregnancy Discrimination Federal Register(10/5/17)

EEOC FAQs (Fact Sheet): Domestic or Dating Violence, Sexual Assault, Stalking(11/2/12)

State Licensing

Articles and Materials

2024 SPBA Third Party Administrator State Licensing Statutes as of April 2024 (4/17/24)

2022 TPA License Corrections (10/11/22)

TPA License Change For Michigan (7/5/22)

Official Source Documents

Kansas TPA Act; SB22(4/27/17)

Indiana Department of Insurance: Bulletin 236 - Nonresident TPA Licensing(4/27/17)

Hospital Transparency

Articles and Materials

SPBA Meeting with GAO on the Use of Hospital Pricing Information (2/27/24)

SPBA Comments on CMS Hospital Transparency Proposed Rule(2/6/20)

YOUR Achievement on Hospital Price Transparency(5/8/13)

Transparency Documentary Trailer(6/5/12)

SPBA Policy Brief on Hospital Transparency (Updated version posted 4/20/12)(10/28/11)

Sharing Hospital Transparency(7/12/11)

Hospital Transparency(6/3/11)

Dependent Coverage

Articles and Materials

Dependent Coverage to Age 26 and Active Duty(2/13/24)

DOL Q & A on Grandchildren Dependency Factors(6/5/22)

Dependent Child Coverage Questions Posed by SPBA Members(6/10/10)

IRS Guidance on Tax-Free Employer-Provided Health Coverage for Dependent Children(5/13/10)

Agencies Release Interim Final Rules on Dependent Coverage of Children to Age 26 (Email Alert)(5/10/10)

Interim Final Rules on Dependent Coverage of Children Released (Email Alert)(5/10/10)

Official Source Documents

Interim Final Rules on Dependent Coverage of Children to Age 26 Fact Sheet(5/1/15)

Interim Final Rules on Dependent Coverage of Children to Age 26 (pdf)(5/11/10)

IRS Notice 2010-38 on Tax Treatment of Health Care Benefits to Children Under Age 27(4/29/10)

Technology Service Partner

Articles and Materials

Service Partner Application (2024)(2/7/24)

DOL

Articles and Materials

Plan Asset Regulations(1/24/24)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

DOL Makes Claims Records Relevant(7/15/21)

Record Retention and Electronic Disclosure Rules(1/30/20)

ERISA Advisory Council Recommends DOL Action on SPDs(10/7/19)

Comprehensive Guidance on the DOL Claims(10/7/19)

DOL Releases Claims Regs Frequently Asked Questions(10/7/19)

Undocumented Aliens on the Employee Benefit Plan?(10/7/19)

DOL's Proposed FMLA Regulations & Expanded FMLA Leave to Family of MIlitary Service(10/7/19)

DOL Disclosure Rules(4/6/09)

Letter to Brokers, Clients and Friends of TPAs on the Disclosure of Commissions & Payments(7/8/08)

New DOL Proposed Rules on Disclosing TPA Compensation(1/14/08)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form(12/8/06)

Claim Regulations Raises Fees Issue(12/8/06)

New SPD Requirements Under HIPAA(12/8/06)

SPD Disclosure Requirements Under HIPAA Confuse Many(12/8/06)

DOL Cracking down on Late-Paying Plans(3/2/00)

Official Source Documents

Level Funded Plan Arrangements Request for Comments (8/17/23)

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries(2/10/21)

DOL Answers Questions for Joint Committee on Employee Benefits, 2011(10/7/19)

Conflict of Interest (Part II - Rule) FAQs(10/7/19)

DOL Proposed Rule on TPA Fee Disclosure(10/7/19)

DOL Extension/Comments: Definition of "Plan Assets" & National Medical Support Notice(10/7/19)

DOL Extensions/Comments: ERISA Summary Annual Report(10/7/19)

DOL Extensions/Comments: Terminated Individual Account Plans(10/7/19)

DOL Reporting & Disclosure Guide for Employee Benefit Plans(10/7/19)

2017 DOL Annual Report on Self-insured Group Health Plans(3/1/17)

Plan Assets

Articles and Materials

Plan Asset Regulations(1/24/24)

90-Day Waiting Period

Articles and Materials

90 Day Waiting Period Final Rules(1/13/24)

New Rules on 90-Day Waiting Period(1/13/24)

Official Source Documents

90-Day Waiting Period - Final Rule (Federal Register - February 24, 2014)(2/24/14)

90-Day Waiting Period - Proposed Rule - Orientation Periods (Federal Register - February 24, 2014)(2/24/14)

Waiting Period Limitation: Federal Register Proposed Rule(3/22/13)

SPBA Organizational Information

Articles and Materials

SPBA Dues Structure for 2025(1/11/24)

By-Laws of the Society of Professional Benefit Administrators(2/27/23)

SPBA Staff(5/29/22)

SPBA Digital Graphics(11/11/20)

SPBA Non-Discrimination and Anti-Harassment Policy(10/2/14)

SPBA Code of Ethics(9/17/14)

SPBA Code of Ethics(9/8/14)

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)

A Members' Guide to SPBA Operation Policies & Customs(10/20/09)

CEO, COO, CFO Insight(10/20/09)

Hints for senior contacts(10/20/09)

How to figure your income size for SPBA purposes(10/20/09)

Important Warnings(10/20/09)

Members' Bad Office Habits(10/20/09)

Only Named Contacts May Contact SPBA for Technical Assistance(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)

SPBA's Board of Directors: What do they do and how are they chosen?(10/20/09)

What Makes SPBA Tick(10/20/09)

What SPBA Can + Can Not Do to Support State TPA Associations(10/20/09)

Why SPBA Does Not Take Formal "Positions"(10/20/09)

A Brief History of SPBA(5/1/09)

IRS

Articles and Materials

Nutritional Counseling: Is it a Medical Expense? (8/11/23)

Home Exercise Equipment for Obesity(8/8/23)

IRS Private Letter Ruling Holds Some Genetic Testing May Be Considered a Medical Expense(1/3/20)

2010 Excise Tax Requirements(2/2/10)

2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert)(2/2/10)

IRS Releases Guidance on Involuntary Termination in ARRA(4/2/09)

IRS Issues Additional Debit Card Transition Relief(12/9/08)

New Commandments to Live By: IRS Provides New Proposed Regulations(10/11/07)

Congress Reworks Dependent Definition(6/26/07)

1099 - IRS IIR Request(1/26/07)

IRS Issues Debit Card Transition 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)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form(12/8/06)

Extremely important notice to doctors & hospitals to assure you get your money without unintended IRS withholding.(12/8/06)

Good News for Self-Funded Partners/S Corp(12/8/06)

IRS on HMOs(12/8/06)

New Internet Provider TIN Matching Program(12/8/06)

Reserves Reminder(12/8/06)

Section 419A reserve limits for funded welfare benefit plans(10/17/97)

Why VEBA Tax-exemption is Obsolete These Days(9/1/96)

1099 - IRS Letter(12/8/94)

IRS Issues VEBA Regs for Association Geographic Limits(9/1/92)

Official Source Documents

IRS FAQs on Medical Expenses Related to Nutrition, Wellness and General Health (8/11/23)

IRS Notice 2019-63(12/2/19)

IRS - FAQs for Same Sex Couples(10/7/19)

TINs - Incorrect or Missing - IRS Publication 1586(11/21/17)

HR 1304 (Exclude from the definition of health Insurance coverage certain Medical stop-loss insurance)(4/27/17)

IRS ACA Webpages(7/31/13)

IRS Notice 2013-8 - 2012 Transit Benefit Limit(1/18/13)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States(10/29/12)

2010 Excise Tax Requirements: Form 8928(2/4/10)

2010 Excise Tax Requirements: Form 8928 Instructions(2/4/10)

IRS Notice on Debit Card Relief(12/15/06)

1099 - MISC Information Reporting Requirements (Final Regulation)(12/8/06)

Federal Guidance

Articles and Materials

IRS Releases Notice on HDHPs and Post-COVID Coverage Rules (6/29/23)

Agencies Release FAQs on the End of the COVID-19 Emergencies (4/5/23)

NSA Release: Federal Agencies Release Federal Independent Dispute Resolution Process Checklist (6/6/22)

Agencies Release Additional Guidance on OTC COVID-19 Testing Coverage(2/25/22)

What TPAs Should Know About the COVID-19 Mandate(12/15/21)

New FAQ Addresses Vaccine Coverage, Incentives, and Vaccine-based Exclusions(10/5/21)

CMS Releases Vaccine Set of Toolkits(12/30/20)

EEOC Issues Vaccination Guidance(12/30/20)

EEOC Provides Additional Guidance in FAQs regarding COVID-19 (6/22/20)

EEOC Provides Additional Guidance for Re-Opening Workplaces(6/22/20)

OSHA Provides Guidance on Face Coverings for Re-Opening Workplaces(6/22/20)

CMS Offers Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements in Response to the COVID-19 Outbreak(5/15/20)

OCR COVID - 19 Webinar Available Now(4/29/20)

EEOC Posts Additional FAQs Regarding Testing & Returning to Work. (A Continuation of Previous Article)(4/24/20)

EEOC Posts Additional FAQs Regarding Testing & Returning to Work(4/24/20)

B. COVID-19 SPBA Member Questions with Answers April 21(4/23/20)

EEOC Posts Additional FAQs on COVID-19(4/20/20)

EEOC Posts FAQs Responding to Employer Questions Regarding COVID-19(4/10/20)

EEOC Releases FAQs and Webinar on ADEA and Antidiscrimination Issues on COVID-19 and Pandemic(4/8/20)

Department of Labor Regulations Clarifies FFCRA Benefits(4/3/20)

A. COVID-19 Frequent Questions from SPBA Members(4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill(3/27/20)

Department of Labor Releases FAQ, Guidance on Families First Coronavirus Response Act (3/25/20)

DOL Factsheet: Families First Coronavirus Response Act Employee Paid Leave Rights(3/25/20)

DOL Factsheet: Families First Coronavirus Response Act Employer Paid Leave Requirements(3/25/20)

DOL FAQ on Families First Coronavirus Response Act(3/25/20)

EEOC Response to COVID-19(3/20/20)

Official Source Documents

FAQS ABOUT FAMILIES FIRST CORONAVIRUS RESPONSE ACT, CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT, AND HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT IMPLEMENTATION PART 58 (4/4/23)

COVID-19 Vaccination and Testing; Emergency Temporary Standard (Federal Register)(12/13/21)

Testing Price & Preventive - COVID IFC Reg (Federal Register - Nov 6, 2020)(12/1/20)

OCR: Enforcement Discretion Regarding COVID-19 Commercial Testing Sites(5/18/20)

CMS: Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements(5/15/20)

COVID-19 Timeline Extension Final Rule(4/29/20)

HHS: Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency(4/20/20)

Tri-Agencies Issue Coronavirus FAQs (Link)(4/14/20)

OCR Announces Notification of Enforcement Discretion for Community-Based Testing Sites During the COVID-19 Nationwide Public Health Emergency(4/9/20)

OCR Issues Bulletin on Civil Rights Laws and HIPAA Flexibilities That Apply During the COVID-19 Emergency(4/9/20)

CDC - ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020 (4/7/20)

HHS OCR: Notification of Enforcement Discretion to Allow Uses & Disclosures of PHI relating to COVID-19 by Business Associates (4/7/20)

Treasury Factsheet on Paycheck Protection Program (4/2/20)

IRS FAQs on Tax Credits(4/1/20)

OCR: OCR Announces Notification of Enforcement Discetion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency(3/30/20)

DOL Q&A: Families First Coronavirus Response Act: Questions & Answers(3/30/20)

DOL: U.S. Department of Labor Adds to Guidance for Workers & Employers Explaining Paid Sick Leave & Expanded Family & Medical Leave Benefits Under the Families First Coronavirus Response Act(3/30/20)

HHS: COVID-10-19 and HIPAA Disclosures to Law Enforcement, Paramedics & Other First Responders & Public Health Authorities(3/30/20)

Essential Worker Definition Guidance from US Homeland Security(3/24/20)

Agencies Announce Plan to Implement Paid Leave and Tax Credits (3/21/20)

CMS: Essential Health Benchmark Coverage & COVID-19(3/19/20)

IRS Notice 2020-15: High-deductible health plans can cover coronavirus costs(3/11/20)

Stop Loss

Articles and Materials

2024 SPBA Stop-Loss Application(5/30/23)

Minnesota Stop-Loss(2/1/17)

Self-Funding: Myths vs. Facts(9/2/14)

NAIC White Paper: Stop-Loss & Self-Funding (Attached: White Paper: Stop-Loss Insurance, Self-Funding & ACA) (8/13/14)

Old Deficit Law Triggers Modern Stop-Loss Misunderstanding(5/22/13)

SPBA Talking Points for Letters on Stop-Loss Attachment Points(8/31/12)

California Stop-Loss Legislation Stalled(8/29/12)

Stop-Loss Model Act(8/8/12)

Request for Information on Stop-Loss: SPBA's Comments(6/29/12)

Request for Information on Stop-Loss: SPBA Past President Fred Hunt's Comments(6/29/12)

Request for Information on Stop-Loss: 13 Questions(6/5/12)

Stop-Loss Summit Issues(3/9/11)

Stop-Loss as Plan Asset + Fiduciary Reminder(2/2/09)

Plan Trends that Reduce Costs & Data to Back-Up the Results(11/5/08)

What happens when TPA & Stop-Loss disagree on a claim amount?(11/5/08)

TPA Frustrations with Stop-Loss + Their Insights(5/8/08)

Future of Stop-Loss in a "Markets" Environment(10/12/07)

ERISA Clarification re Stop-Loss Ownership(12/8/06)

ERISA Follows the Plan Money(12/8/06)

Open Letter to SPBA TPAs & Stop-Loss Service Partners(12/8/06)

Questionnaire: Stop Loss Carrier Approval Info Checklist(12/8/06)

Questionnaire: Stop-Loss TPA Questionnaire(12/8/06)

STOP-LOSS Fraud(12/8/06)

Who Owns Stop-Loss Policy(12/8/06)

Disclosure Form Background & Explanation(10/31/06)

Stop Loss Senior Management & Underwriting(9/25/06)

Official Source Documents

Report to Congress: 2018 Annual Report on Self-Insured Group Health Plans(3/20/19)

2017 DOL Annual Report on Self-insured Group Health Plans(3/1/17)

State of Connecticut Stop Loss Insurance Coverage (Bulletin HC-108 & PC-80)(12/30/15)

Maryland 2016 Interim Medical Stop-Loss Report(12/28/15)

White Paper: Stop-Loss Insurance, Self-Funding & ACA(11/17/14)

Guidance on State Regulation of Stop-Loss Insurance(11/6/14)

White Paper: Stop-Loss Insurance, Self-Funding & ACA(8/13/14)

States: Minnesota Stop-Loss Legislation Senate: SF 650(3/19/13)

States: Minnesota Stop-Loss Legislation House: HF 647(3/19/13)

States: Rhode Island Stop-Loss Legislation H54459(3/19/13)

Cafeteria Plans - Explanation and Commentary

Articles and Materials

IRS Issues Memo on FSA Claim Substantiation (5/26/23)

IRS Issues Notices to Relax Cafeteria Plan Election Rules for COVID-19 and Increase Health FSA Carryover(9/28/20)

$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 Changes in the Economic Downturn(7/30/09)

Cafeteria Plans: Identifying Trouble Areas(11/5/08)

New Proposed Cafeteria Plan Regulations(1/23/08)

IRS Issues New Proposed Cafeteria Plan Regulations - John Hickman, Esq. Alston & Bird(10/11/07)

Cafeteria Plan Election Changes(12/8/06)

IRS Comments on Reimbursing Over-the-Counter Drugs(12/8/06)

IRS Notice on Debit Cards and Substantiation in FSAs(12/8/06)

IRS Suspends Requirement to File Schedule F of the 5500 Form for Cafeteria Plans(12/8/06)

Warning!! IRS Seeks to Audit for Debit Card Compliance(11/20/06)

Cafeteria Plans and Other Related Documents - Ashley Gillihan, Alston & Bird, LLP(10/31/06)

Debit Cards(10/24/06)

COVID-19 Resource Center

Articles and Materials

Legislation to End National Emergency Likely Does Not Impact Outbreak Period (4/12/23)

HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health Emergency HIPAA Notifications of Enforcement Discretion (4/11/23)

Essential Health Benefits

Articles and Materials

HHS sends RFI to Update Essential Health Benefits(1/31/23)

HHS Has Released the Essential Health Benefits Bulletin: How Does it Affect Group Health Plans?(12/20/11)

IOM Issues Report on Essential Health Benefits under Health Care Reform(10/31/11)

Announcement of IHB IOM Report(10/7/11)

DOL's Essential Health Benefits Report(6/3/11)

Reprint of February 22nd Email Concerning Comments on Essential Benefits(4/14/11)

Reprint of February 22, 2011 Email: Essential Health Benefits(3/9/11)

Essential Benefits & Task of Crafting Definition(2/22/11)

Essential Health Benefits(1/21/11)

Essential Health Benefits(1/14/11)

Official Source Documents

HHS's Propsed Regulations on Essential Health Benefits: Federal Register(12/20/12)

HHS Releases the Essential Health Benefits Bulletin(12/16/11)

Essential Health Benefits: Balancing Coverage and Cost Report(10/7/11)

Medicaid

Articles and Materials

Caution on Medicaid Information Sharing Requests (1/31/23)

CMS Letter to States(12/29/06)

Congress Requires States to Be More Aggressive in Demanding Plan Eligibility Files for Medicaid Recovery(12/8/06)

Letter to State Medicaid Directors on Medicaid Recovery - Ronnie Brown, Covenant Administrators, Inc.(12/8/06)

Medicaid Recovery Provision in the Deficit Reduction Act of 2005(12/8/06)

State Medicaid Agencies Want TPA Eligibility Files(12/8/06)

State Medicaid Compliance(9/25/06)

Medicaid Recovery Initiatives: Markup of Title 19 - Prepared by Sue Knefley (CMS)(3/8/06)

Official Source Documents

State Medicaid Programs TPL Contact List April 2018 (2/2/23)

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)

Analysis & Articles

Articles and Materials

Administration Plans End Date to COVID-19 Emergency Declarations (1/31/23)

What TPAs Should Know About the COVID-19 Mandate(12/15/21)

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)

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

COVID-19 Vaccine Rollout and Payment(2/2/21)

Tri-Agencies Issue New Group Health Plan Coverage of Covid-19 Vaccines Rules(11/25/20)

CPT Codes for Vaccines Released(11/24/20)

CMS Process to Report Individual Providers Who Fail to Post COVID-19 Test Cash Price(11/24/20)

What Employers Should Know About The COVID-19 Vaccination(10/27/20)

B. COVID-19 SPBA Member Questions with Answers April 21(4/23/20)

Families First Coronavirus Response Act: Paid Leave Chart(4/16/20)

Paycheck Protection Program: A Summary(4/8/20)

A. COVID-19 Frequent Questions from SPBA Members(4/1/20)

SPBA Website COVID-19 Resource Center(4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill(3/27/20)

Coronavirus FAQs for Employers by Alston & Bird(3/20/20)

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)

Health Reform Law

Articles and Materials

Court In ACA Case Imposes ERISA Responsibilities on Plan Sponsor and TPA. (1/30/23)

ACA: Accidental Birth Explains the Law's Illogic Today(5/22/13)

PPACA Time Line Advisory (for Webinar)(5/7/10)

Heath Care Reform: A Perspective Through the Eyes of a Group Health Plan (ppt for webinar)(5/7/10)

Official Source Documents

Keeping the Affordable Care Act Promise (Bill)(11/15/13)

The Second Package of the Health Care Reform Law (statutory language) (pdf format)(4/7/10)

Health Reform Bill Passed by House & Senate (Actual Bill) pdf format(3/22/10)

Medicare Secondary Payer

Articles and Materials

SPBA Sends ESRD Comments to Congressional Leadership (12/1/22)

ESRD Legislation Introduced in House and Senate (9/2/22)

Medicare Secondary Payer Rules and Incentivizing Plan Participants to Join Medicare(1/3/20)

Medicare Secondary Payer Manual: Chapter 2 MSP Provisions(11/21/18)

MSP Mandatory Reporting Penalties(12/1/15)

MSP Reporting and HRAs(6/10/10)

CMS Posts Model Form for Soliciting SSNs(7/22/09)

MSP Mandatory Reporting User Guide, Version 2.0 (Article + User Guide)(1/5/09)

Implementation of Medicare Secondary Payer Mandatory Reporting Provisions(11/5/08)

Older Workers Declining the Group Plan Due to Medicare Coverage(12/14/07)

Official Source Documents

MSP ESRD Introduction by CMS (10/24/24)

GHP User Guide 2020(8/7/20)

Support Act GHP Reporting Requirements: FAQs(1/3/20)

SSN Model Collection Form(3/4/11)

Alert on Obtaining SSNs(3/4/11)

MSP Mandatory Reporting User Guide - Version 3(9/1/10)

PCORI

Articles and Materials

IRS Releases Updated PCORI Fee (11/15/22)

IRS Releases Updated PCORI Fee + Form 720 (March 2022)(1/3/22)

Updated PCORI Released (11/30/20)

Updated PCORI Fee Released(6/8/20)

Spending Bill Reauthorizes PCORI, Repeals Cadillac Tax(1/3/20)

IRS Releases Adjusted PCORTF Fee(11/6/18)

PICORI Fees(6/29/18)

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)

Insights on PCORI from Webinar (March 2013)(5/13/13)

Official Source Documents

IRS Notice 2018-85: PCORI Fee(11/6/18)

PCORI Fee IRS Notice 2017-61(10/20/17)

IRS Webpage on Filing Due Dates & Applicable Rates (Link)(5/4/17)

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)

Nondiscrimination - HIPAA/GINA

Articles and Materials

Self-Inflicted Injury Clauses in Health Plans(9/10/22)

Nondiscriminatory Wellness Programs in Group Health Coverage(12/18/19)

Genetic Nondiscrimination Act(6/6/08)

Beware of Designing Wellness Programs with Penalties Rather than Incentives(5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule(5/21/07)

Plan Incentives for Healthy Behavior(5/11/07)

Rewards and Penalties for Disease Management Participation(5/11/07)

Article on HIPAA Nondiscrimination Final Rules(1/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan?(12/8/06)

Reducing Benefits for Active Workers(10/26/05)

Official Source Documents

September 2009 GINA Regs(10/2/09)

Federal Register Notice on the Genetic Information Nondiscrimination Act(11/17/08)

Final Rules on HIPAA Nondiscrimination & Wellness Programs(1/11/07)

Americans with Disabilities Act

Articles and Materials

Court Holds ADA Covers Gender Dysphoria (9/7/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

EEOC Expands ADA's Definition of "Disability"(8/15/19)

Judge Dismisses Challenge to Wellness Program(8/15/19)

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)

Pregnancy Discrimination: EEOC Delivers New Guidance on Pregnancy Discrimination under ADA Duties (article)(7/31/14)

Official Source Documents

Pregnancy Discrimination: Press Release: EEOC Issues Updated Enforcement Guidance on Pregnancy & Related Issues (Link)(8/4/14)

Pregnancy Discrimination: Enforcement Guidance: Pregnancy Discrimination & Related Issues (Link)(8/4/14)

Pregnancy Discrimination: Q & As about the EEOC's Enforcement Guidance on Pregnancy Discrimination & Related Issues (Link)(8/4/14)

HHS

Articles and Materials

Health and Human Services Re-Issue Section 1557 Non- Discrimination Regulations (9/7/22)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Official Source Documents

Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance(8/17/23)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

EDI/HIPAA Administrative Simplification

Articles and Materials

Administrative Simplification HIPAA Regulations Fact Sheet (7/7/22)

Administrative Simplification Reassociation Basics Fact Sheet (7/7/22)

OCR Updated the Health Data Breach Reporting Tool(12/13/21)

HHS Audit + HIPAA Administration Simplification Audit - Criteria(12/17/20)

ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)

HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers(1/27/12)

Final Rules on EDI Transactions/Code Sets are Released (August 2000)(10/4/11)

National Provider Identifier Numbers Available(6/28/07)

HHS Provides Feedback on NPI(12/8/06)

TPA Websites for Providers and EDI(12/8/06)

CMS Alerts Regional Offices to Digital Healthcare(9/8/06)

Official Source Documents

HIPAA Administrative Simplification Regulations Overview (7/7/22)

EFT and ERA: Payment Remittance Reassociation Basics (7/7/22)

Administrative Simplification Compliance Resources(6/29/18)

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities(7/29/15)

CMS-AMA ICD-10 Flexibilities Statement(7/29/15)

ICD-10 - Testing with CMS(7/29/15)

Federal Register: Updated Version of HIPAA Transactions Adopted(1/26/09)

National Provider Identifier Dissemination System(6/4/07)

CMS Announces Contingency Plan on NPI(4/27/07)

Federal Register 2004 Final Rule on National Provider Identifier(12/8/06)

Federal Register 2005 Proposed Rules HIPAA Standards for Electronic Health Care Claims Attachments(12/8/06)

Abortion

Articles and Materials

HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe (7/6/22)

Supreme Court Decision on Abortion (7/5/22)

Official Source Documents

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet (7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

Nondiscrimination - HHS

Articles and Materials

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

HHS Proposes Revisions ACA Section 1557 Rule: Article + Regs + Fact Sheet(6/6/19)

District Court Injunction on ACA Section 1557(1/5/17)

Transgender Benefits and Application to Employer Plans(6/29/16)

HHS Non-Discrimination Regulations(6/1/16)

Official Source Documents

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

Franciscan-Alliance v. Burwell(1/5/17)

Civil Rights: HHS FAQs: Section 1557 of ACA(6/29/16)

Nondiscrimination in Health Programs & Activities Proposed Rule: News Release + Fact Sheet + FAQs(9/9/15)

ERISA, Fiduciary Issues, and Types of Plans

Articles and Materials

MHP and FMLA (7/5/22)

Plan Limitations and ERISA (7/5/22)

Grandfathered Plans

Articles and Materials

What Happens When Grandfathered Status is Lost(6/5/22)

DOL Clarifies Contribution Rate Changes to Grandfather Rule (6/5/22)

Final Rule on Grandfathered Health Plans Amends Some Cost Sharing Requirements(12/30/20)

DOL Clarifies Contribution Rate Changes to the Grandfather Rule(9/27/11)

Amendment to Grandfather Rules & Waiver Limits(11/16/10)

Expendable Grandfather(8/17/10)

Agency Grandfather Table(8/2/10)

Grandfathered Interim Final Rules- A Detailed Look(7/12/10)

Grandfathered Interim Final Rules - First Look(6/15/10)

What is the Benefit of Being a Grandfathered Plan?(6/14/10)

Official Source Documents

Grandfathered Group Health Plans & Grandfathered Group Health Insurance Coverage(2/26/19)

Amendment to the Grandfather Interim Rule (pdf)(12/8/10)

Grandfathered Plans Interim Final Rules(6/14/10)

Air Ambulance

Articles and Materials

Air Ambulance and Patient Billing Advisory Committee Report #1(7/15/21)

Air Ambulance Letter to Senate(8/8/18)

Congressional Activity

Articles and Materials

Public Health Emergency Extension Expected in July(7/15/21)

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

A. COVID-19 Frequent Questions from SPBA Members(4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill(3/27/20)

Update on Congressional COVID-19 Response(3/19/20)

House Passes Additional COVID-19 Response Bill(3/16/20)

Official Source Documents

Premium Assistance for COBRA Benefits (Notice 2021-31)(5/19/21)

HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act(4/1/20)

HR 6201 - Families First Coronavirus Response Act(3/23/20)

COBRA

Articles and Materials

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

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)

IRS Posts Reminder and Form for Reporting on COBRA Subsidy Recipients(8/16/19)

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)

Refresher on Medicare as a Second Qualifying Event and COBRA(8/16/19)

FAQ 32 COBRA(8/15/19)

FAQ 32 COBRA(6/29/16)

Gillihan's COBRA Presentation(11/3/05)

Final COBRA Regulations & Other COBRA Guidance - Ashley Gillihan. Esq. Alston & Bird LLP(10/21/04)

Summary of Changes from 2003 Proposed COBRA Regulations - Hickman & Gillihan, Alston & Bird LLP(10/21/04)

Official Source Documents

Premium Assistance for COBRA Benefits (Notice 2021-31)(5/19/21)

FAQs About the ACA Implementation Part 32: COBRA & Health Insurance Marketplace(8/15/19)

1999 and 2001 Final COBRA Regs(8/16/09)

Wellness

Articles and Materials

EEOC Proposes New Wellness Regulations (2/2/21)

Judge Dismisses Challenge to Wellness Program(8/15/19)

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)

Incentives in Employer Wellness Programs for Employees' Spouses to Provide their Current or Past Health Status Information(12/1/15)

SPBA Comments to EEOC on Proposed Wellness Rule(6/19/15)

EEOC Wellness Proposed Rule Article(4/28/15)

EEOC Fails to Resolve Wellness Issues in Final GINA Title II (12-21-10)(12/21/10)

Wellness - Developing as a Strategy(11/16/09)

EEOC Informal Letter on Health Risk Assessments(6/26/09)

Family Medical History Questions Problematic in Wellness Programs(5/20/09)

TPA Success in Wellness(11/5/08)

NCQA Releases Proposed Standards to Evaluate Health Promotion Programs(7/8/08)

Wellness Education Program(10/22/07)

Characteristics of Successful, Low Cost Wellness Programs(10/11/07)

Journal: Characteristics of Successful Wellness Programs(10/11/07)

Wellness Wizard - Determine Your Employee Health Risks, Costs, and Savings(10/11/07)

Beware of Designing Wellness Programs with Penalties Rather than Incentives(5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule(5/21/07)

Plan Incentives for Healthy Behavior(5/11/07)

Rewards and Penalties for Disease Management Participation(5/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan?(12/8/06)

Non-Plan Incentives for Healthy Behavior (Part 2), Howard Bard, Slevin & Hart, P.C. (ppt)(5/3/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule(5/3/06)

Official Source Documents

Sample Notice for Employer-Sponsored Wellness Programs(7/22/16)

Q&As: Sample Notice for Employees Regarding Employer Wellness Programs(7/22/16)

Wellness Final Rules under ADA Title I - Federal Register(7/22/16)

HIPAA 2015 Privacy & Security Wellness Q&A(4/28/15)

EEOC Fact Sheet 2015 - Wellness Fact Sheet for Small Business(4/28/15)

Press Release 2015: EEOC Wellness Proposed Rule(4/28/15)

Federal Register: 2015 EEOC Wellness Proposed Rule(4/28/15)

Q&As on EEOC's Notice of Proposed Rulemaking on Employer Wellness Programs(4/18/15)

HIPAA Nondiscriminatory Wellness Programs: Final Regulation(5/30/13)

Webinar

Webinar: An Overview of Wellness Rules Governing Health Plans (10/2/23)

Marketing TPA Services + PR

Articles and Materials

Why Use a TPA?(10/13/20)

Choosing & Evaluating TPA Services(6/25/19)

Self-Funding Success Website: Use Self-Funding 101 Content in your Content(11/15/16)

Self-Funding Success Website: Adding Links to Your Site(11/15/16)

Self-Funding Success Website: Develop Your Testimonials into Success Stories(11/15/16)

Self-Funding Success Website: Posting Success Stories on Your Social Channels(11/15/16)

Self-Funding Success Website: Your "Actual Success" Articles Requested(11/15/16)

What Brokers Should Seek in A TPA(2/13/12)

What Happens When an Employer Makes the Switch to Self-Funding(2/2/12)

An Open Letter to Cost-conscious Clients of SPBA Member TPAs(11/3/09)

Hints on Marketing to TPAs(11/3/09)

"Stung" or Risk Averse?(10/20/09)

A Handy Way to Remember Who is "Administrator" & "Fiduciary"(10/20/09)

An Open Letter to Clients and Potential Clients of SPBA Members(10/20/09)

Canada Issues: Admin Costs: US vs Canada(10/20/09)

Congratulations & Press Tips(10/20/09)

Letter to Editor - "Business Insurance" - Value of TPAs(10/20/09)

Luring Your Clients Away(10/20/09)

Outsourcing & Offshore Considerations(10/20/09)

Performance Standards, Guarantees, Penalties & Bonuses(10/20/09)

Responses to Anti TPA Propaganda(10/20/09)

Rewards for TPAs in Government Complicance(10/20/09)

The greatest challenge for employee benefits: Government Compliance(10/20/09)

TPA Cost Value(10/20/09)

Your TPA Firm as a Leading "Good Guy"(10/20/09)

IRS Retirement Plan News(10/1/09)

What We Tell Vendors and Researchers About You(12/8/06)

Misperceptions About "Extra Security" When an Insurer is Contract Administrator Versus an Independent TPA Firm(7/10/95)

Size and Role of TPA Market + Stop Loss

Articles and Materials

Numbers: Describing the Number of TPAs & Distortions in Counting(10/12/20)

Everything You Wanted to Know About TPAs But Were Afraid to Ask(6/25/19)

Testimony Given by SPBA Board Chair at the DOL Advisory Council(8/25/14)

Goofy Views On Benefits, ERISA, Fiduciary, TPAs & ASO(1/23/12)

"Biggest" and "Independent" TPAs(11/8/11)

Frequently Asked Questions About TPAs(7/26/11)

What's Allowable Error Rate?(12/8/06)

What's the Regulatory Status of Government & Religious Plans?(12/8/06)

Cautions

Articles and Materials

Read All Your Contracts(10/12/20)

Funding: Action Steps When a Client Stops Funding Claims(4/18/18)

Percents, rebates & any unusual payment arrangements: ERISA concerns(8/26/16)

States Taxing TPAs?: Talking Points & Strategy(7/27/11)

Overpayment Refunds from Providers (for your eyes only)(4/25/11)

More & Broader Privacy Expected(12/21/10)

Welfare Benefit Plan Subject to Suit Based on Assignment(10/1/09)

Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims(4/1/09)

Passing Info from TPA to TPA during Client Change: Some Considerations(4/1/09)

Caution to TPAs Related to Medical Entities or other outside owners(2/2/09)

Double Warning on Independent Contractor Employment Status(2/2/09)

Bank Failures and Dumping TPAs(11/7/08)

When You Overpay a Provider(11/5/08)

Hints When the TPA is Being Sued or Attacked(9/11/08)

Disaster Thinking & Planning Strategies for Your Firm(1/28/08)

Avoiding the Big-Buck Costs & Liabilities(12/8/06)

Beware "Too Easy" Options In Benefit Administration(12/8/06)

Bill Collector Woes: PPO, Providers and Old Higher Charges - Still at it.(12/8/06)

Canada Issues: Importing Drugs - Canada Drug Warning (again) (Nov 2003)(12/8/06)

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)

Why 99% of Plans Should Have a Formal Trust(12/8/06)

Bill Collectors: More "Bill Collector" Tactics & Defense(1/24/06)

Collection Agency Harassment for Medical Bills(11/8/02)

Bill Collectors: Under State and Federal Law(11/8/02)

Why VEBA Tax-exemption is Obsolete These Days(9/1/96)

State Guidance

Articles and Materials

Worker's Comp: Workers Comp for Essential Employees(4/29/20)

Worker's Comp: State Worker's Compensation Issues May Impact Claims Processing(4/23/20)

Worker's Comp: State by State Worker's Compensation Bulletins & Orders - April 2020(4/23/20)

NAIC Database Features State COVID-19 Actions(4/17/20)

States May Become the Nexus of COVID-19 Action(4/17/20)

State Responses to COVID-19(4/7/20)

Official Source Documents

Illinois: Worker's Comp Commission: Notice of Emergency Amendments(5/4/20)

South Dakota: COVID-19 & Health Benefit Plans(4/6/20)

Nevada: Emergency Regulation Concerning COVID-19 & Insurance(4/6/20)

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)

Peurto Rico: Extension of Term of Insurance Contracts & Policies(4/6/20)

Ohio: Access to Coverage for Ohioans Impaced by COVID-19 + FAQs(4/6/20)

Rhode Island: Bulletin 2020-4: Flexibility in Insurance during COVID-19 Emergency(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)

Texas: Coverage for COVID-19 Testing & Network Adequacy(4/6/20)

Virginia: Payment Extensions of COVID-19 Deadlines(4/6/20)

Virginia: Flexibility & Consideration in Determining Due Dates & Cancellations(4/6/20)

Wyoming: WY Licensing Updates Ralated to COVID-19(4/6/20)

Wyoming: Bulletin 20-01: Requirements for Cost-Sharing & Coverage Related to Respiratory Illnesses including COVID-19(4/6/20)

Oklahoma: Imediate Measures Related to Impact of COVID-19(4/3/20)

Oklahoma: Bulletin No 2020-1 - Immediate Measures Relating to COVID-19(4/2/20)

Maine: Supplemental Order Regarding Remote Delivery of Health Services(4/2/20)

Kansas: Insurance Carriers to Cover COVID-19 Testing(4/2/20)

Colorado: Establishing a COVID-19 Special Enrollment Period(4/2/20)

Minnesota: Memo to Health Insurance Carriers Related to Coronavirus(4/2/20)

Illinois: Expand Telehealth Services & Protect Health Care Providers(4/2/20)

Michigan: State of Emergency Executive Order 2020-21(4/2/20)

Mississippi: Insurance Coverage Regarding the Use of Telemedicine (4/2/20)

Mississippi: Moratorium on Policy Cancellations/Non-Renewals + Q&As(4/2/20)

District of Columbia: Response to COVID-19 Public Health Emergency(4/2/20)

District of Columbia: FAQs on Insurance Issues Related to COVID-19(4/2/20)

Connecticut: 60-Day Grace Period for Insurance Premium Payments Due to Disruption Caused by COVID-19(4/2/20)

California: 60-Day Grace Period for Insurance Premium Payments(4/2/20)

Alabama: Cancellation or Non-Renewal Recommendation due to COVID-19 Pandemic(4/2/20)

Arizona: Expansion of Telemedicine + Expansion of Telemedicine Memo(4/2/20)

Missouri: Assistance to Policyholders Impacted by COVID-19(4/1/20)

Rhode Island: COVID-19 Health Benefit Changes Consumer FAQs(4/1/20)

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)

Pennsylvania: Notice Regarding COVID-19 Insurance Coverage(4/1/20)

Louisiana: Declaration of Emergency(4/1/20)

Wisconsin: COVID-19 Coverage Request(4/1/20)

Iowa: Proclamation of Disaster Emergency (3-22-2020)(4/1/20)

Iowa: Proclamation of Disaster Emergency (3-17-2020)(4/1/20)

Utah: Coverage for COVID-19(4/1/20)

Utah: Premium Holiday for Employers that have Closed Due to the Coronavirus but Continue to Pay Employees(4/1/20)

Utah: Guidance for Business Interruption Claims Related to COVID-19 or the March 18 Earthquake(4/1/20)

Tennessee: COVIDS-19 Guidance to Carriers(4/1/20)

West Virginia: COVID-19 Regulatory Guidance(4/1/20)

Texas: COVID-19 Bulletin for Claim-handling Deadlines & Premium Payments(4/1/20)

Iowa: Proclamation of Disaster Emergency (3-19-2020)(4/1/20)

Washington: Emergency Order in Response to COVID-19 Outbreak in Washington State(4/1/20)

Washington: Clarifiying & Expanding of the Requiremnts of Emergency Order 20-01, Ordering Increased Flexibility regarding the Use of Telemedicine & Providing a Minimum 60-Day Grace Period for Payment of Premiums(4/1/20)

Washington: Telemedicine(4/1/20)

Hawaii: Request Regarding Policyholders Affected by COVID-19(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)

Delaware: Additional Guidance Relating to COVID-19(4/1/20)

Florida: Guidance for Business Continuity & Continuity of Operation Plans(4/1/20)

North Dakota: Coverage for COVID-19 Testing(4/1/20)

North Dakota: Assistance for Consumers, Claimants & Covered Persons Impacted by COVID-19(4/1/20)

North Dakota: Expansion of Telehealth Services(4/1/20)

North Dakota: Electronic Reporting & Deadline Extentions(4/1/20)

Missouri: Executive Order(4/1/20)

Maryland: Proclamation of State of Emergency & Catastrophic Health Emergency(4/1/20)

New York: Continuing Temporary Suspensiopn & Modification of Laws Relating to the Disaster Emergency(4/1/20)

Alaska: Requirements for Group Health Plans, Claims, & Telehealth Related to the COVID-19 Public Health Emergency(4/1/20)

Alaska: Fair Treatment of Consumers During State of Emergency Due to COVID-19(4/1/20)

Alaska: Temporary Suspension of Certain Utilization Review & Notification Requirements(4/1/20)

Alaska: Premium Relief Due to COVID-19(4/1/20)

Alaska: Requirements for Cost Sharing & Coverage Related to Respiratory Illnesses Including COVID-19(4/1/20)

Alaska: Changes to Coverage for Telehealth(4/1/20)

Arkansas: State COVID-19 Health Emergency(3/31/20)

Arkansas: Cancellation Moratorium for Employment Disruption(3/31/20)

Georgia: Georgia Directive: Temporary Suspension of Certain Utilization Review & Notification Requirements(3/31/20)

Georgia: Georgia Bulletin: Lost of Health Insurance Due to COVID-19(3/31/20)

Indiana: Indiana COVID-19 Bulletin(3/30/20)

Louisiana: Louisana Emergency Rule(3/30/20)

Kentucky: Kentucky Department of Insurance COVID-19 Executive Order(3/30/20)

Ohio: Ohio Bulletin on Out-of-Network Coverage(3/26/20)

Ohio: Ohio Bulletin on Stop Loss and Non-federal Government Plans(3/26/20)

New York: New York to Require Insurers to Waive Covid-19 Test Cost-Sharing(3/3/20)

Stop-Loss

Articles and Materials

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)

FMLA (Family Medical Leave Act)

Articles and Materials

FMLA Regs(1/29/20)

FMLA Proposed Regulation for Same Sex Marriage(2/25/15)

Wage and Hour Division (WHD) Family and Medical Leave Act(4/18/12)

FMLA Case Referral(12/21/10)

Official Source Documents

Definition of Spouse under the Family & Medical Leave Act: Fact Sheet(2/23/15)

Definition of Spouse under the Family & Medical Leave Act: FAQs(2/23/15)

Definition of Spouse under the Family & Medical Leave Act: Final Rule(2/23/15)

Cadillac Tax

Articles and Materials

Spending Bill Reauthorizes PCORI, Repeals Cadillac Tax(1/3/20)

Cadillac Tax Delay(1/29/18)

Cadillac Tax Delayed Until 2020(5/17/17)

Excise Tax Comments from SPBA(5/21/15)

Excise Tax (Slides from Webinar: Latest Developments & Looking Ahead)(3/13/13)

Official Source Documents

IRS Second Notice (2015-52) on Excise Tax on High Cost Plans(7/31/15)

Statute of Excise Tax on High Cost Employer Sponsored Health Coverage(5/8/15)

Congressional Report on Explanation of Cadillac Tax(5/8/15)

IRS Notice on Excise Tax on High Cost Coverage(2/24/15)

States

Articles and Materials

Alabama: Notice of Regulation Hearing on PBMs(10/10/19)

California Standing Strong to Fight Surprise Billing(9/11/19)

Nevada: Revised Statutes - Third Party Parental Guaranty & Notification Requirement(10/25/17)

Arkansas: TPA License Survey 2017 Corrections(10/24/17)

Nevada: Revised Statutes(10/24/17)

Minnesota Stop-Loss(2/1/17)

Texas Prompt-Pay Law(2/29/16)

Washington State TPA Legislation Update + Original Article from January's UPDATE(2/17/16)

Washington State TPA Legislation + Link to Bill(1/29/16)

Michigan: Determining Which Entity Must Pay(5/1/12)

Georgia - OCGA § 33-30-13.1(11/5/08)

Indiana & Maine(11/5/08)

Iowa - 509.19 Claims & Premium Disclosure(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)

State Survey of Insurer Claims Data: Florida - 2007 Florida Statutes(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)

New Transparency Legislation in Texas for Health Care Plans(10/11/07)

State Health Care Reform(10/11/07)

Texas Loss Experience Legislation(10/11/07)

The 2007 Texas Legislative Session - Sam Francis, JI Companies(10/11/07)

Additional Questions on the NYHCRA(12/8/06)

Mississippi Starting Surcharge Applies to Insurers, Stop-loss + some TPA situations(12/8/06)

New State Surcharge Nicks Employer Health Plans(12/8/06)

New York Surcharge Impacts Employers(12/8/06)

NJ Law Turns Lemons to Lemonade(12/8/06)

Questions and Answers about the New York Health Care Act(12/8/06)

State TPAs: Together you stand. Divided you fall.(12/8/06)

Strategies on Massachusetts(12/8/06)

Third Party Administrator Statute(12/8/06)

Massachusetts Health Care Reform - James Stirling, Stirling Benefits(9/25/06)

State Legislatures Hurt Insurance Companies & Policyholders(11/2/02)

Frequently Asked Questions on the New York State's Health Care Reform Act(11/22/96)

Official Source Documents

Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions(11/5/18)

North Carolina: North Carolina General Assembly Conference Report (House Bill 649)(8/1/13)

Connecticut: Childhood Immunization Vaccine Assessment(8/1/13)

North Carolina General Assembly Conference Report(7/29/13)

Defense of Marriage Act (DOMA)

Articles and Materials

Supreme Court Decides DOMA(8/17/19)

What is DOMA? and Why Is It Under Challenge(8/17/19)

DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans(8/16/19)

Treasury Clarifies Federal Government Position on DOMA(8/16/19)

FMLA Proposed Regulation for Same Sex Marriage(2/25/15)

Health Reform: SCOTUS DOMA = Confusion for Plans & TPAS(7/8/13)

Official Source Documents

U.S. v. Windsor: Marketplace Guidance on Internal Revenue Ruling 2013-17(10/4/13)

U.S. v. Windsor: A CMS Update(10/4/13)

Guidance to Employee Benefit Plans on the Definition of "Spouse" and "Marriage" under ERISA & The Supreme Court Decision(9/23/13)

H. Guidance to Employee Benefit Plans on the Definition of "Spouse" & "Marriage" under ERISA & the Supreme Court Decision(9/18/13)

Treasury Revenue Ruling 2013-17 + Treasury Answers on Same Sex Marriages + Treasury Revenue Ruling 2013-19 , DOMA + Treasury Press Release - DOMA(9/3/13)

U.S. v. Windsor: DOMA Opinion(6/26/13)

U.S. v. Windsor(11/1/12)

COBRA-ARRA

Articles and Materials

COBRA Model Notices(8/16/19)

DOL Posts Application for Review of Denial of COBRA Premium Reduction(8/16/19)

Fate of COBRA Subsidy and Health Reform PR(6/7/10)

COBRA Subsidy Extension(2/24/10)

COBRA Subsidy Extension Signed into Law(12/28/09)

Frequent ARRA COBRA Subsidy Questions(7/30/09)

Draft COBRA Subsidy Applications for Expedited Review of Denials(5/8/09)

No COBRA Premium Assistance Information Return Required(5/1/09)

COBRA Expanded for TAA Individuals(4/27/09)

ARRA COBRA Subsidy Issues Discussed at SPBA Spring Meeting(4/16/09)

ARRA COBRA Subsidy: Phase II(4/16/09)

ARRA Second Chance Election(4/9/09)

DOL Releases Clarifying Illustrations of which Model Notices to Send(4/3/09)

IRS Releases Guidance on Involuntary Termination in ARRA(4/2/09)

How Multi-Employer Plans Collect COBRA 65% Subsidy(4/1/09)

Which COBRA Subsidy Model Notice Should Be Sent?(3/30/09)

Top Issue on COBRA Subsidy Model Notices Today(3/20/09)

IRS Releases Information on Reducing Payroll Deposits for the COBRA Subsidy(3/12/09)

DOL Releases Some Guidance on the COBRA Subsidy(2/27/09)

COBRA Premium Update(2/23/09)

Official Source Documents

CMS COBRA Denial Application(5/8/09)

DOL COBRA Denial Application(5/8/09)

Medicare

Articles and Materials

Refresher on Medicare as a Second Qualifying Event and COBRA(8/16/19)

Medicare Part D - Health Reform's Impact on Medicare Part D(4/27/10)

Designing Plans for Older Workers(5/23/08)

Data Elements under Consideration for the New Medicare Eligibility Sharing Rule(1/28/08)

Clarification: Additional Information on How to find an Actuary(12/8/06)

Client Handout: Quick Overview of Employer Notice Requirements(12/8/06)

CMS Clarifies Notification Deadlines(12/8/06)

CMS Clarifies Payment in HRAs(12/8/06)

Medicare - Calculating the Late Enrollment Penalty(12/8/06)

Medicare Part D Coverage Questions Persist(12/8/06)

Medicare Part D Questions Abound on Plan Design(12/8/06)

Medicare Regulations Clarify Medicare Part D Subsidy(12/8/06)

Medicare Wrap Arounds(12/8/06)

New Release About Medicare Prescriptions(12/8/06)

Retiree Drug Subsidy Applications: Important Reminders(12/8/06)

Medicare Part D - Employers, Unions and the MMA: Lessons Learned & Important Updates(9/25/06)

Medicare Part D Plan Sponsor Notice Deadlines(9/1/05)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

Medicare Part D: Updated guidance on Disclosure of Creditable Coverage(11/5/09)

CHIPRA

Articles and Materials

Employer CHIP Notices(8/15/19)

CHIPRA Notice Requirements(4/27/09)

Official Source Documents

CHIP DOL Release(8/15/19)

CHIP Model Notice Regs (Federal Register)(8/15/19)

Explanation of CHIP Model Notice (Federal Register 2-4-10)(2/4/10)

Model CHIP Notice(2/4/10)

Access/Protection

Articles and Materials

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)

Purchaser Guide for Employers on Value-Driven Health Care(2/8/07)

Medicare for All

Articles and Materials

The Costs of a National Single-Payer Healthcare System(8/2/19)

Health Reimbursement Arrangements

Articles and Materials

Administration Finalizes New HRA Rule(6/14/19)

CMS Clarifies Payment in HRAs(12/8/06)

Historical Reminders about Patient-Directed Healthcare (PDHC) and Health Reimbursement Accounts (HRAs)(12/8/06)

Ken Harvey's Perspective on Consumer-Driven Health Plans(1/12/06)

Historical Practical Points about Patient-Directed & HRA In Your Market(10/31/02)

The Big Picture of Patient-Directed Health Care(9/1/02)

Historical Prognosis on Patient-Directed Health Care(7/1/02)

Official Source Documents

Individual Coverage HRA and Excepted Benefit HRA FAQs(1/9/20)

Final Regulations on HRAs and Account-Based Group Health Plans (6/20/19)

IRS Guidance on Small Employer HRAs (IRS Notice 2017-67)(11/2/17)

HRA - IRS Notice 2002-45(12/8/06)

HRA - IRS Revenue Ruling 2002-41(12/8/06)

Portability - HIPAA

Articles and Materials

Special Enrollment Question and DOL Response(1/30/19)

Dependents Losing Coverage and HIPAA Special Enrollment Periods(3/23/07)

Lifetime Maximums and HIPAA Special Enrollment Periods(12/8/06)

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)

Self-Compliance Tool for Part 7 of ERISA: HIPAA and Other Health Care-Related Provisions(3/26/13)

Model HIPAA Exemption Election for Non-Federal Governmental Plans(5/4/07)

Federal Register 2002: Non-Federal Governmental Opt-Out Requirements(12/8/06)

Federal Register 2004: Propsed Rules on Tolling Time Periods(12/8/06)

Reference-Based Pricing

Articles and Materials

How Montana cut healthcare costs with reference-based pricing (1/3/19)

Webinar

Webinar: Reference-Based Pricing(1/3/19)

FSAs

Articles and Materials

IRS Releases 2019 FSA Inflation Adjustment(11/15/18)

Comment Letter on the $2,500 Limit on Health FSAs(7/17/12)

Official Source Documents

Section 125 - Cafeteria Plans (Notice 2012-40)(5/31/12)

Specific Issues

Articles and Materials

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)

Employee Benefit Tax Treatment Letter to Senate(6/12/17)

Health Reform Insights (February 8, 2011)(2/8/11)

Far More Happening Than Health Reform(9/29/09)

Unspoken Secrets of Health Reform(2/2/09)

TPA Cost Value(11/2/07)

Reasons for the cost of US Healthcare(6/4/07)

Collection Agency Harassment for Medical Bills(11/8/02)

Operations + Ownership Tips

Articles and Materials

SSAE 16: Survival Guide (ppt from Fall 2011 Meeting)(3/1/18)

SPBA Non-Discrimination and Anti-Harassment Policy(9/17/14)

Your Spokesperson Responding to Emergencies: How to Strategy(10/18/11)

Frequently Asked Questions about TPAs(3/21/11)

Handling Prescriptions for Non-Prescriptions Progress Report(12/21/10)

Successful Mergers & Acquisitions(11/16/09)

Buy/Sell: Most Frequent Questions about Buying TPAs(11/3/09)

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)

Buy/Sell: What's the Price Range to Buy or Sell a TPA?(12/8/06)

Expense & Operational Benchmarks of Well-Run TPAs(12/8/06)

No TPA Operating Ratios Or Staffing Standards(12/8/06)

TPA Operating Ratios $$$$$: A primer for TPAs and those asking them for this data(12/8/06)

What are the impacts of mergers & buy-outs on TPA operations?(12/8/06)

What are the Roles, Advantages, and Disadvantages of TPAs in Managing Pension Payments?(12/8/06)

Official Source Documents

AICPA Advisory on Outsourced Plan Functions(9/7/07)

Education & Outreach

Articles and Materials

Forecasting Gov't & Politics: Divisiveness + Possible Solutions(1/25/18)

Educating Your Members of Congress(6/6/17)

ACA Repeal & Replace Talking Points(1/17/17)

Self-Funding: Myths vs. Facts(9/2/14)

Health Reform: Today's (June 14, 2013) Insights +PR Tips(6/14/13)

Cures Act

Articles and Materials

New IRS & Treasury FAQs On QSEHRAs(11/28/17)

Official Source Documents

Qualified Small Employer Health Reimbursement Arrangements(11/15/17)

TPA Forecasts and Reports

Articles and Materials

State of the TPA Industry & Forecast for 2018(9/20/17)

Answers to the Most Frequent Questions re: TPAs & Their Marketplace(6/8/17)

State of the TPA Industry & Forecast for 2017(1/9/17)

State of the TPA Industry & Market – June 2016(5/24/16)

State of the TPA Industry + Forecast for 2016(11/3/15)

State of the TPA Industry + Forecast for 2015(10/27/14)

State of the TPA Industry + Forecast for 2013(1/8/13)

State of the TPA Industry + Forecast for 2012(12/21/11)

Year-End 2011 Status Report & Forecast on PPACA(12/12/11)

What's the Future for Insurers?(7/27/11)

Boom time for TPAs is Starting(7/12/11)

State of the TPA Industry + Forecast for 2011(11/9/10)

State of the TPA Industry & Forecast as of May 2010(5/20/10)

State of the TPA Industry + Forecast for 2010(1/19/10)

Mid-2005 TPA Industry Report(11/3/09)

State of the TPA Industry + Forecast for 2009(1/1/09)

Mid- 2008 Forecast for 2009 Health Reform(8/28/08)

Employee Benefits Policies of 7 Presidents: A Historical Perspective(1/29/08)

No National Health Insurance, but Take Advantage of the Opportunities(12/17/07)

State of the TPA Industry + Forecast for 2008(11/2/07)

Planning Your Firm'$ Future(12/8/06)

State of the TPA Industry + Forecast As of December 2000(12/8/06)

What's the Size, Role & Future of TPAs' Marketplace?(12/8/06)

State of the TPA Industry + Forecast for 2007(11/20/06)

State of the TPA Industry + Forecast for 2006(11/30/05)

Pollyanna Predictions?(7/14/05)

TPA Competition Rollercoaster - Ongoing(12/14/04)

State of the TPA Industry + Forecast for 2005(12/1/04)

State of the TPA Industry + Forecast for 2004(12/1/03)

State of the TPA Industry + Forecast for 2003(1/1/03)

State of the TPA Industry + Forecast as of December 2001(12/1/01)

State of the TPA Industry & Forecast as of November 1999(11/30/99)

How to Shape Legislative Proposals & Govt. Policy

Articles and Materials

How to Influence Your Members of Congress Roadmap(8/21/17)

Key Health Policy Committee Members (8/7/17)

General Strategies

Articles and Materials

Roadmap on How to Influence Your Members of Congress (8/11/17)

Educating Your Members of Congress(6/6/17)

Communicating With Your Elected Officials(7/29/13)

The Top Ten Things Congressional Staffers Hate to Hear(10/6/09)

Health Reform Legislative Process(6/18/09)

You Can Start Shaping Public & Political Opinion Today!(11/2/07)

How to Contact Your Member of Congress(10/11/07)

A Guide to Understanding and Influencing Government Policy(5/30/07)

National Provider Identifier Database Notice(5/30/07)

Action Needed Now: Shape Government Policy(5/7/07)

Schedule J

Articles and Materials

DOL Annual Report to Congress on Self-funded Health Plans(4/27/17)

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)

Official Source Documents

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries(2/10/21)

2017 DOL Annual Report on Self-insured Group Health Plans(3/1/17)

Stop-Loss

Articles and Materials

Minnesota Stop-Loss(2/1/17)

NAIC White Paper: Stop-Loss & Self-Funding (Attached: White Paper: Stop-Loss Insurance, Self-Funding & ACA) (8/13/14)

SPBA Talking Points for Letters on Stop-Loss Attachment Points(8/31/12)

Answers to Request for Information about Stop-Loss(5/2/12)

Official Source Documents

State of Connecticut Stop Loss Insurance Coverage (Bulletin HC-108 & PC-80)(12/30/15)

White Paper: Stop-Loss Insurance, Self-Funding & ACA(8/13/14)

Transgender

Articles and Materials

District Court Injunction on ACA Section 1557(1/5/17)

Fiduciary Issues

Articles and Materials

2016 Year in Review (12/29/16)

Percents, rebates & any unusual payment arrangements: ERISA concerns(8/26/16)

An Easy Informal Self-test of Fiduciary Status (5/17/16)

DOL ERISA Fiduciary Explanation (Handout/Spring 2016)(5/16/16)

DOL ERISA Investigation Hints (Handout/Spring 2016)(5/16/16)

What's Payable by ERISA Plan Assets?(8/1/15)

ERISA & Fiduciary explanation for the Medical Community(4/1/15)

ERISA Fiduciary HIghlights + a Flurry of Scary Issues(1/24/13)

What ERISA Preemption Does & Doesn't Do & looking ahead under PPACA(5/3/11)

Overpayment Refunds from Providers (for your eyes only)(4/25/11)

A Handy Way to Remember Who is "Administrator" & "Fiduciary"(10/20/09)

Welfare Benefit Plan Subject to Suit Based on Assignment(10/1/09)

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)

Caution to TPAs Related to Medical Entities or other outside owners(2/2/09)

Status of New Types of Plans(2/2/09)

Stop-Loss as Plan Asset + Fiduciary Reminder(2/2/09)

What happens when TPA & Stop-Loss disagree on a claim amount?(11/5/08)

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)

New DOL Proposed Rules on Disclosing TPA Compensation(1/14/08)

A Quick Refresher on Who & What is ERISA Fiduciary(12/8/06)

Avoiding the Temptation to Bend Plan Rules(12/8/06)

DOL Investigations - Sample Letter to Clients When DOL Says It's Coming to Audit You(12/8/06)

DOL Outlines Fiduciary Duty of Provider Selection & Oversight(12/8/06)

Don't weasel on claims(12/8/06)

ERISA Clarification re Stop-Loss Ownership(12/8/06)

ERISA Fiduciary Reminder(12/8/06)

ERISA Fiduciary: Beware % Payments(12/8/06)

ERISA Follows the Plan Money(12/8/06)

ERISA Says Shop Around for Services to be Prudent(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)

Should a TPA Pay Client's Claims (from TPAs assets)?(12/8/06)

STOP-LOSS Fraud(12/8/06)

TPAs Taking on Fiduciary Duty?(12/8/06)

What DOL Asks During Investigation (Audit)(12/8/06)

What is "Handling Funds" Under ERISA's Fidelity Bond Regulations?(12/8/06)

What's Allowable Error Rate?(12/8/06)

Why 99% of Plans Should Have a Formal Trust(12/8/06)

Bill Collectors: Under State and Federal Law(11/8/02)

Disclosure of Commissions Paid by TPAs to Brokers(6/23/95)

Medical letter(2/1/91)

Official Source Documents

DOL Proposed Rule on TPA Fee Disclosure(10/7/19)

Understanding Your Fiduciary Responsibilities Under a Group Health Plan(5/17/16)

Department of Labor Group Health Plan Fiduciary Responsibilities(5/9/16)

Transitional Reinsurance Program

Articles and Materials

Key Deadlines for Transitional Reinsurance Contributions(12/13/16)

Release of ACA Transitional Reinsurance Program Annual Enrollment & Contributions Submission Form(10/22/14)

Annual Enrollment & Contributions Submission Form Manual(10/22/14)

Supporting Documentation Job Aid Manual(10/22/14)

Official Source Documents

Proposed HHS Notice of Benefit & Payment Parameters for 2016 Fact Sheet(12/2/14)

Transitional Reinsurance Program Proposed Regulations(12/2/14)

Claims

Articles and Materials

Schedule J Proposed in New 5500 Regulations(12/5/16)

Official Source Documents

Claims Regs - Final Rules: 2015-29294(12/28/15)

5500 Forms

Articles and Materials

Schedule J Proposed in New 5500 Regulations(12/5/16)

DOL 5500 Form & Schedule J + Comment Letter(11/26/16)

Official Source Documents

Delinquent Filer Correction Program(2/8/21)

DOL Releases Advance Informational Versions of Form 5500 and Form 5500-SF(10/23/19)

Proposed DOL Rules on 5500 Form: Federal Register(7/28/16)

Proposed Revisions to Form 5500: Federal Register(7/28/16)

Summary of Benefits & Coverage

Articles and Materials

The New 2017 Summary of Benefits and Coverage (SBC) Template(4/28/16)

SBC Calculator is Developed - WEBINAR to Follow(6/5/12)

SBC Corrections, FAQs & Calculation Guidance Have Been Issued(5/29/12)

Summary of Benefits and Coverage and Uniform Glossary (4/18/12)

Agencies Issue FAQs for the Summary of Benefits & Coverage(3/20/12)

DOL Changes Compliance Date for the Summary of Benefits and Coverage(11/28/11)

DOL Changes Compliance Date for the Summary of Benefits and Coverage(11/21/11)

DOL Comment Letter on the Summary Benefit of Coverage(10/26/11)

Uniform Summary of Benefits and Coverage(7/12/11)

Official Source Documents

SBC Calculator Correction(7/27/12)

Link to the SBC Coverage Example Calculator(5/14/12)

FAQs Regarding the Implementation of Summary of Benefits & Coverage(5/14/12)

Corrected Sumarry of Benefits & Coverage Template(5/14/12)

Corrected Sample Summary of Benefits & Coverage(5/14/12)

Final Rules Released on the Summary of Benefits & Coverage & Uniform Glossary (Revised 4/12/12)(2/9/12)

Clinical Trials

Articles and Materials

ACA FAQs (Part 31) Clinical Trials & MHPAEA(4/27/16)

Clinical Trials(5/28/13)

Preemption and MEWA

Articles and Materials

MEWA Plan Contacts(1/20/16)

MEWA Reporting Under ACA Section 9010, The Health Insurance Providers Fee, IRS Form 8963(12/4/14)

MEWA 2010 M-1 Form(1/31/11)

MEWA 2010 Form + Labor Department's Regulatory Agenda(1/31/11)

Double Warning on Employment Status(8/28/08)

Leasing & Independent Contractor Do's & Don'ts(12/8/06)

Plans sponsored by Governmental & Religious Groups are NOT Under ERISA(12/8/06)

What's the Regulatory Status of Government & Religious Plans?(12/8/06)

A Wishful Thinking MEWA Mindset(5/1/03)

MEWA & Association Health Plan (AHP) Background(3/1/99)

Leasing Do's & Don'ts(1/10/95)

Official Source Documents

MEWA 2018: Form M-1 + 10 Tips for Filing(12/11/18)

MEWA Form M-1 - Report for MEWAs & Certain Entities Claiming Exception (2/12/18)

MEWA: Form M-1: Report for MEWAs & Certain Entities Claiming Exception (ECEs)(12/22/14)

IRS Bulletin: 8963 Health Insurance Providers Fee(12/4/14)

MEWA Regs: Fillings Required of MEWA Arrangements and Certain Other Related Entities(3/1/13)

MEWA Regs: ExParte Cease and Desist and Summary Seizure Orders(3/1/13)

MEWA Regs: Final Revision & Publication of the 2012 Form M-1, Notice(3/1/13)

MEWA Regs: Revision of Annual Information Return/Reports (Form 5500)(3/1/13)

Auto Enrollment

Articles and Materials

Auto Enrollment(11/4/15)

Auto-enrollment Rules for Employers with Over 200 Employees(12/21/10)

Official Source Documents

DOL Technical Release: No. 2012-01 - Auto Enrollment(7/12/13)

Minimum Essential Coverage

Articles and Materials

Non-Major Medical Plans and Preventive Services(11/4/15)

Non-Major Medical Plan and MEC(10/24/13)

Official Source Documents

Rev. Proc. 2019-29(7/22/19)

IRS Final Regs MEC(11/26/14)

CCIIO Guidance on Minimum Essential Coverage(11/4/13)

Wellness

Articles and Materials

SPBA Comments to EEOC on Proposed Wellness Rule(6/19/15)

EEOC Wellness Proposed Rule Article(4/28/15)

Official Source Documents

DOL-IRS-HHS Wellness FAQ - April 2015(4/28/15)

HHS FAQs on Wellness April 2015(4/28/15)

HIPAA Nondiscriminatory Wellness Programs: Final Regulation(5/30/13)

Webinar

Webinar: An Overview of Wellness Rules Governing Health Plans (10/2/23)

Stop-Loss Activity

Articles and Materials

State News: Colorado(5/27/15)

Stop Loss(5/27/15)

A. Stop-Loss Templet + Definitions + Self-Funding Myths vs Facts(2/27/15)

NAIC Committees Explore Stop Loss (9/5/13)

State Stop-Loss Developments: North Carolina(5/28/13)

Colorado House Approves Stop-Loss Legislation(4/26/13)

Administrative Simplification

Articles and Materials

HIPAA Operating Rules Survey + Free Webinar(5/27/15)

Issues for TPAs regarding HIPAA First EDI Certification(3/26/14)

New ACA Proposed Rule on EFT Certification(2/27/14)

HIPAA – Administration Simplification(1/30/14)

HHS issues Health Identifier Rule and Formally Delays ICD 10(4/18/12)

HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers(1/27/12)

Health Reform Changes to EDI (ppt. from Webinar)(9/2/11)

New Rules on EDI(7/12/11)

Official Source Documents

Rescinding HPID Requirement Final Rule 2019(11/1/19)

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities(7/29/15)

CMS-AMA ICD-10 Flexibilities Statement(7/29/15)

ICD-10 - Testing with CMS(7/29/15)

Administration Simplification: Certification of Compliance Proposed Rule for Health Plans: Federal Register January 2, 2014(1/2/14)

IFR on Administrative Simplification (HHS: a pdf document)(7/13/11)

Minimum Value

Articles and Materials

CMS Director Comments on Minimum Value at SPBA Meeting(4/30/15)

Final Rule Minimum Value includes "Substantial Coverage"(2/26/15)

Gillihan Memo on Minimum Value(11/12/14)

IRS Proposed Rules on Minimum Value and Wellness Incentives (5/28/13)

Official Source Documents

HHS Final Rule Minimum Value Released 2-20-2015(2/22/15)

IRS Proposed Regulation on Minimum Value(5/3/13)

Minimum Value Calculator under Plan Management Regulations + Minimum Value Calculator Methodology under Plan Management Released on February 20, 2013(2/25/13)

CLASS

Articles and Materials

CLAS County Data + List of Counties (Edition Date: December 2014)(1/30/15)

CLASS Act - Payroll Deductions NOT Required in 2011(9/29/10)

Exchanges

Articles and Materials

Exchange Premiums for Individual Shared Responsibility(1/29/15)

Transitional Reinsurance Fee, Exchanges & SHOP(2/27/14)

Should You Reconsider Giving FLSA Exchange Notices Given New DOL Guidance?(9/13/13)

Updated: September 12, 2013: Exchange Notice: No Penalties for Noncompliance(9/12/13)

FAQs: Notice of Coverage Options (Updated 9-12-13)(9/12/13)

Penalties for Noncompliance(9/11/13)

Employers Prepare for Exchange Verification of Employer-Sponsored Coverage(9/5/13)

Myth vs. Fact: Health Insurance Marketplace on Track(8/2/13)

Exchange Regs Impact Employer Verification Requirements(7/10/13)

Pay or Play Delayed for One Year, The Exchange Notice was NOT Delayed(7/8/13)

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)

Small Business (SHOP) Exchange Delayed (Corrected)(4/3/13)

Marketplace: Video Description and URL(3/25/13)

New Exchange Regulations Include Exemptions to Individual Shared Responsibility Provision(2/4/13)

Exchange Notice Delayed(1/28/13)

State Exchange Notifications to Employees(1/18/13)

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)

Official Source Documents

FINAL 2016 Letter to Issuers In the Federally-facilitated Marketpalces(2/23/15)

HHS Notice of Benefit & Payment Parameters for 2016(2/23/15)

IRS Revenue Procedure 2015-15(1/30/15)

FAQs: Payment Process for January 2014(10/23/13)

FAQs: Agent & Broker Frequently Asked Questions(10/4/13)

FAQs: FF-SHOP Issuer Frequently Asked Question(10/4/13)

Affordable Insurance Exchanges Guidance: Members of Congress & Staff Accessing Coverage through Marketplaces(10/1/13)

FAQs: Affordable Care Act Implementation (Part XVI)(9/9/13)

CMS Guidance on Clarifying Income Verification on Exchanges(8/12/13)

Employer Coverage Tool(8/1/13)

CMS Navigator Assistance Roles(8/1/13)

Exchange Regs: Standards for Navigators and Assisters (Final Rule) (7/26/13)

HHS Final Rule on Exchange Verification(7/10/13)

NAIC Consumer Information Subgroup, Exchanges, Flow Chart etc.(4/17/13)

CCIIO Letter to Exchanges(4/8/13)

Marketplace: Non FA Paper Application(3/25/13)

Marketplace Individual Questionnaire(3/25/13)

Marketplace: FA Paper Application(3/25/13)

Marketplace: Individual Application Supporting Statement(3/25/13)

Exchange Rules(2/1/13)

HHS Proposed Rule: Exchange Eligibility Appeals and Other Provisions Related to Eligibility & Enrollment for Exchanges(1/14/13)

Establishment of Exchanges & Qualified Health Plans; Exchange Standards for Employees(3/13/12)

Excepted Benefits

Articles and Materials

Amendments to "Excepted Benefits"(10/24/14)

HHS Issues Essential Health Benefit FAQs(2/24/12)

"Excepted Benefits" and Health Care Reform(9/29/10)

Dental Plans and Dependent Coverage of Children to Age 26(5/13/10)

Official Source Documents

Amendments to Excepted Benefits: Federal Register Proposed Rules December 24, 2013(12/27/13)

Self-Funding

Articles and Materials

Self-Funding: Myths vs. Facts(9/2/14)

Administrative Fix for Policy Cancelations(11/15/13)

Self-Funding: Self-Funding Will Flourish in ACA(1/28/13)

Tax on Plans

Articles and Materials

Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014)(5/29/14)

Transitional Reinsurance Fee, Exchanges & SHOP(2/27/14)

Text of HHS Notice of Benefit & Payment Parameters for 2015(11/26/13)

Program Integrity Rule(11/1/13)

Transitional Reinsurance Fee: Changes in New Regulations(10/29/13)

PCORI Questions from SPBA Members(6/27/13)

Insights on PCORI from Webinar (March 2013)(5/13/13)

Reinsurance Fees Comment Letter(1/4/13)

Reinsurance Fee and the Impact on TPAs and Self-Funded Plans(12/17/12)

Official Source Documents

Dollar Amount 2015/2016 (IRS Notice 2015-60)(2/24/16)

Transitional Reinsurance 2013-28610(11/26/13)

Transitional Reinsurance Regulation 10-30-13 (Federal Register)(10/31/13)

Final Rule(10/28/13)

Reinsurance Fees: Payment Notice Technical Summary(3/12/13)

Reinsurance Fees: Federal Register Proposed Regulations(12/18/12)

PCORI: Federal Register Final Regulations(12/10/12)

Shared Responsibility

Articles and Materials

IRS Released Two Final Rules on Employer/Plan Reporting(3/26/14)

Transition Relief for 2014(7/10/13)

Multiemployer Plans Transition Relief(5/29/13)

New Exchange Regulations Include Exemptions to Individual Shared Responsibility Provision(2/4/13)

ACA Premium Tax Credit Affordability(2/1/13)

Play or Pay in 2014 (Shared Responsibility for Employers Regarding Health Coverage)(1/2/13)

Minimum Value of an Employer-Sponsored Health Plan(5/29/12)

Health Care Reform: Employer Mandate and Federal Subsidies(8/17/11)

Official Source Documents

IRS Publication: Making a Shared Responsibility Payment... What you Need to Know(12/15/14)

IRS Publication: Health Care Law: What's New for Individuals & Families (Tax Year 2014)(12/15/14)

IRS Final Regulations on Individual Shared Responsibility(9/3/13)

IRS Proposed Regulation on Individual Shared Responsibility(5/7/13)

Individual Responsibility Q and A (Link)(1/31/13)

IRS Notice 2012-58 - Determining Full-Time Employees(9/4/12)

IRS Notice 2012-59 - Guidance on 90 Day Waiting Period Limitation(9/4/12)

NAIC Resources

Articles and Materials

NAIC Managed Care B Committees (as of 2/7/14)(2/7/14)

Old Deficit Law Triggers Modern Stop-Loss Misunderstanding(5/22/13)

TPAs Impact NAIC Vote(12/5/12)

Official Source Documents

NAIC Commissioners List (Revised1/27-14)(2/7/14)

NAIC Consumer Information Subgroup, Exchanges, Flow Chart etc.(4/17/13)

NAIC ERISA Working Group FAQs(10/18/12)

NAIC News

Articles and Materials

SPBA 2013 NAIC Press Release(12/16/13)

SPBA Talking Points for Letters on Stop-Loss Attachment Points(8/31/12)

SPBA Stop-Loss Issue Debated at NAIC Summer Convention(8/22/12)

SPBA Testifies at NAIC on Stop-Loss(8/13/12)

URGENT: Self-funding Challenged by NAIC(8/8/12)

Official Source Documents

Letter to Insurance Commissioners Providing a Transitional Policy for Individual & Small Group Market Policies(11/14/13)

HRAs (Health Reimbursement Accounts)

Articles and Materials

Chart and Summary of ACA Premium Reimbursement HRA Guidance(11/27/13)

Deductible Caps on Small Business (4/26/13)

Deductible Caps on Small Business Health Plans(3/21/13)

Official Source Documents

IRS Guidance on Small Employer HRAs (IRS Notice 2017-67)(11/2/17)

Health Coverage Reimbursement Arrangements- IRS Notice 2015-17(2/18/15)

HRA Annual Limit Waiver Guidelines(10/4/13)

Technical Release 2013-03 (10/4/13)

Tax Credits for Premiums

Articles and Materials

Spouse Eligibility for Premium Tax Credits in the Exchange(10/24/13)

ACA Premium Tax Credit Affordability(2/1/13)

Health Care Reform: Employer Mandate and Federal Subsidies(8/17/11)

Treasury Releases Guidance on Health Reform Tax Credits(8/12/11)

Official Source Documents

Premium Tax Credit: Form 8962 + Instructions for Form 8962(1/26/15)

IRS Weblink: Q&As on the Premium Tax Credit(1/26/15)

IRS Final Regulations on Premium Tax Credits(9/10/12)

Treasury Fact Sheet on Premium Tax Credits(8/12/11)

Premium Tax Credits - Proposed Reg(8/12/11)

Penalties

Articles and Materials

Pay or Play Delayed for One Year, The Exchange Notice was NOT Delayed(7/8/13)

Important

Articles and Materials

You ARE an "Employer Sponsored Plan" under ACA(2/21/13)

PPACA: Health Reform Questions & Answers(9/12/12)

Q & As to Test Your Knowledge of Health Care Reform(6/3/11)

PPACA Reg Writers Answer SPBA Questions (Fall 2010)(11/16/10)

PPACA Reg Writers Answer SPBA Questions(10/29/10)

Official Source Documents

Federal Register: November 26 2014 (ACA)(12/2/14)

Self-Compliance Tool for Part 7 of ERISA: Health Care-Related Provisions(12/2/14)

DOL Compliance Assistance Guide(11/20/14)

IRS FAQs on Automatic Enrollment, Employer Shared Responsibility and Waiting Periods (2/9/12)

Over the Counter Drugs (OTC)

Articles and Materials

How Does the Revised Definition of Medical Expenses Relate to OTC Drugs(1/24/13)

FSA & HRA Debit Cards for OTC Purchases (12/29/10)

IRS Releases Guidance on OTC Drugs: Issue for Debit Cards(9/7/10)

Official Source Documents

Questions & Answers on Over-the-Counter Medicines and Drugs (Revised Version - 3/21/12)(12/1/10)

Over the Counter Drug Notice (IRS)(9/7/10)

Mini-Med Waivers

Articles and Materials

Annual Limit Waivers Filing Due(10/31/12)

Guidance Released by HHS for Annual Limit Waivers(7/12/11)

Health Reform: Guidance Released by HHS for Annual Limit Waivers(6/23/11)

Mini-Med Waiver Extension to 12/31/13(6/20/11)

More Limited Benefit Plan Waiver Guidance- December 2010(12/13/10)

Amendment to Grandfather Rules & Waiver Limits(11/16/10)

Mini-Med Waiver : HHS Issues Guidance September 2010(9/7/10)

Mini-Meds and the Waiver Program(8/17/10)

Official Source Documents

Technical Instructions for Waivers as of 8/19/2011(8/24/11)

Guidance: Exemption for Health Reimbursement Arrangements that are Subject to PHS Act Section 2711(8/24/11)

Supplemental Guidance on Waiver December 2010(12/13/10)

Sale of New Limited Benefit Plan Guidance(12/13/10)

Waiver Application Form(12/13/10)

Waiver Guidance November 2010(11/16/10)

Mini-Meds Waiver & Annual Limits Guidance & Requirements Sept 2010(9/7/10)

Student Health Insurance

Articles and Materials

CMS Issues Final Rules on the Affordable Care Act Requirements for Student Health Policies(7/17/12)

Student health Insurance Coverage Subject to Certain PPACA Provisions(5/2/11)

Official Source Documents

Student Health Insurance Proposed Regulation (Federal Register, February 11, 2011)(4/28/11)

SCOTUS

Articles and Materials

Supreme Court Decision Upheld; Medicaid Provisions Must Be Reworked(6/29/12)

What's Next After SCOTUS(6/28/12)

The Morning After SCOTUS: A Reality Check & Prep(6/27/12)

Official Source Documents

Supreme Court Opinion - June 28, 2012(6/28/12)

Cases

Articles and Materials

Defense of Marriage Act Headed to Supreme Court(6/1/12)

Official Source Documents

Order from Florida Court on Obamacare(2/7/11)

Webinar

Webinar: The Chevron Decision: What You Need To Know (8/2/24)

W-2s

Articles and Materials

ACA IRS W-2 Presentation(3/6/12)

W-2 Reporting and Controlled Groups(2/29/12)

Double Hot News: W-2 Health Value Reporting Chart + Hospital Transparency (e-mail alert)(2/24/12)

Article on IRS W-2 Guidance in 2012(2/3/12)

W-2 Health Care Value Reporting Updated(1/27/12)

W-2 Health Care Cost Reporting Interim Guidance (Article)(5/3/11)

History on W-2 Health Value Reporting(10/25/10)

W-2 Health Care Cost Reporting Optional for 2011(10/19/10)

No Tax on Benefits $ on W-2(8/20/10)

W-2 Health Care Cost Reporting(8/20/10)

W-2 Reporting on the Value of Health Coverage(6/10/10)

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)

Health Reform Impacts and Trends

Articles and Materials

The Number of "Uninsured": Past and Future(1/17/12)

Vouchers

Articles and Materials

Free Choice Vouchers(11/23/11)

Disclosure of Fees

Articles and Materials

SPBA Comments on 408(b)(2)(9/20/11)

New DOL Proposed Rules on Disclosing TPA Compensation(1/14/08)

Official Source Documents

Temporary Enforcement Policy Regarding Group Health Plan Service Provider Disclosures(1/5/22)

Medicare Part D

Articles and Materials

CMS Medicare Part D(8/17/11)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

Claims and Appeals/External Review

Articles and Materials

Benefit Claims, Appeals and External Review Deadlines(8/17/11)

Revised Model Notices, and Guidance on Internal Claims and External Review(7/12/11)

Agencies Release New External Review Technical Release(6/23/11)

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)

Benefit Claims, Appeals and External Review Timeline(6/20/11)

DOL Extends enforcement of Internal Claims and Appeals Rules(3/21/11)

Internal Claims/Appeals & External Review Processes Fall 2010 Meeting Notes(11/9/10)

Grace Period for Internal Claims & Appeals; DOL Technical Release 2010-02(11/3/10)

Model Notices on Federal External Review Procedures for Self-Funded Plans(9/1/10)

Internal Claims/Appeals and External Review Processes under PPACA and its Companion Bill, The Health Care and Education Reconciliation Act of 2010 and its Model Notices(8/17/10)

Interim Final Regs on Internal Claims & Appeals & External-Review Requirements (E-mail Alert/Article)(7/22/10)

Interim Final Rules for Claims & Appeals & External Review Processes (statutory language)(7/22/10)

Uniform Health Carrier External Review Act (statutory language)(7/22/10)

Official Source Documents

DOL Technical Release: Extension of External Review Process 2013-01(3/20/13)

Rules Relating to Internal Claims & Appeals & External Review Process: Amendment to Interim Final Rules with Request for Comments(6/23/11)

Technical Release 2011-02: Guidance on External Reviews(6/23/11)

Regulations for Internal Claims & Appeals Effective Date Extended + Technical Release 2011-01(3/18/11)

Federal External Review Process: Request for Information (Federal Register 11/17/10)(11/18/10)

DOL Technical Release 2010-02/Interim Procedures(10/25/10)

Early Retiree Reinsurance Program

Articles and Materials

ERRP New Guidance(8/17/11)

ERRP Clarification(8/17/11)

Early Retiree Program Issues New Q/A/ and Reminders(6/3/11)

ERRP Update(12/21/10)

DOL News: Trusts & Confidential Communications(12/21/10)

ERRP Application(8/18/10)

The ERRP Application is Now Officially Available for Filing(6/29/10)

HHS Releases Draft Application for Early Retiree Claims Subsidy(6/4/10)

Early Retirees in the Affordable Care Act(5/14/10)

Health Care Reform: Early Retirees in the Affordable Care Act(5/7/10)

Early Retirees in the Affordable Care Act (Email Alert)(5/5/10)

Official Source Documents

CMS to Stop Accepting Applications; ERRP - Federal Register Reg(4/5/11)

CMS to Stop Accepting Applications - ERRP(4/5/11)

CMS Posts New Version of ERRP Application + Dos & Don'ts(11/5/10)

Early Retiree Reinsurance Program Application etc.(6/29/10)

Early Retiree Reinsurance Program - Federal Register, May 4, 2010(5/5/10)

Reinsurance Program for Early Retirees (Temporary)(4/27/10)

HHS Reinsurance Fact Sheet(4/8/10)

Self-Funded Reports

Articles and Materials

Self Insured Health Benefit Plans(7/27/11)

Official Source Documents

Self Funded Report to Congress(7/27/11)

Group Health Plans Report: Form 5500 Annual Reports(7/27/11)

Opt-Out

Articles and Materials

Reminder on Opt-Out Rules for State and Local Government Plans(5/3/11)

HHS Releases Guidance on Opt-Out Rules for State and Local Government Plans(9/23/10)

Official Source Documents

HIPAA Opt-Out Model Election Form(5/9/11)

HIPAA Opt-Out Model Notice to Participants (5/9/11)

HIPAA Opt Out

Articles and Materials

Reminder on Opt-Out Rules for State and Local Government Plans(5/3/11)

Official Source Documents

HIPAA Opt-Out Model Notice to Participants(4/25/11)

HIPAA Opt Out Model Election Form(4/25/11)

Sample Speeches

Articles and Materials

Political Overview & New Developments in PPACA: What's Going to Happen??(4/5/11)

Report on Key PPACA Reg Developments and Attitude(4/5/11)

Is PPACA Rationing?(2/14/11)

Sample Speech: What the Fate of PPACA and What's Ahead(2/10/11)

Rescissions

Articles and Materials

Retroactively Cancel Coverage under PPACA(3/9/11)

Retroactive Rescission(12/21/10)

Rescissions: Reg Writers Provide Insights on PPACA Issues (Fall 2010)(10/19/10)

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)

"Excepted Benefits" and Health Care Reform(9/29/10)

Dental Plans and Dependent Coverage of Children to Age 26(5/13/10)

Medical Loss Ratio

Articles and Materials

Medical Loss Ratio Provision in Health Reform(5/13/10)

Official Source Documents

Fact Sheet: Middle Class Americans Saving Billions Under the Health Care Law's Medical Loss Ratio Refunds(7/29/13)

Mandated Claims Appeals

Articles and Materials

Mandated Claims Appeals Processes(4/27/10)

Michelle's Law

Articles and Materials

Opt-Out from Michelle's Law(2/19/10)

Michelle’s Law: Questions Remain(2/19/10)

USERRA/Veterans

Articles and Materials

Veterans Affairs Requests Electronic Remittances(6/16/09)

Legislation Benefits for Military Personnel (Heroes or Heart Act)(6/27/08)

USERRA Final Regulations: Overview(12/8/06)

USERRA: Veterans Benefits Improvement Act of 2004(12/8/06)

USERRA Final Regulations Wm. Kenan Torrans, DOL(5/3/06)

USERRA Overview - William Kenan Torrans, DOL VETS(5/19/05)

USERRA: Military Mobilization Impacts Employer Plans(1/1/03)

New Veterans Rights Law Highlights Employer Responsibilities(12/2/95)

Employee Benefit Impact of the Mobilization of Military Reserves for Operation Desert Shield and Operation Desert Storm(1/15/90)

Official Source Documents

USERRA: Final Regulations(12/8/06)

Value Driven Initiatives

Articles and Materials

Be Prepared for Client Question on Value-Driven(5/4/07)

Purchaser Guide for Employers on Value-Driven Health Care(2/8/07)

Understanding Government Role & Perspective

Articles and Materials

11 Common Benefits Myths(12/8/06)

A Dozen Quick Answers to Frequently Asked Questions(12/8/06)

Form over Function(12/8/06)

Government Compliance: Your Biggest Cost & Threat(12/8/06)

Recognizing Who is the Boss of Your Benefit Plan and Your Largest Legal Liability(12/8/06)

What We Tell Vendors and Researchers About You(12/8/06)

Who is "Government"(12/8/06)

Why So Much Government Regulation? Why Use a TPA?(12/8/06)

A Guide to Really Understanding and Really Influencing Government Policy-Making(11/1/96)

Privacy - GLBA

Articles and Materials

Gramm-Leach Bliley Act - New Financial Services Legislation(12/8/06)

Gramm-Leach-Bliley Act - Decision Tree and Sample Privacy Notice(12/8/06)

What TPAs Need to Know and Do about the Gramm-Leach-Bliley Act(12/8/06)

Subrogation

Articles and Materials

Subrogation News: Sereboff - What the Plan Did Right(12/8/06)

Supreme Court Case: Sereboff(12/8/06)

Statistics/Numbers

Official Source Documents

2024 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (12/12/24)

2024 Milliman Medical Index (4/20/24)

2023 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (4/5/24)

2023 Milliman Medical Index (4/5/24)

2022 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (5/23/23)

2022 Milliman Medical Index (5/23/23)

2021 Milliman Medical Index(4/22/22)

2021 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary(4/22/22)

FAQs Implementation

Official Source Documents

DOL EBSA Webpage of ACA FAQs(8/1/23)

Fraud

Official Source Documents

Cyber Criminals Target Healthcare & Essential Services to Steal Sensitive Research Data & Intellectual Property(5/6/20)

IC3 Releases Alert on Extortion Email Scams(4/21/20)

FBI Releases Guidance on Defending Against VTC Hijacking & Zoom-bombing(4/13/20)

CISA: COVID-19 Exploited by Malicious Cyber Actors(4/9/20)

FBI Sees Rise in Fraud Schemes Related to the Coronavirus Pandemic(4/7/20)

Domestic Partners

Official Source Documents

IRS - FAQs for Same Sex Couples(10/7/19)

U.S. v. Windsor(11/1/12)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States(10/29/12)

AHPs (Association Health Plans)

Official Source Documents

Presidential Executive Order Promoting Healthcare Choice & Competition(8/13/19)

Associated Health Plans & DOL (Case)(3/29/19)

AHP: ERISA Compliance Assistance(10/22/18)

Q&As on Employer Shared Responsibility Provisions Under the ACA(8/22/18)

Same-Sex

Official Source Documents

Attorney General Lynch Announces Federal Marriage Benefits Available to Same-Sex Couples Nationwide(7/30/15)

ACOs (Accountable Care Organizations)

Official Source Documents

ACO Proposed Regs: Federal Register April 7, 2011(4/15/11)

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 Lifetime Limits No Longer Applying & Enrollment Opportunity(6/29/10)

Model Notice on Patient Protections(6/29/10)

Chevron

Webinar

Webinar: The Chevron Decision: What You Need To Know (8/2/24)

90-Day Waiting Period

Articles and Materials

90 Day Waiting Period Final Rules (1/13/24)

New Rules on 90-Day Waiting Period (1/13/24)

Official Source Documents

90-Day Waiting Period - Final Rule (Federal Register - February 24, 2014) (2/24/14)

90-Day Waiting Period - Proposed Rule - Orientation Periods (Federal Register - February 24, 2014) (2/24/14)

Waiting Period Limitation: Federal Register Proposed Rule (3/22/13)

Abortion

Articles and Materials

HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe (7/6/22)

Supreme Court Decision on Abortion (7/5/22)

Official Source Documents

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet (7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

Basic Board Policy

Guiding precepts, policies & priorities of the SPBA Founders & Board over the years (11/11/09)

Founding Purposes of SPBA (11/11/09)

Articles and Materials

By-Laws of the Society of Professional Benefit Administrators (2/27/23)

SPBA Non-Discrimination and Anti-Harassment Policy (10/2/14)

Congressional Activity

Articles and Materials

Public Health Emergency Extension Expected in July (7/15/21)

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

A. COVID-19 Frequent Questions from SPBA Members (4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill (3/27/20)

Update on Congressional COVID-19 Response (3/19/20)

House Passes Additional COVID-19 Response Bill (3/16/20)

Official Source Documents

Premium Assistance for COBRA Benefits (Notice 2021-31) (5/19/21)

HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (4/1/20)

HR 6201 - Families First Coronavirus Response Act (3/23/20)

Directory of TPAs, Stop-Loss & Service Partners

Articles and Materials

SPBA 2024 Member Directory of TPAs, Stop-Loss, and Service Partners (11/15/24)

Fiduciary Issues

Articles and Materials

2016 Year in Review (12/29/16)

Percents, rebates & any unusual payment arrangements: ERISA concerns (8/26/16)

An Easy Informal Self-test of Fiduciary Status (5/17/16)

DOL ERISA Fiduciary Explanation (Handout/Spring 2016) (5/16/16)

DOL ERISA Investigation Hints (Handout/Spring 2016) (5/16/16)

What's Payable by ERISA Plan Assets? (8/1/15)

ERISA & Fiduciary explanation for the Medical Community (4/1/15)

ERISA Fiduciary HIghlights + a Flurry of Scary Issues (1/24/13)

What ERISA Preemption Does & Doesn't Do & looking ahead under PPACA (5/3/11)

Overpayment Refunds from Providers (for your eyes only) (4/25/11)

A Handy Way to Remember Who is "Administrator" & "Fiduciary" (10/20/09)

Welfare Benefit Plan Subject to Suit Based on Assignment (10/1/09)

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)

Caution to TPAs Related to Medical Entities or other outside owners (2/2/09)

Status of New Types of Plans (2/2/09)

Stop-Loss as Plan Asset + Fiduciary Reminder (2/2/09)

What happens when TPA & Stop-Loss disagree on a claim amount? (11/5/08)

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)

New DOL Proposed Rules on Disclosing TPA Compensation (1/14/08)

A Quick Refresher on Who & What is ERISA Fiduciary (12/8/06)

Avoiding the Temptation to Bend Plan Rules (12/8/06)

DOL Investigations - Sample Letter to Clients When DOL Says It's Coming to Audit You (12/8/06)

DOL Outlines Fiduciary Duty of Provider Selection & Oversight (12/8/06)

Don't weasel on claims (12/8/06)

ERISA Clarification re Stop-Loss Ownership (12/8/06)

ERISA Fiduciary Reminder (12/8/06)

ERISA Fiduciary: Beware % Payments (12/8/06)

ERISA Follows the Plan Money (12/8/06)

ERISA Says Shop Around for Services to be Prudent (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)

Should a TPA Pay Client's Claims (from TPAs assets)? (12/8/06)

STOP-LOSS Fraud (12/8/06)

TPAs Taking on Fiduciary Duty? (12/8/06)

What DOL Asks During Investigation (Audit) (12/8/06)

What is "Handling Funds" Under ERISA's Fidelity Bond Regulations? (12/8/06)

What's Allowable Error Rate? (12/8/06)

Why 99% of Plans Should Have a Formal Trust (12/8/06)

Bill Collectors: Under State and Federal Law (11/8/02)

Disclosure of Commissions Paid by TPAs to Brokers (6/23/95)

Medical letter (2/1/91)

Official Source Documents

DOL Proposed Rule on TPA Fee Disclosure (10/7/19)

Understanding Your Fiduciary Responsibilities Under a Group Health Plan (5/17/16)

Department of Labor Group Health Plan Fiduciary Responsibilities (5/9/16)

General Strategies

Articles and Materials

Roadmap on How to Influence Your Members of Congress (8/11/17)

Educating Your Members of Congress (6/6/17)

Communicating With Your Elected Officials (7/29/13)

The Top Ten Things Congressional Staffers Hate to Hear (10/6/09)

Health Reform Legislative Process (6/18/09)

You Can Start Shaping Public & Political Opinion Today! (11/2/07)

How to Contact Your Member of Congress (10/11/07)

A Guide to Understanding and Influencing Government Policy (5/30/07)

National Provider Identifier Database Notice (5/30/07)

Action Needed Now: Shape Government Policy (5/7/07)

Independent Dispute Resolution

No Surprises Act Regulations Part II - Independent Dispute Resolution (Webinar) (10/13/21)

Articles and Materials

IRS Releases Guidance on Calculating 2024 QPA Payments (3/21/24)

No Surprises Act Independent Dispute Resolution Process Proposed Rule (12/15/23)

Calculating the QPA in the Aftermath of the Texas Medical Association et al. Case (10/31/23)

Overview Highlights of the SPBA Spring Meeting Session:  “The No Surprises Act Independent Dispute Resolution Process” (5/1/23)

Independent Dispute Resolution: Status Update (3/10/23)

H. The No Surprises Act Independent Dispute Resolution Process from the Date of Service to the Decision of the IDR Entity - Scott Bennett (3/28/22)

Federal IDR Portal Stakeholder Testing Round Table (2/25/22)

Federal Judge Strikes Down Pieces of No Surprises Act Independent Dispute Resolution IFR (2/24/22)

SPBA Submits Comment Letter on No Surprises Act Independent Dispute Resolution Process (12/15/21)

No Surprises Act and Transparency Effective Date Chart (10/19/21)

No Surprises Act Regulations - Part II Released (10/4/21)

Official Source Documents

Fact Sheet: No Surprises Act Independent Dispute Resolution Process Proposed Rule (11/3/23)

ACA FAQ Part 62 on QPA Post Court Decision in TMA III (10/20/23)

Payment Disputes Between Providers and Health Plans (9/19/23)

IDR Disputing Parties Guidance for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022 (4/24/23)

Guidance for IDR Entities for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022 (4/24/23)

Webinar

Webinar: New Proposed Federal IDR Process, Court Decision, New FAQ and AI Compliance Tools (12/5/23)

Sponsorship

2020 Webinar Sponsorship Opportunities (5/18/20)

Webinar Sponsorship Opportunities for 2020 (5/8/20)

Stop Loss

Articles and Materials

2024 SPBA Stop-Loss Application (5/30/23)

Minnesota Stop-Loss (2/1/17)

Self-Funding: Myths vs. Facts (9/2/14)

NAIC White Paper: Stop-Loss & Self-Funding (Attached: White Paper: Stop-Loss Insurance, Self-Funding & ACA) (8/13/14)

Old Deficit Law Triggers Modern Stop-Loss Misunderstanding (5/22/13)

SPBA Talking Points for Letters on Stop-Loss Attachment Points (8/31/12)

California Stop-Loss Legislation Stalled (8/29/12)

Stop-Loss Model Act (8/8/12)

Request for Information on Stop-Loss: SPBA's Comments (6/29/12)

Request for Information on Stop-Loss: SPBA Past President Fred Hunt's Comments (6/29/12)

Request for Information on Stop-Loss: 13 Questions (6/5/12)

Stop-Loss Summit Issues (3/9/11)

Stop-Loss as Plan Asset + Fiduciary Reminder (2/2/09)

Plan Trends that Reduce Costs & Data to Back-Up the Results (11/5/08)

What happens when TPA & Stop-Loss disagree on a claim amount? (11/5/08)

TPA Frustrations with Stop-Loss + Their Insights (5/8/08)

Future of Stop-Loss in a "Markets" Environment (10/12/07)

ERISA Clarification re Stop-Loss Ownership (12/8/06)

ERISA Follows the Plan Money (12/8/06)

Open Letter to SPBA TPAs & Stop-Loss Service Partners (12/8/06)

Questionnaire: Stop-Loss TPA Questionnaire (12/8/06)

STOP-LOSS Fraud (12/8/06)

Who Owns Stop-Loss Policy (12/8/06)

Questionnaire: Stop Loss Carrier Approval Info Checklist (12/8/06)

Disclosure Form Background & Explanation (10/31/06)

Stop Loss Senior Management & Underwriting (9/25/06)

Official Source Documents

Report to Congress: 2018 Annual Report on Self-Insured Group Health Plans (3/20/19)

2017 DOL Annual Report on Self-insured Group Health Plans (3/1/17)

State of Connecticut Stop Loss Insurance Coverage (Bulletin HC-108 & PC-80) (12/30/15)

Maryland 2016 Interim Medical Stop-Loss Report (12/28/15)

White Paper: Stop-Loss Insurance, Self-Funding & ACA (11/17/14)

Guidance on State Regulation of Stop-Loss Insurance (11/6/14)

White Paper: Stop-Loss Insurance, Self-Funding & ACA (8/13/14)

States: Minnesota Stop-Loss Legislation Senate: SF 650 (3/19/13)

States: Minnesota Stop-Loss Legislation House: HF 647 (3/19/13)

States: Rhode Island Stop-Loss Legislation H54459 (3/19/13)

Analysis & Articles

Articles and Materials

Administration Plans End Date to COVID-19 Emergency Declarations (1/31/23)

What TPAs Should Know About the COVID-19 Mandate (12/15/21)

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)

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

COVID-19 Vaccine Rollout and Payment (2/2/21)

Tri-Agencies Issue New Group Health Plan Coverage of Covid-19 Vaccines Rules (11/25/20)

CPT Codes for Vaccines Released (11/24/20)

CMS Process to Report Individual Providers Who Fail to Post COVID-19 Test Cash Price (11/24/20)

What Employers Should Know About The COVID-19 Vaccination (10/27/20)

B. COVID-19 SPBA Member Questions with Answers April 21 (4/23/20)

Families First Coronavirus Response Act: Paid Leave Chart (4/16/20)

Paycheck Protection Program: A Summary (4/8/20)

A. COVID-19 Frequent Questions from SPBA Members (4/1/20)

SPBA Website COVID-19 Resource Center (4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill (3/27/20)

Coronavirus FAQs for Employers by Alston & Bird (3/20/20)

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)

JUNE 2024 - MAY 2025 SPBA BOARD, PAST CHAIRMEN & STAFF E-MAIL ADDRESSES (11/14/24)

June 2024 - May 2025 SPBA Board of Directors Contact Info. (11/14/24)

Future Meetings

Future Meetings (Click Here) (11/1/23)

Plan Transparency

Articles and Materials

Enforcement Relief for Gag Clause Prohibition Compliance Attestation (4/30/25)

Departments Issue FAQ 69 on Independent Dispute Resolution and the Gag Clause (2/25/25)

CAA HB SB Gag Clause Chart (8/29/24)

Gag Clause Prohibition Compliance Attestation User Manual Updated (6/28/24)

Machine‑Readable Rx Files Enforcement (10/26/23)

TinC 2.0 Complexity and HR 3561 Impact (7/14/23)

New Requirements Under CMS' Transparency in Coverage Rule Take Effect January 1, 2024 (6/30/23)

The CAA Gag Clause Prohibition Attestation (6/29/23)

New Requirements Under CMS' Transparency in Coverage Rule Take Effect January 1, 2024 (6/26/23)

Transparency in Coverage Rules….What is it and What it Requires Part 1 (7/15/21)

Future Rollout of Federal Guidance Planned (7/7/21)

SPBA Transparency Summit - 3rd Session - Video Recording (6/15/21)

SPBA Transparency Summit - 2nd Session - Video Recording (3/29/21)

SPBA Transparency Summit - 1st Session - Video Recording (3/22/21)

SPBA Transparency Summit Slides - March 18, 2021 (3/18/21)

Administration Finalizes Transparency in Coverage Rule (11/24/20)

SPBA Comments on CMS Transparency in Coverage Proposed Rule (2/6/20)

SPBA's Comments on Transparency Submitted to HHS (6/28/18)

Media Reports on Medical $ Transparency (4/9/13)

Escape the Fire (Health Care) Trailer (3/28/13)

Sales Tool & Opportunity (2/9/12)

Official Source Documents

Gag Clause Prohibition Compliance Attestation Annual Submission Instructions & User Manual 2024 (6/5/24)

Transparency in Coverage Final Rule (8/6/21)

Health Coverage Transparency Proposed Rule 11-2019 (11/22/19)

HHS Report on Reforming America's Healthcare System Through Choice & Competition (8/1/19)

Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First (6/25/19)

SPBA 2020 Fall Virtual Meeting

L. HIPAA Administration - Prior Authorization & Referrals (278) Rule Making (9/13/20)

J. Hospital Price Transparency Rule (9/13/20)

I. Extexive New Plan Disclosures in Transparency Coverage Proposed Rule (9/13/20)

H. Social Hour with "World Piano Man' Martyn Lucas's Song List (9/13/20)

G. TPA/Self-Administrators & Stop-Loss Partnering (9/13/20)

F. Stopping Losses - Coordinating with Stop-Loss in a COVID-19 Era (9/13/20)

K. Social Hour - "Mixin' It Up with Ben" - Recipes (9/13/20)

C. Congressional/State Activity & Prospects for Changes Impacting Employer Sponsored Plans (9/13/20)

SPBA Value To You

Articles and Materials

2024 SPBA Value To You (12/3/24)

2023 SPBA Value To You (12/19/23)

Special Types of Plans & Situations

Articles and Materials

Reference Based Pricing Wins in California Court Case (2/25/25)

DOL Electronic Disclosure Rule + Federal Register: Electronic Disclosure by Employee Pension Benefit Plans Under ERISA (10/30/19)

Taft-Hartley/Multi-Employer/Collective-Bargain Description for Laymen (10/30/17)

Admin Fees + "Leftover" Money + Premium Tax Implications for Self-funded vs Insured Plans (7/27/11)

Self-Funding: Why Use Self-Funding? (5/27/11)

Self-Funding: Why Use Self-Funding? (5/27/11)

State and Local Government Employers Must Account for Post-Employment Health Benefits on Financial Statements Soon (8/4/08)

TRICARE: DOD Proposed Rules on TRICARE: Prohibited Financial Incentives (6/5/08)

EEOC Changes Retiree Benefits (12/8/06)

Govt. Announced New Coverage for National Guard And Reserve Members (12/8/06)

Leasing & Independent Contractor Do's & Don'ts (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)

Plans sponsored by Governmental & Religious Groups are NOT Under ERISA (12/8/06)

VA Complaints about Fiduciary Duty (12/8/06)

What's the Regulatory Status of Government & Religious Plans? (12/8/06)

Leasing Do's & Don'ts (1/10/95)

Official Source Documents

Guidance to Employee Benefit Plans on the Definition of "Spouse" and "Marriage" under ERISA & The Supreme Court Decision (9/23/13)

ERISA Q&As (DOL, ABA & JCEB) (1/7/13)

Specific Issues

Articles and Materials

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)

Employee Benefit Tax Treatment Letter to Senate (6/12/17)

Health Reform Insights (February 8, 2011) (2/8/11)

Far More Happening Than Health Reform (9/29/09)

Unspoken Secrets of Health Reform (2/2/09)

TPA Cost Value (11/2/07)

Reasons for the cost of US Healthcare (6/4/07)

Collection Agency Harassment for Medical Bills (11/8/02)

Statistics/Numbers

Official Source Documents

2024 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (12/12/24)

2024 Milliman Medical Index (4/20/24)

2023 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (4/5/24)

2023 Milliman Medical Index (4/5/24)

2022 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (5/23/23)

2022 Milliman Medical Index (5/23/23)

2021 Milliman Medical Index (4/22/22)

2021 Kaiser Family Foundation: Annual Employer Health Benefits Survey + Summary (4/22/22)

Access/Protection

Articles and Materials

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)

Purchaser Guide for Employers on Value-Driven Health Care (2/8/07)

Board Elections & Orientation

Board of Directors Application (11/20/24)

Board Orientation Powerpoint (7/9/18)

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)

Articles and Materials

Board of Director's Role Description (7/11/17)

Important

Articles and Materials

You ARE an "Employer Sponsored Plan" under ACA (2/21/13)

PPACA: Health Reform Questions & Answers (9/12/12)

Q & As to Test Your Knowledge of Health Care Reform (6/3/11)

PPACA Reg Writers Answer SPBA Questions (Fall 2010) (11/16/10)

PPACA Reg Writers Answer SPBA Questions (10/29/10)

Official Source Documents

Federal Register: November 26 2014 (ACA) (12/2/14)

Self-Compliance Tool for Part 7 of ERISA: Health Care-Related Provisions (12/2/14)

DOL Compliance Assistance Guide (11/20/14)

IRS FAQs on Automatic Enrollment, Employer Shared Responsibility and Waiting Periods (2/9/12)

Meeting Handouts

Workshop B: Cafeteria Plans (3/20/17)

Workshop A: How Well do You Know Your Network & It's Legal/Administrative Implications? (3/20/17)

M. Designing Compliant Wellness Programs (3/20/17)

L. Health Care Fraud 2017: Challenges & Opportunities for Benefit Admin. (3/20/17)

K. The Future of HIPAA Administrative Transactions (3/20/17)

J. Navigating the HIPAA Enforcement Landscape (3/20/17)

I. Mental Health Parity & the 21st Century Cures Act (3/20/17)

H. Section 1557: Accessing the Impact of Section 1557 on Group Health Plans (3/20/17)

G. Section 1557 of the Affordable Care Act (3/20/17)

F. ACA Employer Plan Reporting (3/20/17)

E. Recent Employee Benefit Litigation: TPA Edition (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)

A. 2017 Spring Meeting Agenda (For Reference) (3/20/17)

R. Cybersecurity Liability Insurance (10/14/16)

Q. PBM Insights (10/14/16)

P. Workshop H - Next Level of Cyber Risk Reduction Part II (10/14/16)

O. Simplifying Business Transaction to Increase TPA Cost Savings & Efficiency (10/14/16)

N. Workshop G: Stop-Loss Training on ACA (10/14/16)

M. Workshop E: Free Market Health Care (10/14/16)

L. Workshop C: Wellness Final Rules under ACA Title I (10/14/16)

K. Workshop B: Next Level of Cyber Risk Reduction (Part I) (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)

E. Top Six Affordable Care Act Issues You Should be Focused On (10/13/16)

D. Specialty Drugs (10/13/16)

C. Innovative Plan Designs to Create Efficiences & Strategies to Avoid Compliance Challenges (10/13/16)

B. Why Every TPA Website Needs Real-Life Client Success Stories (10/13/16)

A. 2016 Fall Meeting Agenda (For Reference) (10/13/16)

Tues: Social Media - The Straight Scoop for TPAs (10/15/15)

B. The Commercial Application of Bundled Payments (9/22/15)

Ashley Gillihan - ALE/MEC Information Reporting Presentation + Examples from 2015 Spring Meeting (4/1/15)

H. Wellness Programs: Operating Without EEOC Guidance (3/31/15)

G. Specialty Pharmacy (3/27/15)

F. Drafting Self-Funded Welfare Plan Documents (3/27/15)

D. Federal Enforcement of the ACA & Other Health Laws (3/27/15)

C. The ADA: Voluntary Wellness Programs & Health Insurance Issues + Pregnancy Discrimination (3/27/15)

B. Prospects for Health Reform Changes in the 114th Congress (3/27/15)

A. Agenda (for reference purposes) (3/27/15)

Surprise Billing

No Surprises Act - First Set of New Regulations (Webinar) (7/20/21)

Articles and Materials

Progress Toward Advanced Explanation of Benefits (AEOB) Rulemaking and Implementation (12/16/24)

No Surprises Act – Determining Cost-Sharing and Payment Amounts to Providers (12/13/24)

National Emergency or Public Health Emergency Declaration (9/2/22)

SPBA Reviews the Administration's Executive Order (7/15/21)

Future Rollout of Federal Guidance Planned (7/7/21)

Administration Releases Interim Final Rule on the No Surprises Act (7/2/21)

Advanced Explanation of Benefits in the No Surprises Act (5/28/21)

SPBA Submits Comments on No Surprises Act Regulations (5/26/21)

F. New Federal No Surprises Act & Related Transparency Requirements (4/7/21)

End of Year Spending and COVID Stimulus Package: A Summary (2/4/21)

No Surprises Act - Section by Section Summary (2/4/21)

Official Source Documents

HHS Progress-AEOB-Rulemaking-Implementation-1 April 2024 (12/16/24)

HHS Progress on AEOB Rulemaking Update-2 December-2024 (12/16/24)

Interim Final Rule - Requirements Related to Surprise Billing Part II (4/24/23)

Guidance for IDR Entities for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022 (4/24/23)

Requirements Related to Surprise Billing - Final Rules (8/2022) (4/24/23)

Rx Reporting IFR (8/15/22)

Surprise Billing Model Notice (10/18/21)

Interim Final Rule - Requirements Related to Surprise Billing; Part I (8/6/21)

No Surprises Act Bill Text (2/4/21)

TPA Forecasts and Reports

Articles and Materials

State of the TPA Industry & Forecast for 2018 (9/20/17)

Answers to the Most Frequent Questions re: TPAs & Their Marketplace (6/8/17)

State of the TPA Industry & Forecast for 2017 (1/9/17)

State of the TPA Industry & Market – June 2016 (5/24/16)

State of the TPA Industry + Forecast for 2016 (11/3/15)

State of the TPA Industry + Forecast for 2015 (10/27/14)

State of the TPA Industry + Forecast for 2013 (1/8/13)

State of the TPA Industry + Forecast for 2012 (12/21/11)

Year-End 2011 Status Report & Forecast on PPACA (12/12/11)

What's the Future for Insurers? (7/27/11)

Boom time for TPAs is Starting (7/12/11)

State of the TPA Industry + Forecast for 2011 (11/9/10)

State of the TPA Industry & Forecast as of May 2010 (5/20/10)

State of the TPA Industry + Forecast for 2010 (1/19/10)

Mid-2005 TPA Industry Report (11/3/09)

State of the TPA Industry + Forecast for 2009 (1/1/09)

Mid- 2008 Forecast for 2009 Health Reform (8/28/08)

Employee Benefits Policies of 7 Presidents: A Historical Perspective (1/29/08)

No National Health Insurance, but Take Advantage of the Opportunities (12/17/07)

State of the TPA Industry + Forecast for 2008 (11/2/07)

Planning Your Firm'$ Future (12/8/06)

State of the TPA Industry + Forecast As of December 2000 (12/8/06)

What's the Size, Role & Future of TPAs' Marketplace? (12/8/06)

State of the TPA Industry + Forecast for 2007 (11/20/06)

State of the TPA Industry + Forecast for 2006 (11/30/05)

Pollyanna Predictions? (7/14/05)

TPA Competition Rollercoaster - Ongoing (12/14/04)

State of the TPA Industry + Forecast for 2005 (12/1/04)

State of the TPA Industry + Forecast for 2004 (12/1/03)

State of the TPA Industry + Forecast for 2003 (1/1/03)

State of the TPA Industry + Forecast as of December 2001 (12/1/01)

State of the TPA Industry & Forecast as of November 1999 (11/30/99)

Webinars

Webinar: Coronavirus Preparedness and Prevention Plan by Employers (#1) (3/18/20)

Articles and Materials

Webinar: Recent Guidance on Extension of Certain Timeframes for Employee Benefit Plans (With Direct Link to Webinar) (5/8/20)

Coronavirus FAQs for Employers by Alston & Bird (3/20/20)

AHP (Association Health Plans)

Articles and Materials

Association Health Plans Subject to Guidance of the ACA Past (4/30/24)

Association Health Plans Proposed Regulations Released + AHP Regulation Overview (8/15/19)

Association Health Plans Regulations Under Consideration by DOL (8/15/19)

AHP Comment Letter on Behalf of SPBA (8/15/19)

Department of Labor Final Regulations Expanding ERISA's Definition of "Employer" to Provide Access to Association Health Plans + FAQs (8/15/19)

Official Source Documents

Association Health Plans: ERISA Compliance Assistance (8/15/19)

Definition of "Employer" under Section 3(5) ERISA - Association Health Plans (Proposed Rule) (8/15/19)

Association Health Plans - Final Rule (8/15/19)

Cautions

Articles and Materials

Read All Your Contracts (10/12/20)

Funding: Action Steps When a Client Stops Funding Claims (4/18/18)

Percents, rebates & any unusual payment arrangements: ERISA concerns (8/26/16)

States Taxing TPAs?: Talking Points & Strategy (7/27/11)

Overpayment Refunds from Providers (for your eyes only) (4/25/11)

More & Broader Privacy Expected (12/21/10)

Welfare Benefit Plan Subject to Suit Based on Assignment (10/1/09)

Funding: Practical Hints to Protect Yourself If You Think a Client Isn't Going to Fund Claims (4/1/09)

Passing Info from TPA to TPA during Client Change: Some Considerations (4/1/09)

Caution to TPAs Related to Medical Entities or other outside owners (2/2/09)

Double Warning on Independent Contractor Employment Status (2/2/09)

Bank Failures and Dumping TPAs (11/7/08)

When You Overpay a Provider (11/5/08)

Hints When the TPA is Being Sued or Attacked (9/11/08)

Disaster Thinking & Planning Strategies for Your Firm (1/28/08)

Avoiding the Big-Buck Costs & Liabilities (12/8/06)

Beware "Too Easy" Options In Benefit Administration (12/8/06)

Bill Collector Woes: PPO, Providers and Old Higher Charges - Still at it. (12/8/06)

Canada Issues: Importing Drugs - Canada Drug Warning (again) (Nov 2003) (12/8/06)

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)

Why 99% of Plans Should Have a Formal Trust (12/8/06)

Bill Collectors: More "Bill Collector" Tactics & Defense (1/24/06)

Collection Agency Harassment for Medical Bills (11/8/02)

Bill Collectors: Under State and Federal Law (11/8/02)

Why VEBA Tax-exemption is Obsolete These Days (9/1/96)

Contacts - Technology

SPBA Technology Contacts (11/21/24)

Federal Guidance

Articles and Materials

IRS Releases Notice on HDHPs and Post-COVID Coverage Rules (6/29/23)

Agencies Release FAQs on the End of the COVID-19 Emergencies (4/5/23)

NSA Release: Federal Agencies Release Federal Independent Dispute Resolution Process Checklist (6/6/22)

Agencies Release Additional Guidance on OTC COVID-19 Testing Coverage (2/25/22)

What TPAs Should Know About the COVID-19 Mandate (12/15/21)

New FAQ Addresses Vaccine Coverage, Incentives, and Vaccine-based Exclusions (10/5/21)

CMS Releases Vaccine Set of Toolkits (12/30/20)

EEOC Issues Vaccination Guidance (12/30/20)

EEOC Provides Additional Guidance in FAQs regarding COVID-19 (6/22/20)

EEOC Provides Additional Guidance for Re-Opening Workplaces (6/22/20)

OSHA Provides Guidance on Face Coverings for Re-Opening Workplaces (6/22/20)

CMS Offers Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements in Response to the COVID-19 Outbreak (5/15/20)

OCR COVID - 19 Webinar Available Now (4/29/20)

EEOC Posts Additional FAQs Regarding Testing & Returning to Work. (A Continuation of Previous Article) (4/24/20)

EEOC Posts Additional FAQs Regarding Testing & Returning to Work (4/24/20)

B. COVID-19 SPBA Member Questions with Answers April 21 (4/23/20)

EEOC Posts Additional FAQs on COVID-19 (4/20/20)

EEOC Posts FAQs Responding to Employer Questions Regarding COVID-19 (4/10/20)

EEOC Releases FAQs and Webinar on ADEA and Antidiscrimination Issues on COVID-19 and Pandemic (4/8/20)

Department of Labor Regulations Clarifies FFCRA Benefits (4/3/20)

A. COVID-19 Frequent Questions from SPBA Members (4/1/20)

House Passes ‘Phase 3’ COVID-19 Stimulus Bill (3/27/20)

Department of Labor Releases FAQ, Guidance on Families First Coronavirus Response Act (3/25/20)

DOL Factsheet: Families First Coronavirus Response Act Employee Paid Leave Rights (3/25/20)

DOL Factsheet: Families First Coronavirus Response Act Employer Paid Leave Requirements (3/25/20)

DOL FAQ on Families First Coronavirus Response Act (3/25/20)

EEOC Response to COVID-19 (3/20/20)

Official Source Documents

FAQS ABOUT FAMILIES FIRST CORONAVIRUS RESPONSE ACT, CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT, AND HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT IMPLEMENTATION PART 58 (4/4/23)

COVID-19 Vaccination and Testing; Emergency Temporary Standard (Federal Register) (12/13/21)

Testing Price & Preventive - COVID IFC Reg (Federal Register - Nov 6, 2020) (12/1/20)

OCR: Enforcement Discretion Regarding COVID-19 Commercial Testing Sites (5/18/20)

CMS: Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements (5/15/20)

COVID-19 Timeline Extension Final Rule (4/29/20)

HHS: Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency (4/20/20)

Tri-Agencies Issue Coronavirus FAQs (Link) (4/14/20)

OCR Announces Notification of Enforcement Discretion for Community-Based Testing Sites During the COVID-19 Nationwide Public Health Emergency (4/9/20)

OCR Issues Bulletin on Civil Rights Laws and HIPAA Flexibilities That Apply During the COVID-19 Emergency (4/9/20)

CDC - ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020 (4/7/20)

HHS OCR: Notification of Enforcement Discretion to Allow Uses & Disclosures of PHI relating to COVID-19 by Business Associates (4/7/20)

Treasury Factsheet on Paycheck Protection Program (4/2/20)

IRS FAQs on Tax Credits (4/1/20)

OCR: OCR Announces Notification of Enforcement Discetion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency (3/30/20)

DOL Q&A: Families First Coronavirus Response Act: Questions & Answers (3/30/20)

DOL: U.S. Department of Labor Adds to Guidance for Workers & Employers Explaining Paid Sick Leave & Expanded Family & Medical Leave Benefits Under the Families First Coronavirus Response Act (3/30/20)

HHS: COVID-10-19 and HIPAA Disclosures to Law Enforcement, Paramedics & Other First Responders & Public Health Authorities (3/30/20)

Essential Worker Definition Guidance from US Homeland Security (3/24/20)

Agencies Announce Plan to Implement Paid Leave and Tax Credits (3/21/20)

CMS: Essential Health Benchmark Coverage & COVID-19 (3/19/20)

IRS Notice 2020-15: High-deductible health plans can cover coronavirus costs (3/11/20)

Health Reform Law

Articles and Materials

Court In ACA Case Imposes ERISA Responsibilities on Plan Sponsor and TPA. (1/30/23)

ACA: Accidental Birth Explains the Law's Illogic Today (5/22/13)

PPACA Time Line Advisory (for Webinar) (5/7/10)

Heath Care Reform: A Perspective Through the Eyes of a Group Health Plan (ppt for webinar) (5/7/10)

Official Source Documents

Keeping the Affordable Care Act Promise (Bill) (11/15/13)

The Second Package of the Health Care Reform Law (statutory language) (pdf format) (4/7/10)

Health Reform Bill Passed by House & Senate (Actual Bill) pdf format (3/22/10)

Hospital Transparency

Articles and Materials

SPBA Meeting with GAO on the Use of Hospital Pricing Information (2/27/24)

SPBA Comments on CMS Hospital Transparency Proposed Rule (2/6/20)

YOUR Achievement on Hospital Price Transparency (5/8/13)

Transparency Documentary Trailer (6/5/12)

SPBA Policy Brief on Hospital Transparency (Updated version posted 4/20/12) (10/28/11)

Sharing Hospital Transparency (7/12/11)

Hospital Transparency (6/3/11)

ACOs (Accountable Care Organizations)

Official Source Documents

ACO Proposed Regs: Federal Register April 7, 2011 (4/15/11)

Air Ambulance

Articles and Materials

Air Ambulance and Patient Billing Advisory Committee Report #1 (7/15/21)

Air Ambulance Letter to Senate (8/8/18)

Financial

Audited Financial Statements 2023 (11/15/24)

Accounting Services Wendroff Business Engagement Letter (9/30/24)

Bank Contacts (8/2/24)

Dues Structure Approved Through 2024 (8/4/23)

Audited Financial Statements 2020 (11/19/21)

Oversight of Money into/from SPBA and Office Money Handling Processes (5/13/21)

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)

Showing Overhead Charges for Association Major Activities for IRS Reporting Purposes (11/12/09)

History: Dues & Contacts Worksheet Approved for 2008 (11/12/09)

History on Dues & "Contacts" (11/12/09)

SPBA, Money + Management + Board Perks Philosophy History (11/12/09)

Safeguard Procedures for SPBA Audit (3/20/07)

Lobbying Accounting Explanation (5/1/05)

Marketing TPA Services + PR

Articles and Materials

Why Use a TPA? (10/13/20)

Choosing & Evaluating TPA Services (6/25/19)

Self-Funding Success Website: Use Self-Funding 101 Content in your Content (11/15/16)

Self-Funding Success Website: Adding Links to Your Site (11/15/16)

Self-Funding Success Website: Develop Your Testimonials into Success Stories (11/15/16)

Self-Funding Success Website: Posting Success Stories on Your Social Channels (11/15/16)

Self-Funding Success Website: Your "Actual Success" Articles Requested (11/15/16)

What Brokers Should Seek in A TPA (2/13/12)

What Happens When an Employer Makes the Switch to Self-Funding (2/2/12)

An Open Letter to Cost-conscious Clients of SPBA Member TPAs (11/3/09)

Hints on Marketing to TPAs (11/3/09)

"Stung" or Risk Averse? (10/20/09)

A Handy Way to Remember Who is "Administrator" & "Fiduciary" (10/20/09)

An Open Letter to Clients and Potential Clients of SPBA Members (10/20/09)

Canada Issues: Admin Costs: US vs Canada (10/20/09)

Congratulations & Press Tips (10/20/09)

Letter to Editor - "Business Insurance" - Value of TPAs (10/20/09)

Luring Your Clients Away (10/20/09)

Outsourcing & Offshore Considerations (10/20/09)

Performance Standards, Guarantees, Penalties & Bonuses (10/20/09)

Responses to Anti TPA Propaganda (10/20/09)

Rewards for TPAs in Government Complicance (10/20/09)

The greatest challenge for employee benefits: Government Compliance (10/20/09)

TPA Cost Value (10/20/09)

Your TPA Firm as a Leading "Good Guy" (10/20/09)

IRS Retirement Plan News (10/1/09)

What We Tell Vendors and Researchers About You (12/8/06)

Misperceptions About "Extra Security" When an Insurer is Contract Administrator Versus an Independent TPA Firm (7/10/95)

Reference-Based Pricing

Articles and Materials

How Montana cut healthcare costs with reference-based pricing (1/3/19)

Webinar

Webinar: Reference-Based Pricing (1/3/19)

State Guidance

Articles and Materials

Worker's Comp: Workers Comp for Essential Employees (4/29/20)

Worker's Comp: State Worker's Compensation Issues May Impact Claims Processing (4/23/20)

Worker's Comp: State by State Worker's Compensation Bulletins & Orders - April 2020 (4/23/20)

NAIC Database Features State COVID-19 Actions (4/17/20)

States May Become the Nexus of COVID-19 Action (4/17/20)

State Responses to COVID-19 (4/7/20)

Official Source Documents

Illinois: Worker's Comp Commission: Notice of Emergency Amendments (5/4/20)

South Dakota: COVID-19 & Health Benefit Plans (4/6/20)

Nevada: Emergency Regulation Concerning COVID-19 & Insurance (4/6/20)

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)

Peurto Rico: Extension of Term of Insurance Contracts & Policies (4/6/20)

Ohio: Access to Coverage for Ohioans Impaced by COVID-19 + FAQs (4/6/20)

Rhode Island: Bulletin 2020-4: Flexibility in Insurance during COVID-19 Emergency (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)

Texas: Coverage for COVID-19 Testing & Network Adequacy (4/6/20)

Virginia: Payment Extensions of COVID-19 Deadlines (4/6/20)

Virginia: Flexibility & Consideration in Determining Due Dates & Cancellations (4/6/20)

Wyoming: WY Licensing Updates Ralated to COVID-19 (4/6/20)

Wyoming: Bulletin 20-01: Requirements for Cost-Sharing & Coverage Related to Respiratory Illnesses including COVID-19 (4/6/20)

Oklahoma: Imediate Measures Related to Impact of COVID-19 (4/3/20)

Oklahoma: Bulletin No 2020-1 - Immediate Measures Relating to COVID-19 (4/2/20)

Maine: Supplemental Order Regarding Remote Delivery of Health Services (4/2/20)

Kansas: Insurance Carriers to Cover COVID-19 Testing (4/2/20)

Colorado: Establishing a COVID-19 Special Enrollment Period (4/2/20)

Minnesota: Memo to Health Insurance Carriers Related to Coronavirus (4/2/20)

Illinois: Expand Telehealth Services & Protect Health Care Providers (4/2/20)

Michigan: State of Emergency Executive Order 2020-21 (4/2/20)

Mississippi: Insurance Coverage Regarding the Use of Telemedicine (4/2/20)

Mississippi: Moratorium on Policy Cancellations/Non-Renewals + Q&As (4/2/20)

District of Columbia: Response to COVID-19 Public Health Emergency (4/2/20)

District of Columbia: FAQs on Insurance Issues Related to COVID-19 (4/2/20)

Connecticut: 60-Day Grace Period for Insurance Premium Payments Due to Disruption Caused by COVID-19 (4/2/20)

California: 60-Day Grace Period for Insurance Premium Payments (4/2/20)

Alabama: Cancellation or Non-Renewal Recommendation due to COVID-19 Pandemic (4/2/20)

Arizona: Expansion of Telemedicine + Expansion of Telemedicine Memo (4/2/20)

Missouri: Assistance to Policyholders Impacted by COVID-19 (4/1/20)

Rhode Island: COVID-19 Health Benefit Changes Consumer FAQs (4/1/20)

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)

Pennsylvania: Notice Regarding COVID-19 Insurance Coverage (4/1/20)

Louisiana: Declaration of Emergency (4/1/20)

Wisconsin: COVID-19 Coverage Request (4/1/20)

Iowa: Proclamation of Disaster Emergency (3-22-2020) (4/1/20)

Iowa: Proclamation of Disaster Emergency (3-17-2020) (4/1/20)

Utah: Coverage for COVID-19 (4/1/20)

Utah: Premium Holiday for Employers that have Closed Due to the Coronavirus but Continue to Pay Employees (4/1/20)

Utah: Guidance for Business Interruption Claims Related to COVID-19 or the March 18 Earthquake (4/1/20)

Tennessee: COVIDS-19 Guidance to Carriers (4/1/20)

West Virginia: COVID-19 Regulatory Guidance (4/1/20)

Texas: COVID-19 Bulletin for Claim-handling Deadlines & Premium Payments (4/1/20)

Iowa: Proclamation of Disaster Emergency (3-19-2020) (4/1/20)

Washington: Emergency Order in Response to COVID-19 Outbreak in Washington State (4/1/20)

Washington: Clarifiying & Expanding of the Requiremnts of Emergency Order 20-01, Ordering Increased Flexibility regarding the Use of Telemedicine & Providing a Minimum 60-Day Grace Period for Payment of Premiums (4/1/20)

Washington: Telemedicine (4/1/20)

Hawaii: Request Regarding Policyholders Affected by COVID-19 (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)

Delaware: Additional Guidance Relating to COVID-19 (4/1/20)

Florida: Guidance for Business Continuity & Continuity of Operation Plans (4/1/20)

North Dakota: Coverage for COVID-19 Testing (4/1/20)

North Dakota: Assistance for Consumers, Claimants & Covered Persons Impacted by COVID-19 (4/1/20)

North Dakota: Expansion of Telehealth Services (4/1/20)

North Dakota: Electronic Reporting & Deadline Extentions (4/1/20)

Missouri: Executive Order (4/1/20)

Maryland: Proclamation of State of Emergency & Catastrophic Health Emergency (4/1/20)

New York: Continuing Temporary Suspensiopn & Modification of Laws Relating to the Disaster Emergency (4/1/20)

Alaska: Requirements for Group Health Plans, Claims, & Telehealth Related to the COVID-19 Public Health Emergency (4/1/20)

Alaska: Fair Treatment of Consumers During State of Emergency Due to COVID-19 (4/1/20)

Alaska: Temporary Suspension of Certain Utilization Review & Notification Requirements (4/1/20)

Alaska: Premium Relief Due to COVID-19 (4/1/20)

Alaska: Requirements for Cost Sharing & Coverage Related to Respiratory Illnesses Including COVID-19 (4/1/20)

Alaska: Changes to Coverage for Telehealth (4/1/20)

Arkansas: State COVID-19 Health Emergency (3/31/20)

Arkansas: Cancellation Moratorium for Employment Disruption (3/31/20)

Georgia: Georgia Directive: Temporary Suspension of Certain Utilization Review & Notification Requirements (3/31/20)

Georgia: Georgia Bulletin: Lost of Health Insurance Due to COVID-19 (3/31/20)

Indiana: Indiana COVID-19 Bulletin (3/30/20)

Louisiana: Louisana Emergency Rule (3/30/20)

Kentucky: Kentucky Department of Insurance COVID-19 Executive Order (3/30/20)

Ohio: Ohio Bulletin on Out-of-Network Coverage (3/26/20)

Ohio: Ohio Bulletin on Stop Loss and Non-federal Government Plans (3/26/20)

New York: New York to Require Insurers to Waive Covid-19 Test Cost-Sharing (3/3/20)

Administrative Simplification

Articles and Materials

HIPAA Operating Rules Survey + Free Webinar (5/27/15)

Issues for TPAs regarding HIPAA First EDI Certification (3/26/14)

New ACA Proposed Rule on EFT Certification (2/27/14)

HIPAA – Administration Simplification (1/30/14)

HHS issues Health Identifier Rule and Formally Delays ICD 10 (4/18/12)

HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers (1/27/12)

Health Reform Changes to EDI (ppt. from Webinar) (9/2/11)

New Rules on EDI (7/12/11)

Official Source Documents

Rescinding HPID Requirement Final Rule 2019 (11/1/19)

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities (7/29/15)

CMS-AMA ICD-10 Flexibilities Statement (7/29/15)

ICD-10 - Testing with CMS (7/29/15)

Administration Simplification: Certification of Compliance Proposed Rule for Health Plans: Federal Register January 2, 2014 (1/2/14)

IFR on Administrative Simplification (HHS: a pdf document) (7/13/11)

Americans with Disabilities Act

Articles and Materials

Court Holds ADA Covers Gender Dysphoria (9/7/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

EEOC Expands ADA's Definition of "Disability" (8/15/19)

Judge Dismisses Challenge to Wellness Program (8/15/19)

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)

Pregnancy Discrimination: EEOC Delivers New Guidance on Pregnancy Discrimination under ADA Duties (article) (7/31/14)

Official Source Documents

Pregnancy Discrimination: Press Release: EEOC Issues Updated Enforcement Guidance on Pregnancy & Related Issues (Link) (8/4/14)

Pregnancy Discrimination: Enforcement Guidance: Pregnancy Discrimination & Related Issues (Link) (8/4/14)

Pregnancy Discrimination: Q & As about the EEOC's Enforcement Guidance on Pregnancy Discrimination & Related Issues (Link) (8/4/14)

Education & Outreach

Articles and Materials

Forecasting Gov't & Politics: Divisiveness + Possible Solutions (1/25/18)

Educating Your Members of Congress (6/6/17)

ACA Repeal & Replace Talking Points (1/17/17)

Self-Funding: Myths vs. Facts (9/2/14)

Health Reform: Today's (June 14, 2013) Insights +PR Tips (6/14/13)

Fraud

Official Source Documents

Cyber Criminals Target Healthcare & Essential Services to Steal Sensitive Research Data & Intellectual Property (5/6/20)

IC3 Releases Alert on Extortion Email Scams (4/21/20)

FBI Releases Guidance on Defending Against VTC Hijacking & Zoom-bombing (4/13/20)

CISA: COVID-19 Exploited by Malicious Cyber Actors (4/9/20)

FBI Sees Rise in Fraud Schemes Related to the Coronavirus Pandemic (4/7/20)

Incoming Chair & Sec/Treas Orientation

Secretary/Treasurer Invitation for Orientation (11/11/09)

Operations + Ownership Tips

Articles and Materials

SSAE 16: Survival Guide (ppt from Fall 2011 Meeting) (3/1/18)

SPBA Non-Discrimination and Anti-Harassment Policy (9/17/14)

Your Spokesperson Responding to Emergencies: How to Strategy (10/18/11)

Frequently Asked Questions about TPAs (3/21/11)

Handling Prescriptions for Non-Prescriptions Progress Report (12/21/10)

Successful Mergers & Acquisitions (11/16/09)

Buy/Sell: Most Frequent Questions about Buying TPAs (11/3/09)

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)

Buy/Sell: What's the Price Range to Buy or Sell a TPA? (12/8/06)

Expense & Operational Benchmarks of Well-Run TPAs (12/8/06)

No TPA Operating Ratios Or Staffing Standards (12/8/06)

TPA Operating Ratios $$$$$: A primer for TPAs and those asking them for this data (12/8/06)

What are the impacts of mergers & buy-outs on TPA operations? (12/8/06)

What are the Roles, Advantages, and Disadvantages of TPAs in Managing Pension Payments? (12/8/06)

Official Source Documents

AICPA Advisory on Outsourced Plan Functions (9/7/07)

Anti-Fraud

Articles and Materials

Health Care Reform Anti-Fraud Sleepers (12/21/10)

Cafeteria Plans

Articles and Materials

2025 Health FSA Inflation-Adjusted Amounts (12/9/24)

Health FSA Inflation-Adjusted Amounts for 2024 (11/12/23)

IRS Issues Notice Expanding Some Permitted Change-in-Status Rules for Cafeteria Plans (12/1/22)

2021 COLAs for "HCP" and "Key" in Cafeteria Plans (12/1/20)

A. 2019 COLAs for "HCP" and "Key" in Cafeteria Plans (11/13/18)

B. 2018 COLAs for "HCP" and "Key" in Cafeteria Plans (11/30/17)

Official Source Documents

IRS Notice 2020-90: COVID-19 Guidance Under § 125 Cafeteria Plans and Related to High Deductible Health Plans (9/28/20)

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)

IRS Notice on FSA Distributions for Reservists (11/21/08)

Federal Register: Final Rules on Dependent Care Services (8/28/07)

Federal Register: Proposed Cafeteria Plan Regulations, August 6, 2007 (8/10/07)

Debit Card IRS Revenue Ruling (12/8/06)

Preamble to Proposed Reg on Dependent Care Expenses (12/8/06)

Prop Reg § 1.21-1. Expenses for household and dependent care services necessary for gainful employment. (12/8/06)

IRS Notice on "Use-It-or-Lose-It" Grace Period (5/19/05)

ERISA, Fiduciary Issues, and Types of Plans

Articles and Materials

MHP and FMLA (7/5/22)

Plan Limitations and ERISA (7/5/22)

Investment Statements

October 2021 Investment Statement (11/12/21)

SPBA 2020 First Quarter Investor Holdings Report (4/3/20)

SPBA Board of Directors

Articles and Materials

SPBA Board of Directors Application (11/20/24)

June 2024 - May 2025 SPBA Board of Directors Contact Info. (7/19/22)

Board of Director's Role Description (7/11/17)

Self-Nominate to be a SPBA Board Candidate (4/3/13)

Stop-Loss

Articles and Materials

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)

NAIC White Paper: Stop-Loss & Self-Funding (Attached: White Paper: Stop-Loss Insurance, Self-Funding & ACA) (8/13/14)

SPBA Talking Points for Letters on Stop-Loss Attachment Points (8/31/12)

Answers to Request for Information about Stop-Loss (5/2/12)

Official Source Documents

State of Connecticut Stop Loss Insurance Coverage (Bulletin HC-108 & PC-80) (12/30/15)

White Paper: Stop-Loss Insurance, Self-Funding & ACA (8/13/14)

AHPs (Association Health Plans)

Official Source Documents

Presidential Executive Order Promoting Healthcare Choice & Competition (8/13/19)

Associated Health Plans & DOL (Case) (3/29/19)

AHP: ERISA Compliance Assistance (10/22/18)

Q&As on Employer Shared Responsibility Provisions Under the ACA (8/22/18)

Lobbying & Government Relations Policy

IRS Technical Guide on 501(c)(6) (7/27/23)

What Percent of SPBA Activities are "lobbying" in IRS eyes? (11/13/09)

General Positions* of SPBA as Board guidance of how SPBA approaches & proceeds with govt. issues. (11/13/09)

Lobbying Disclosure vs Lobbying Non-Deductible (3/11/96)

Articles and Materials

A Reality Check of SPBA's Role (11/13/09)

SPBA Organizational Information

Articles and Materials

SPBA Dues Structure for 2025 (1/11/24)

By-Laws of the Society of Professional Benefit Administrators (2/27/23)

SPBA Staff (5/29/22)

SPBA Digital Graphics (11/11/20)

SPBA Non-Discrimination and Anti-Harassment Policy (10/2/14)

SPBA Code of Ethics (9/17/14)

SPBA Code of Ethics (9/8/14)

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)

A Members' Guide to SPBA Operation Policies & Customs (10/20/09)

CEO, COO, CFO Insight (10/20/09)

Hints for senior contacts (10/20/09)

How to figure your income size for SPBA purposes (10/20/09)

Important Warnings (10/20/09)

Members' Bad Office Habits (10/20/09)

Only Named Contacts May Contact SPBA for Technical Assistance (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)

SPBA's Board of Directors: What do they do and how are they chosen? (10/20/09)

What Makes SPBA Tick (10/20/09)

What SPBA Can + Can Not Do to Support State TPA Associations (10/20/09)

Why SPBA Does Not Take Formal "Positions" (10/20/09)

A Brief History of SPBA (5/1/09)

Annual and Lifetime Limits

Articles and Materials

Annual and Lifetime Limits: Reg Writers Provide Insights on PPACA Issues (11/15/24)

More on Annual and Lifetime Limits (Email) (1/13/24)

Prohibition on Lifetime and Annual Limits (Article) (5/13/10)

Official Source Documents

Annual and Lifetime Limits (Federal Register): Preexisting Condition Exclusions, Patient Protections (primary care physician choice, emergency services), Rescissions (6/29/10)

Fact Sheet on Patient Protection Annual Limits (Email) (6/22/10)

Cafeteria Plans - Explanation and Commentary

Articles and Materials

IRS Issues Memo on FSA Claim Substantiation (5/26/23)

IRS Issues Notices to Relax Cafeteria Plan Election Rules for COVID-19 and Increase Health FSA Carryover (9/28/20)

$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 Changes in the Economic Downturn (7/30/09)

Cafeteria Plans: Identifying Trouble Areas (11/5/08)

New Proposed Cafeteria Plan Regulations (1/23/08)

IRS Issues New Proposed Cafeteria Plan Regulations - John Hickman, Esq. Alston & Bird (10/11/07)

Cafeteria Plan Election Changes (12/8/06)

IRS Comments on Reimbursing Over-the-Counter Drugs (12/8/06)

IRS Notice on Debit Cards and Substantiation in FSAs (12/8/06)

IRS Suspends Requirement to File Schedule F of the 5500 Form for Cafeteria Plans (12/8/06)

Warning!! IRS Seeks to Audit for Debit Card Compliance (11/20/06)

Cafeteria Plans and Other Related Documents - Ashley Gillihan, Alston & Bird, LLP (10/31/06)

Debit Cards (10/24/06)

Technology Service Partner

Articles and Materials

Service Partner Application (2024) (2/7/24)

Auto Enrollment

Articles and Materials

Auto Enrollment (11/4/15)

Auto-enrollment Rules for Employers with Over 200 Employees (12/21/10)

Official Source Documents

DOL Technical Release: No. 2012-01 - Auto Enrollment (7/12/13)

Understanding Government Role & Perspective

Articles and Materials

11 Common Benefits Myths (12/8/06)

A Dozen Quick Answers to Frequently Asked Questions (12/8/06)

Form over Function (12/8/06)

Government Compliance: Your Biggest Cost & Threat (12/8/06)

Recognizing Who is the Boss of Your Benefit Plan and Your Largest Legal Liability (12/8/06)

What We Tell Vendors and Researchers About You (12/8/06)

Who is "Government" (12/8/06)

Why So Much Government Regulation? Why Use a TPA? (12/8/06)

A Guide to Really Understanding and Really Influencing Government Policy-Making (11/1/96)

Cadillac Tax

Articles and Materials

Spending Bill Reauthorizes PCORI, Repeals Cadillac Tax (1/3/20)

Cadillac Tax Delay (1/29/18)

Cadillac Tax Delayed Until 2020 (5/17/17)

Excise Tax Comments from SPBA (5/21/15)

Excise Tax (Slides from Webinar: Latest Developments & Looking Ahead) (3/13/13)

Official Source Documents

IRS Second Notice (2015-52) on Excise Tax on High Cost Plans (7/31/15)

Statute of Excise Tax on High Cost Employer Sponsored Health Coverage (5/8/15)

Congressional Report on Explanation of Cadillac Tax (5/8/15)

IRS Notice on Excise Tax on High Cost Coverage (2/24/15)

Chevron

Webinar

Webinar: The Chevron Decision: What You Need To Know (8/2/24)

Membership Eligibility & Trends

The Unique Relationship & Expectations of SPBA Members (9/1/09)

Cases

Articles and Materials

Defense of Marriage Act Headed to Supreme Court (6/1/12)

Official Source Documents

Order from Florida Court on Obamacare (2/7/11)

Webinar

Webinar: The Chevron Decision: What You Need To Know (8/2/24)

CHIPRA

Articles and Materials

Employer CHIP Notices (8/15/19)

CHIPRA Notice Requirements (4/27/09)

Official Source Documents

CHIP DOL Release (8/15/19)

CHIP Model Notice Regs (Federal Register) (8/15/19)

Explanation of CHIP Model Notice (Federal Register 2-4-10) (2/4/10)

Model CHIP Notice (2/4/10)

Minutes of Board Meetings

10/26/2018 - Fall - 2018 - September 26, 2018 (12/10/18)

4/4/2018 - Spring - 2018 - April 4, 2018 (11/26/18)

6/22/2018 Board Minutes & Resolution (7/18/18)

Articles and Materials

2024-June-6: SPBA Board Call Minutes (8/3/24)

2024-May-20: SPBA In-Person Board Meeting Minutes (8/3/24)

2024-May-19: SPBA Board Strategy Meeting Minutes (8/3/24)

2024-May-2: SPBA Board Call Minutes (8/3/24)

2024-Apr-4: SPBA Board Call Minutes (8/3/24)

2024-Mar-7: SPBA Board Call Minutes (8/2/24)

2024-Feb-1: SPBA Board Call Minutes (8/2/24)

2024-Jan-4: SPBA Board Call Minutes (8/2/24)

2023-Dec-7: SPBA Board Call Minutes (8/2/24)

2023-Nov-2: SPBA Board Call Minutes (8/2/24)

2023-Oct-5: SPBA Board Call Minutes (8/2/24)

2023-Sep-13: SPBA In-Person Board Meeting Minutes (8/2/24)

2023-Aug-3: SPBA Board Call Minutes (8/2/24)

2023-Jul: SPBA Board Call Minutes (8/2/24)

2023-Jun-1: SPBA Board Call Minutes (8/2/24)

2023-May-4: SPBA Board Call Minutes (8/2/24)

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)

Claims

Articles and Materials

Schedule J Proposed in New 5500 Regulations (12/5/16)

Official Source Documents

Claims Regs - Final Rules: 2015-29294 (12/28/15)

COBRA

Articles and Materials

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

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)

IRS Posts Reminder and Form for Reporting on COBRA Subsidy Recipients (8/16/19)

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)

Refresher on Medicare as a Second Qualifying Event and COBRA (8/16/19)

FAQ 32 COBRA (8/15/19)

FAQ 32 COBRA (6/29/16)

Gillihan's COBRA Presentation (11/3/05)

Final COBRA Regulations & Other COBRA Guidance - Ashley Gillihan. Esq. Alston & Bird LLP (10/21/04)

Summary of Changes from 2003 Proposed COBRA Regulations - Hickman & Gillihan, Alston & Bird LLP (10/21/04)

Official Source Documents

Premium Assistance for COBRA Benefits (Notice 2021-31) (5/19/21)

FAQs About the ACA Implementation Part 32: COBRA & Health Insurance Marketplace (8/15/19)

1999 and 2001 Final COBRA Regs (8/16/09)

Other Issues & Explanations

Why the No-Commercialism Policy? (11/13/09)

SPBA's Role, Government Strategies, Visibility etc. with Other Organizations (2/3/09)

The Image & PR of the TPA Industry (10/1/99)

White Paper - Oct. 1999: Answers from Spring Meeting Speakers (10/1/99)

"White Paper" on Meetings (10/1/94)

Self Regulation for TPAs? (12/27/89)

Claims and Appeals/External Review

Articles and Materials

Benefit Claims, Appeals and External Review Deadlines (8/17/11)

Revised Model Notices, and Guidance on Internal Claims and External Review (7/12/11)

Agencies Release New External Review Technical Release (6/23/11)

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)

Benefit Claims, Appeals and External Review Timeline (6/20/11)

DOL Extends enforcement of Internal Claims and Appeals Rules (3/21/11)

Internal Claims/Appeals & External Review Processes Fall 2010 Meeting Notes (11/9/10)

Grace Period for Internal Claims & Appeals; DOL Technical Release 2010-02 (11/3/10)

Model Notices on Federal External Review Procedures for Self-Funded Plans (9/1/10)

Internal Claims/Appeals and External Review Processes under PPACA and its Companion Bill, The Health Care and Education Reconciliation Act of 2010 and its Model Notices (8/17/10)

Interim Final Regs on Internal Claims & Appeals & External-Review Requirements (E-mail Alert/Article) (7/22/10)

Interim Final Rules for Claims & Appeals & External Review Processes (statutory language) (7/22/10)

Uniform Health Carrier External Review Act (statutory language) (7/22/10)

Official Source Documents

DOL Technical Release: Extension of External Review Process 2013-01 (3/20/13)

Rules Relating to Internal Claims & Appeals & External Review Process: Amendment to Interim Final Rules with Request for Comments (6/23/11)

Technical Release 2011-02: Guidance on External Reviews (6/23/11)

Regulations for Internal Claims & Appeals Effective Date Extended + Technical Release 2011-01 (3/18/11)

Federal External Review Process: Request for Information (Federal Register 11/17/10) (11/18/10)

DOL Technical Release 2010-02/Interim Procedures (10/25/10)

COBRA-ARRA

Articles and Materials

COBRA Model Notices (8/16/19)

DOL Posts Application for Review of Denial of COBRA Premium Reduction (8/16/19)

Fate of COBRA Subsidy and Health Reform PR (6/7/10)

COBRA Subsidy Extension (2/24/10)

COBRA Subsidy Extension Signed into Law (12/28/09)

Frequent ARRA COBRA Subsidy Questions (7/30/09)

Draft COBRA Subsidy Applications for Expedited Review of Denials (5/8/09)

No COBRA Premium Assistance Information Return Required (5/1/09)

COBRA Expanded for TAA Individuals (4/27/09)

ARRA COBRA Subsidy Issues Discussed at SPBA Spring Meeting (4/16/09)

ARRA COBRA Subsidy: Phase II (4/16/09)

ARRA Second Chance Election (4/9/09)

DOL Releases Clarifying Illustrations of which Model Notices to Send (4/3/09)

IRS Releases Guidance on Involuntary Termination in ARRA (4/2/09)

How Multi-Employer Plans Collect COBRA 65% Subsidy (4/1/09)

Which COBRA Subsidy Model Notice Should Be Sent? (3/30/09)

Top Issue on COBRA Subsidy Model Notices Today (3/20/09)

IRS Releases Information on Reducing Payroll Deposits for the COBRA Subsidy (3/12/09)

DOL Releases Some Guidance on the COBRA Subsidy (2/27/09)

COBRA Premium Update (2/23/09)

Official Source Documents

CMS COBRA Denial Application (5/8/09)

DOL COBRA Denial Application (5/8/09)

Relations with ACL, Inc.

ACL, Inc. Management Agreement (4/26/10)

CLASS

Articles and Materials

CLAS County Data + List of Counties (Edition Date: December 2014) (1/30/15)

CLASS Act - Payroll Deductions NOT Required in 2011 (9/29/10)

Defense of Marriage Act (DOMA)

Articles and Materials

Supreme Court Decides DOMA (8/17/19)

What is DOMA? and Why Is It Under Challenge (8/17/19)

DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans (8/16/19)

Treasury Clarifies Federal Government Position on DOMA (8/16/19)

FMLA Proposed Regulation for Same Sex Marriage (2/25/15)

Health Reform: SCOTUS DOMA = Confusion for Plans & TPAS (7/8/13)

Official Source Documents

U.S. v. Windsor: Marketplace Guidance on Internal Revenue Ruling 2013-17 (10/4/13)

U.S. v. Windsor: A CMS Update (10/4/13)

Guidance to Employee Benefit Plans on the Definition of "Spouse" and "Marriage" under ERISA & The Supreme Court Decision (9/23/13)

H. Guidance to Employee Benefit Plans on the Definition of "Spouse" & "Marriage" under ERISA & the Supreme Court Decision (9/18/13)

Treasury Revenue Ruling 2013-17 + Treasury Answers on Same Sex Marriages + Treasury Revenue Ruling 2013-19 , DOMA + Treasury Press Release - DOMA (9/3/13)

U.S. v. Windsor: DOMA Opinion (6/26/13)

U.S. v. Windsor (11/1/12)

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

ACA FAQs (Part 31) Clinical Trials & MHPAEA (4/27/16)

Clinical Trials (5/28/13)

Disclosure of Fees

Articles and Materials

SPBA Comments on 408(b)(2) (9/20/11)

New DOL Proposed Rules on Disclosing TPA Compensation (1/14/08)

Official Source Documents

Temporary Enforcement Policy Regarding Group Health Plan Service Provider Disclosures (1/5/22)

NAIC Resources

Articles and Materials

NAIC Managed Care B Committees (as of 2/7/14) (2/7/14)

Old Deficit Law Triggers Modern Stop-Loss Misunderstanding (5/22/13)

TPAs Impact NAIC Vote (12/5/12)

Official Source Documents

NAIC Commissioners List (Revised1/27-14) (2/7/14)

NAIC Consumer Information Subgroup, Exchanges, Flow Chart etc. (4/17/13)

NAIC ERISA Working Group FAQs (10/18/12)

Stop-Loss Relations

Reviewing the Stop-Loss / SPBA Relationship (1/10/00)

Cost Sharing

Articles and Materials

HHS Addresses Permissible Employee Cost Sharing under Group Health Plans (12/13/24)

New Proposed Rules on EHB and Cost Sharing for plan year 2016 (1/8/15)

JCEB Meeting with Agencies on Taxation (May Meeting 2013) (8/12/13)

HHS Issues Proposed Regulations on Essential Health Benefits (12/19/12)

Official Source Documents

Standards Related to Essential Health Benefits, Actuarial Value & Accreditation; Final Rule (Federal Register) (8/16/13)

Domestic Partners

Official Source Documents

IRS - FAQs for Same Sex Couples (10/7/19)

U.S. v. Windsor (11/1/12)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)

Strategy

2023 Strategy Meeting (7/6/23)

2022 Strategy Meeting (7/6/23)

Strategic Planning Options (1/31/14)

Cures Act

Articles and Materials

New IRS & Treasury FAQs On QSEHRAs (11/28/17)

Official Source Documents

Qualified Small Employer Health Reimbursement Arrangements (11/15/17)

DOL

Articles and Materials

Plan Asset Regulations (1/24/24)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

DOL Makes Claims Records Relevant (7/15/21)

Record Retention and Electronic Disclosure Rules (1/30/20)

ERISA Advisory Council Recommends DOL Action on SPDs (10/7/19)

Comprehensive Guidance on the DOL Claims (10/7/19)

DOL Releases Claims Regs Frequently Asked Questions (10/7/19)

Undocumented Aliens on the Employee Benefit Plan? (10/7/19)

DOL's Proposed FMLA Regulations & Expanded FMLA Leave to Family of MIlitary Service (10/7/19)

DOL Disclosure Rules (4/6/09)

Letter to Brokers, Clients and Friends of TPAs on the Disclosure of Commissions & Payments (7/8/08)

New DOL Proposed Rules on Disclosing TPA Compensation (1/14/08)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form (12/8/06)

Claim Regulations Raises Fees Issue (12/8/06)

New SPD Requirements Under HIPAA (12/8/06)

SPD Disclosure Requirements Under HIPAA Confuse Many (12/8/06)

DOL Cracking down on Late-Paying Plans (3/2/00)

Official Source Documents

Level Funded Plan Arrangements Request for Comments (8/17/23)

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries (2/10/21)

DOL Answers Questions for Joint Committee on Employee Benefits, 2011 (10/7/19)

Conflict of Interest (Part II - Rule) FAQs (10/7/19)

DOL Proposed Rule on TPA Fee Disclosure (10/7/19)

DOL Extension/Comments: Definition of "Plan Assets" & National Medical Support Notice (10/7/19)

DOL Extensions/Comments: ERISA Summary Annual Report (10/7/19)

DOL Extensions/Comments: Terminated Individual Account Plans (10/7/19)

DOL Reporting & Disclosure Guide for Employee Benefit Plans (10/7/19)

2017 DOL Annual Report on Self-insured Group Health Plans (3/1/17)

Dental Plans

Articles and Materials

Dental Plans and Health Care Reform (11/3/10)

"Excepted Benefits" and Health Care Reform (9/29/10)

Dental Plans and Dependent Coverage of Children to Age 26 (5/13/10)

EDI/HIPAA Administrative Simplification

Articles and Materials

Administrative Simplification HIPAA Regulations Fact Sheet (7/7/22)

Administrative Simplification Reassociation Basics Fact Sheet (7/7/22)

OCR Updated the Health Data Breach Reporting Tool (12/13/21)

HHS Audit + HIPAA Administration Simplification Audit - Criteria (12/17/20)

ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)

HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers (1/27/12)

Final Rules on EDI Transactions/Code Sets are Released (August 2000) (10/4/11)

National Provider Identifier Numbers Available (6/28/07)

HHS Provides Feedback on NPI (12/8/06)

TPA Websites for Providers and EDI (12/8/06)

CMS Alerts Regional Offices to Digital Healthcare (9/8/06)

Official Source Documents

HIPAA Administrative Simplification Regulations Overview (7/7/22)

EFT and ERA: Payment Remittance Reassociation Basics (7/7/22)

Administrative Simplification Compliance Resources (6/29/18)

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities (7/29/15)

CMS-AMA ICD-10 Flexibilities Statement (7/29/15)

ICD-10 - Testing with CMS (7/29/15)

Federal Register: Updated Version of HIPAA Transactions Adopted (1/26/09)

National Provider Identifier Dissemination System (6/4/07)

CMS Announces Contingency Plan on NPI (4/27/07)

Federal Register 2004 Final Rule on National Provider Identifier (12/8/06)

Federal Register 2005 Proposed Rules HIPAA Standards for Electronic Health Care Claims Attachments (12/8/06)

Dependent Coverage

Articles and Materials

Dependent Coverage to Age 26 and Active Duty (2/13/24)

DOL Q & A on Grandchildren Dependency Factors (6/5/22)

Dependent Child Coverage Questions Posed by SPBA Members (6/10/10)

IRS Guidance on Tax-Free Employer-Provided Health Coverage for Dependent Children (5/13/10)

Agencies Release Interim Final Rules on Dependent Coverage of Children to Age 26 (Email Alert) (5/10/10)

Interim Final Rules on Dependent Coverage of Children Released (Email Alert) (5/10/10)

Official Source Documents

Interim Final Rules on Dependent Coverage of Children to Age 26 Fact Sheet (5/1/15)

Interim Final Rules on Dependent Coverage of Children to Age 26 (pdf) (5/11/10)

IRS Notice 2010-38 on Tax Treatment of Health Care Benefits to Children Under Age 27 (4/29/10)

EEOC

Articles and Materials

Pregnant Workers Fairness Act (4/26/24)

EEOC Releases New COVID Rules (9/7/22)

EEOC Nonbinary (7/5/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

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)

Questions for the EEOC Staff for the 2015 Joint Committee of Employee Benefits Technical Session, May 7,2015 (10/7/19)

EEOC Fact Sheet: (FAQs) Domestic or Dating Violence, Sexual Assault, Stalking (Article) (10/7/17)

Official Source Documents

EEOC Guidelines on Sex & Pregnancy Discrimination Federal Register (10/5/17)

EEOC FAQs (Fact Sheet): Domestic or Dating Violence, Sexual Assault, Stalking (11/2/12)

5500 Forms

Articles and Materials

Schedule J Proposed in New 5500 Regulations (12/5/16)

DOL 5500 Form & Schedule J + Comment Letter (11/26/16)

Official Source Documents

Delinquent Filer Correction Program (2/8/21)

DOL Releases Advance Informational Versions of Form 5500 and Form 5500-SF (10/23/19)

Proposed DOL Rules on 5500 Form: Federal Register (7/28/16)

Proposed Revisions to Form 5500: Federal Register (7/28/16)

Early Retiree Reinsurance Program

Articles and Materials

ERRP New Guidance (8/17/11)

ERRP Clarification (8/17/11)

Early Retiree Program Issues New Q/A/ and Reminders (6/3/11)

ERRP Update (12/21/10)

DOL News: Trusts & Confidential Communications (12/21/10)

ERRP Application (8/18/10)

The ERRP Application is Now Officially Available for Filing (6/29/10)

HHS Releases Draft Application for Early Retiree Claims Subsidy (6/4/10)

Early Retirees in the Affordable Care Act (5/14/10)

Health Care Reform: Early Retirees in the Affordable Care Act (5/7/10)

Early Retirees in the Affordable Care Act (Email Alert) (5/5/10)

Official Source Documents

CMS to Stop Accepting Applications; ERRP - Federal Register Reg (4/5/11)

CMS to Stop Accepting Applications - ERRP (4/5/11)

CMS Posts New Version of ERRP Application + Dos & Don'ts (11/5/10)

Early Retiree Reinsurance Program Application etc. (6/29/10)

Early Retiree Reinsurance Program - Federal Register, May 4, 2010 (5/5/10)

Reinsurance Program for Early Retirees (Temporary) (4/27/10)

HHS Reinsurance Fact Sheet (4/8/10)

Employer Shared Responsibility

Issues to Consider When Designing Compliant Non-Major Medical Minimum Essential Coverage Plans (Webinar) (3/27/14)

Articles and Materials

Are ALEs Required to hold Open Enrollment Periods? (1/3/20)

IRS Extends 2019 ACA Reporting Deadlines (1/3/20)

IRS Releases ACA Affordability Rates for 2020 + Rev. Proc 2019-29 (8/6/19)

Employer Shared Responsibility Penalties for 2019 (2/12/19)

Marketplace Appeal Letters (8/30/16)

A Variable Hour Employee/Measurement Issues (7/25/15)

Dependent PTC and Impact on ESR Payment (6/27/15)

Documentation of Coverage Offer (9/29/14)

The SPBA Manual to the Pay or Play Rules (Updated November 26, 2014) (7/11/14)

TRANSITION RELIEF for Employer Shared Responsibility (2/27/14)

Cafeteria Plan Elections and Going to the Exchange (10/24/13)

Non-Major Medical Plan and MEC (10/24/13)

Will Changing a Plan's Renewal Date Delay Compliance with ACA? (5/31/13)

Play or Pay in 2014 (Shared Responsibility for Employers Regarding Health Coverage) (1/2/13)

Employer Penalties and Issues to Watch For (9/14/12)

Minimum Value of an Employer-Sponsored Health Plan (5/29/12)

Health Care Reform: Employer Mandate and Federal Subsidies (8/17/11)

Official Source Documents

IRS Memo on ESR Penalty Statute of Limitations (3/13/20)

ESRP Response + Employee Premium Tax Credit (PTC) Listing: Forms 14764 + 14765 (12/6/17)

IRS Letter on Calculating ESR Liability (11/13/17)

IRS Notice 2015-87: Variety of ACA Related Provisions (12/17/15)

IRS Notice on Proposed Approach to Look-Back Measurement (9/19/14)

Play or Pay 2014 Final Rules (Single Column) (3/1/14)

Notice 2013-45: Transition Relief for 2014 (7/10/13)

Play or Pay 2013 Rules: Federal Register Proposed Rules (1/2/13)

Play or Pay 2013 IRS Q&As (1/2/13)

IRS Notice 2012-31 on Minimum Value of Employer-Sponsored Health Plan (12/7/12)

IRS Notice 2012-58 - Determining Full-Time Employees (9/4/12)

IRS Notice 2012-59 - Guidance on 90 Day Waiting Period Limitation (9/4/12)

FMLA (Family Medical Leave Act)

Articles and Materials

FMLA Regs (1/29/20)

FMLA Proposed Regulation for Same Sex Marriage (2/25/15)

Wage and Hour Division (WHD) Family and Medical Leave Act (4/18/12)

FMLA Case Referral (12/21/10)

Official Source Documents

Definition of Spouse under the Family & Medical Leave Act: Fact Sheet (2/23/15)

Definition of Spouse under the Family & Medical Leave Act: FAQs (2/23/15)

Definition of Spouse under the Family & Medical Leave Act: Final Rule (2/23/15)

Essential Health Benefits

Articles and Materials

HHS sends RFI to Update Essential Health Benefits (1/31/23)

HHS Has Released the Essential Health Benefits Bulletin: How Does it Affect Group Health Plans? (12/20/11)

IOM Issues Report on Essential Health Benefits under Health Care Reform (10/31/11)

Announcement of IHB IOM Report (10/7/11)

DOL's Essential Health Benefits Report (6/3/11)

Reprint of February 22nd Email Concerning Comments on Essential Benefits (4/14/11)

Reprint of February 22, 2011 Email: Essential Health Benefits (3/9/11)

Essential Benefits & Task of Crafting Definition (2/22/11)

Essential Health Benefits (1/21/11)

Essential Health Benefits (1/14/11)

Official Source Documents

HHS's Propsed Regulations on Essential Health Benefits: Federal Register (12/20/12)

HHS Releases the Essential Health Benefits Bulletin (12/16/11)

Essential Health Benefits: Balancing Coverage and Cost Report (10/7/11)

FTC (Federal Trade Commission)

Articles and Materials

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

Excepted Benefits

Articles and Materials

Amendments to "Excepted Benefits" (10/24/14)

HHS Issues Essential Health Benefit FAQs (2/24/12)

"Excepted Benefits" and Health Care Reform (9/29/10)

Dental Plans and Dependent Coverage of Children to Age 26 (5/13/10)

Official Source Documents

Amendments to Excepted Benefits: Federal Register Proposed Rules December 24, 2013 (12/27/13)

Health Reimbursement Arrangements

Articles and Materials

Administration Finalizes New HRA Rule (6/14/19)

CMS Clarifies Payment in HRAs (12/8/06)

Historical Reminders about Patient-Directed Healthcare (PDHC) and Health Reimbursement Accounts (HRAs) (12/8/06)

Ken Harvey's Perspective on Consumer-Driven Health Plans (1/12/06)

Historical Practical Points about Patient-Directed & HRA In Your Market (10/31/02)

The Big Picture of Patient-Directed Health Care (9/1/02)

Historical Prognosis on Patient-Directed Health Care (7/1/02)

Official Source Documents

Individual Coverage HRA and Excepted Benefit HRA FAQs (1/9/20)

Final Regulations on HRAs and Account-Based Group Health Plans (6/20/19)

IRS Guidance on Small Employer HRAs (IRS Notice 2017-67) (11/2/17)

HRA - IRS Notice 2002-45 (12/8/06)

HRA - IRS Revenue Ruling 2002-41 (12/8/06)

Exchanges

Articles and Materials

Exchange Premiums for Individual Shared Responsibility (1/29/15)

Transitional Reinsurance Fee, Exchanges & SHOP (2/27/14)

Should You Reconsider Giving FLSA Exchange Notices Given New DOL Guidance? (9/13/13)

Updated: September 12, 2013: Exchange Notice: No Penalties for Noncompliance (9/12/13)

FAQs: Notice of Coverage Options (Updated 9-12-13) (9/12/13)

Penalties for Noncompliance (9/11/13)

Employers Prepare for Exchange Verification of Employer-Sponsored Coverage (9/5/13)

Myth vs. Fact: Health Insurance Marketplace on Track (8/2/13)

Exchange Regs Impact Employer Verification Requirements (7/10/13)

Pay or Play Delayed for One Year, The Exchange Notice was NOT Delayed (7/8/13)

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)

Small Business (SHOP) Exchange Delayed (Corrected) (4/3/13)

Marketplace: Video Description and URL (3/25/13)

New Exchange Regulations Include Exemptions to Individual Shared Responsibility Provision (2/4/13)

Exchange Notice Delayed (1/28/13)

State Exchange Notifications to Employees (1/18/13)

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)

Official Source Documents

FINAL 2016 Letter to Issuers In the Federally-facilitated Marketpalces (2/23/15)

HHS Notice of Benefit & Payment Parameters for 2016 (2/23/15)

IRS Revenue Procedure 2015-15 (1/30/15)

FAQs: Payment Process for January 2014 (10/23/13)

FAQs: Agent & Broker Frequently Asked Questions (10/4/13)

FAQs: FF-SHOP Issuer Frequently Asked Question (10/4/13)

Affordable Insurance Exchanges Guidance: Members of Congress & Staff Accessing Coverage through Marketplaces (10/1/13)

FAQs: Affordable Care Act Implementation (Part XVI) (9/9/13)

CMS Guidance on Clarifying Income Verification on Exchanges (8/12/13)

Employer Coverage Tool (8/1/13)

CMS Navigator Assistance Roles (8/1/13)

Exchange Regs: Standards for Navigators and Assisters (Final Rule) (7/26/13)

HHS Final Rule on Exchange Verification (7/10/13)

NAIC Consumer Information Subgroup, Exchanges, Flow Chart etc. (4/17/13)

CCIIO Letter to Exchanges (4/8/13)

Marketplace: Non FA Paper Application (3/25/13)

Marketplace Individual Questionnaire (3/25/13)

Marketplace: FA Paper Application (3/25/13)

Marketplace: Individual Application Supporting Statement (3/25/13)

Exchange Rules (2/1/13)

HHS Proposed Rule: Exchange Eligibility Appeals and Other Provisions Related to Eligibility & Enrollment for Exchanges (1/14/13)

Establishment of Exchanges & Qualified Health Plans; Exchange Standards for Employees (3/13/12)

Health Savings Accounts

Articles and Materials

IRS Releases HSA Inflation Adjusted Amounts for 2025 (5/28/24)

IRS Releases HSA Inflation Adjusted Amounts for 2024 (5/26/23)

Congress Extends Telehealth Flexibility for Two Years (1/17/23)

HSA Contribution Limits for 2020 (1/3/20)

IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan (1/3/20)

Treasury Releases Guidance on Additional Preventive Care Benefits Permitted by HDHP (7/18/19)

IRS Releases New Guidance on 2018 HSA Contribution Limits & IRS Rev. Proc. 2018-27 (4/27/18)

HSA 2018 Contribution Limits (4/24/18)

IRS Retirement Plan News (10/1/09)

The TPA & The HSA: How Not to be Just Like the Others (10/11/07)

Full-Year Contribution for Part-Year Coverage (5/24/07)

HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP (4/17/07)

Strategies for Promoting Health Savings Accounts (4/17/07)

HSA Provisions in the "Tax Relief and Health Care Act of 2006" (1/26/07)

A New TPA Profit Center: Educating Employees about HSAs (12/8/06)

Everything You Wanted to Know about HSAs: A Crash Course in Health Care Consumerism (12/8/06)

FSA Grace Period and HSA Eligibility Guidance Offers Only Short Term Relief (12/8/06)

FSA Interaction with HSAs (12/8/06)

Health Savings Accounts - First Analysis (12/8/06)

HSA Must Be Established before Qualified Medical Expenses Can Be Incurred (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)

SPBA Seattle Meeting Panel on Health Savings Accounts (12/8/06)

Treasury Releases More HSA Guidance - IRS Notice 2004-50 (12/8/06)

The President's Health Savings Account Proposals (5/3/06)

Gillihan's Overview of HSA Comparability Rules (11/3/05)

HSAs and Out-of-Pocket Maximum Carryovers (10/5/05)

Considering an HSA?. - Kathy McCormick, HSA Bank (5/2/05)

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)

More IRS/Treasury HSA Guidance Interaction with FSAs and HRAs (5/12/04)

DOL Releases Guidance on ERISA Applicability to HSAs (4/12/04)

SPBA Insights on HSA Bank/Trustee Issues (2/9/04)

Official Source Documents

IRS Notice 2004-2 (11/14/14)

IRS Notice 2004-50 (7/30/10)

Custodial Account Form (7/10/08)

IRS Notice 2008-59: New Q & As on HSAs (6/27/08)

IRS Notice 2007-22 on FSA and HRA Rollovers to HSAs (2/16/07)

All About HSAs (12/8/06)

DOL FAB 2004-01 (12/8/06)

DOL FAB 2006-02 (12/8/06)

Final HSA Comparability Rules (12/8/06)

IRS Notice 2005-86, HSA and FSA Grace Period (12/8/06)

IRS Proposed Rules on Employer Comparable Contributions (12/8/06)

Treasury Guidance on Preventive Care (1/19/06)

Notice 2005-8 - 2% Shareholders (8/5/05)

FAQs Implementation

Official Source Documents

DOL EBSA Webpage of ACA FAQs (8/1/23)

HIPAA Opt Out

Articles and Materials

Reminder on Opt-Out Rules for State and Local Government Plans (5/3/11)

Official Source Documents

HIPAA Opt-Out Model Notice to Participants (4/25/11)

HIPAA Opt Out Model Election Form (4/25/11)

FSAs

Articles and Materials

IRS Releases 2019 FSA Inflation Adjustment (11/15/18)

Comment Letter on the $2,500 Limit on Health FSAs (7/17/12)

Official Source Documents

Section 125 - Cafeteria Plans (Notice 2012-40) (5/31/12)

HHS

Articles and Materials

Health and Human Services Re-Issue Section 1557 Non- Discrimination Regulations (9/7/22)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Official Source Documents

Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance (8/17/23)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

Grandfathered Plans

Articles and Materials

What Happens When Grandfathered Status is Lost (6/5/22)

DOL Clarifies Contribution Rate Changes to Grandfather Rule (6/5/22)

Final Rule on Grandfathered Health Plans Amends Some Cost Sharing Requirements (12/30/20)

DOL Clarifies Contribution Rate Changes to the Grandfather Rule (9/27/11)

Amendment to Grandfather Rules & Waiver Limits (11/16/10)

Expendable Grandfather (8/17/10)

Agency Grandfather Table (8/2/10)

Grandfathered Interim Final Rules- A Detailed Look (7/12/10)

Grandfathered Interim Final Rules - First Look (6/15/10)

What is the Benefit of Being a Grandfathered Plan? (6/14/10)

Official Source Documents

Grandfathered Group Health Plans & Grandfathered Group Health Insurance Coverage (2/26/19)

Amendment to the Grandfather Interim Rule (pdf) (12/8/10)

Grandfathered Plans Interim Final Rules (6/14/10)

HIPAA and Privacy

Articles and Materials

New HIPAA Privacy Rules Following the Supreme Court Dobbs Ruling (12/16/24)

HIPAA Privacy Rule to Support Reproductive Health Care Privacy: Resources for Stakeholders and HIPAA Covered Entities or Business Associates (6/28/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (12/30/20)

New Frequently Asked Questions on HIPAA and Health Plans Support Care Coordination and Continuity of Care (7/1/19)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates (6/7/19)

The Supreme Court, CareFirst & Data Breach Lawsuits (2/27/18)

HIPAA Privacy Opioid Guidance (11/28/17)

HHS Modifies HIPAA In An Attempt to Address Gun Violence (1/29/16)

HIPAA Business Associate Agreements (8/27/14)

Revised 2013 Notice of Privacy Practices (Clean) (8/15/13)

Revised 2013 Notice of Privacy Practices (8/15/13)

Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)

BAA and Subcontractor: Business Associate Agreement and Subcontractor Agreement (4/5/13)

HHS Releases Sample Language for Updating Agreements Under HIPAA (1/30/13)

HHS Releases Final HIPAA Rule (1/24/13)

ONC To Develop Model Notice of Privacy Practices for Consumers (9/12/12)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

OCR Says Business Associates Will Not Be a Part of the Pilot Audit (2/24/12)

HHS To Conduct HIPAA Privacy and Security Audits (11/28/11)

HHS’ Office of Civil Rights Releases HIPAA Violations Report (9/27/11)

HIPAA Privacy Rule Accounting of Disclosures – COMMENTS Submitted by SPBA (8/17/11)

HHS Issues Proposed Rule on Disclosures of Electronic Medical Data (6/1/11)

HIPAA Privacy and the Model Notice of Adverse Benefit Determination (3/9/11)

The New HIPAA Privacy & Security Rules: What Is Now Required (10/1/09)

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)

Beware PHI Retained in Computers after a Client is Terminated (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)

Employee Confidentiality Agreement and Training Certification (12/8/06)

Flowchart Brainstorming Tools (12/8/06)

HIPAA Privacy Impact on Employers (Letter to use with Clients) (12/8/06)

HIPAA PRIVACY: Overview for TPAs (12/8/06)

Memo Explaining HIPAA Privacy Documents (12/8/06)

Plan Sponsor’s Certification of Compliance (12/8/06)

Providers Misinterpreting HIPAA Privacy (12/8/06)

Request for Access to Protected Health Information (12/8/06)

Request for Amendment of Protected Health Information Sample Form (12/8/06)

Request for an Accounting of Certain Disclosures of Protected Health Information (12/8/06)

Request for Confidential Communications Sample Form (12/8/06)

Request for Restrictions on Use or Disclosure of Protected Health Information (12/8/06)

Sample Amendment to Plan Documents (12/8/06)

TPA Privacy Issues Addressed at SPBA 2003 Spring Meeting (12/8/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule (5/3/06)

The HIPAA Security Standards: Practical Implementation Considerations - Dorthula Powell-Woodson (5/2/05)

SPBA Model Customer Service Scenarios (9/8/03)

Official Source Documents

HIPAA Privacy Rule to Support Reproductive Health Care Privacy - For Covered Entities and Business Associates. (6/28/24)

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet (7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

OCR Proposes Modifications to the HIPAA Privacy Rule to Empower Individuals, Improve Coordinated Care and Reduce Regulatory Burdens (Fact Sheet) (12/21/20)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (12/21/20)

HIPAA Audit Protocol 2016 (9/22/16)

HIPAA Privacy Rule and National Instant Criminal Background Check System (1/28/16)

Personal Representative rights for another individual's health information (1/28/16)

Individuals' Right under HIPAA to Access their Health Information (1/28/16)

HIPAA Privacy in Emergency Situations (11/18/14)

2009 Interim Final Rules on Breach Notification (9/8/09)

HIPAA Security Guidance - HHS (4/17/07)

IRS

Articles and Materials

Nutritional Counseling: Is it a Medical Expense? (8/11/23)

Home Exercise Equipment for Obesity (8/8/23)

IRS Private Letter Ruling Holds Some Genetic Testing May Be Considered a Medical Expense (1/3/20)

2010 Excise Tax Requirements (2/2/10)

2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)

IRS Releases Guidance on Involuntary Termination in ARRA (4/2/09)

IRS Issues Additional Debit Card Transition Relief (12/9/08)

New Commandments to Live By: IRS Provides New Proposed Regulations (10/11/07)

Congress Reworks Dependent Definition (6/26/07)

1099 - IRS IIR Request (1/26/07)

IRS Issues Debit Card Transition 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)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form (12/8/06)

Extremely important notice to doctors & hospitals to assure you get your money without unintended IRS withholding. (12/8/06)

Good News for Self-Funded Partners/S Corp (12/8/06)

IRS on HMOs (12/8/06)

New Internet Provider TIN Matching Program (12/8/06)

Reserves Reminder (12/8/06)

Section 419A reserve limits for funded welfare benefit plans (10/17/97)

Why VEBA Tax-exemption is Obsolete These Days (9/1/96)

1099 - IRS Letter (12/8/94)

IRS Issues VEBA Regs for Association Geographic Limits (9/1/92)

Official Source Documents

IRS FAQs on Medical Expenses Related to Nutrition, Wellness and General Health (8/11/23)

IRS Notice 2019-63 (12/2/19)

IRS - FAQs for Same Sex Couples (10/7/19)

TINs - Incorrect or Missing - IRS Publication 1586 (11/21/17)

HR 1304 (Exclude from the definition of health Insurance coverage certain Medical stop-loss insurance) (4/27/17)

IRS ACA Webpages (7/31/13)

IRS Notice 2013-8 - 2012 Transit Benefit Limit (1/18/13)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)

2010 Excise Tax Requirements: Form 8928 (2/4/10)

2010 Excise Tax Requirements: Form 8928 Instructions (2/4/10)

IRS Notice on Debit Card Relief (12/15/06)

1099 - MISC Information Reporting Requirements (Final Regulation) (12/8/06)

Medicaid

Articles and Materials

Caution on Medicaid Information Sharing Requests (1/31/23)

CMS Letter to States (12/29/06)

Congress Requires States to Be More Aggressive in Demanding Plan Eligibility Files for Medicaid Recovery (12/8/06)

Letter to State Medicaid Directors on Medicaid Recovery - Ronnie Brown, Covenant Administrators, Inc. (12/8/06)

Medicaid Recovery Provision in the Deficit Reduction Act of 2005 (12/8/06)

State Medicaid Agencies Want TPA Eligibility Files (12/8/06)

State Medicaid Compliance (9/25/06)

Medicaid Recovery Initiatives: Markup of Title 19 - Prepared by Sue Knefley (CMS) (3/8/06)

Official Source Documents

State Medicaid Programs TPL Contact List April 2018 (2/2/23)

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)

Medicare

Articles and Materials

Refresher on Medicare as a Second Qualifying Event and COBRA (8/16/19)

Medicare Part D - Health Reform's Impact on Medicare Part D (4/27/10)

Designing Plans for Older Workers (5/23/08)

Data Elements under Consideration for the New Medicare Eligibility Sharing Rule (1/28/08)

Clarification: Additional Information on How to find an Actuary (12/8/06)

Client Handout: Quick Overview of Employer Notice Requirements (12/8/06)

CMS Clarifies Notification Deadlines (12/8/06)

CMS Clarifies Payment in HRAs (12/8/06)

Medicare - Calculating the Late Enrollment Penalty (12/8/06)

Medicare Part D Coverage Questions Persist (12/8/06)

Medicare Part D Questions Abound on Plan Design (12/8/06)

Medicare Regulations Clarify Medicare Part D Subsidy (12/8/06)

Medicare Wrap Arounds (12/8/06)

New Release About Medicare Prescriptions (12/8/06)

Retiree Drug Subsidy Applications: Important Reminders (12/8/06)

Medicare Part D - Employers, Unions and the MMA: Lessons Learned & Important Updates (9/25/06)

Medicare Part D Plan Sponsor Notice Deadlines (9/1/05)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

Medicare Part D: Updated guidance on Disclosure of Creditable Coverage (11/5/09)

Medicare for All

Articles and Materials

The Costs of a National Single-Payer Healthcare System (8/2/19)

Medicare Secondary Payer

Articles and Materials

SPBA Sends ESRD Comments to Congressional Leadership (12/1/22)

ESRD Legislation Introduced in House and Senate (9/2/22)

Medicare Secondary Payer Rules and Incentivizing Plan Participants to Join Medicare (1/3/20)

Medicare Secondary Payer Manual: Chapter 2 MSP Provisions (11/21/18)

MSP Mandatory Reporting Penalties (12/1/15)

MSP Reporting and HRAs (6/10/10)

CMS Posts Model Form for Soliciting SSNs (7/22/09)

MSP Mandatory Reporting User Guide, Version 2.0 (Article + User Guide) (1/5/09)

Implementation of Medicare Secondary Payer Mandatory Reporting Provisions (11/5/08)

Older Workers Declining the Group Plan Due to Medicare Coverage (12/14/07)

Official Source Documents

MSP ESRD Introduction by CMS (10/24/24)

GHP User Guide 2020 (8/7/20)

Support Act GHP Reporting Requirements: FAQs (1/3/20)

SSN Model Collection Form (3/4/11)

Alert on Obtaining SSNs (3/4/11)

MSP Mandatory Reporting User Guide - Version 3 (9/1/10)

Health Reform Impacts and Trends

Articles and Materials

The Number of "Uninsured": Past and Future (1/17/12)

Medicare Part D

Articles and Materials

CMS Medicare Part D (8/17/11)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

HRAs (Health Reimbursement Accounts)

Articles and Materials

Chart and Summary of ACA Premium Reimbursement HRA Guidance (11/27/13)

Deductible Caps on Small Business (4/26/13)

Deductible Caps on Small Business Health Plans (3/21/13)

Official Source Documents

IRS Guidance on Small Employer HRAs (IRS Notice 2017-67) (11/2/17)

Health Coverage Reimbursement Arrangements- IRS Notice 2015-17 (2/18/15)

HRA Annual Limit Waiver Guidelines (10/4/13)

Technical Release 2013-03 (10/4/13)

Mental Health Parity

Articles and Materials

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

DOL Office of Inspector General Survey on Mental Health Parity Enforcement (4/15/24)

Back to the Future: Mental Health Parity Audits (9/30/16)

Residential Treatment Exclusion Violates Mental Health Parity (2/29/16)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008 (11/12/13)

New Mental Health Coverage Requirements of the Wellstone Act (8/31/09)

Official Source Documents

Final Rule: Mental Health Parity Act (11/12/13)

HSAs (Health Savings Accounts)

Articles and Materials

IRS Releases HSA Inflation Adjusted Amounts for 2025 (5/28/24)

Adult Dependents and HSAs (12/21/10)

Official Source Documents

IRS Rev. Proc. 2018-27 (2018 HSA Deductions) (4/27/18)

Mental Health Parity & Addiction Equity Act (MHPAEA)

Articles and Materials

Enforcement Delay of MHPAEA NQTL (5/28/25)

Report to Congress on MHPAEA Released by Federal Agencies (2/27/25)

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

Tri-Agencies Release MHPAEA Regulations and Report to Congress (7/25/23)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

MHPAEA Provisions in CAA (2/2/21)

Agencies Solicit Comments on MHPAEA, Issue Model and FAQs (6/30/17)

Final Mental Health Parity & Addiction Equity Act (MHPAEA) Regulations (article) (11/12/13)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008 (11/12/13)

New MHPAEA FAQs Released (5/10/12)

New Information on Mental Health Parity & Addiction Equity Act of 2008 Implementation (2/7/11)

DOL Gives Plans Clarification on MHPAEA (7/8/10)

Comments on MHPAEA Interim Final Regulations (5/4/10)

TPAs Don't Need to Inform Their Clients About These Things (3/4/10)

MHPAEA Interim Final Regulations (2/17/10)

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)

Effective Date of Mental Health Parity Addiction Equity Act (7/30/09)

Official Source Documents

Agency Statement on Partial Non-Enforcement of Final MHPAEA Rules (5/20/25)

Biden Administration Releases New MHPAEA Regulation (8/25/23)

DOL PPT on MHPAEA NQTL Comparative Analyses (5/27/22)

2021 MHPAEA Enforcement: Fact Sheet (1/26/22)

2022 MHPAEA Report to Congress (1/26/22)

Mental Health Parity (MHPAEA) Resource Materials for NQTLs (6/30/21)

DOL Issues New FAQs on Mental Health Parity and Substance Use Disorder Rules + Fact Sheet + Proposed FAQs + Documentation Request Form (5/1/18)

Parity of Mental Health & Substance Use Benefits with Other Benefits; Using Your Employer-Sponsored Health Plan to Cover Services (6/29/16)

Warning Signs-Plan or Policy Non-Quantitative Treatment Limitations that Require Additional Analysis to Determine MHP Compliance (6/29/16)

Final Rule: Mental Health Parity Act (11/12/13)

Understanding Implementation of the MHPAEA Act of 2008 - FAQs (5/10/12)

MHPAEA Interim Final Rules - Federal Register (2/2/10)

MHPAEA Request for Information (5/7/09)

Mandated Claims Appeals

Articles and Materials

Mandated Claims Appeals Processes (4/27/10)

Michelle's Law

Articles and Materials

Opt-Out from Michelle's Law (2/19/10)

Michelle’s Law: Questions Remain (2/19/10)

Medical Loss Ratio

Articles and Materials

Medical Loss Ratio Provision in Health Reform (5/13/10)

Official Source Documents

Fact Sheet: Middle Class Americans Saving Billions Under the Health Care Law's Medical Loss Ratio Refunds (7/29/13)

NAIC News

Articles and Materials

SPBA 2013 NAIC Press Release (12/16/13)

SPBA Talking Points for Letters on Stop-Loss Attachment Points (8/31/12)

SPBA Stop-Loss Issue Debated at NAIC Summer Convention (8/22/12)

SPBA Testifies at NAIC on Stop-Loss (8/13/12)

URGENT: Self-funding Challenged by NAIC (8/8/12)

Official Source Documents

Letter to Insurance Commissioners Providing a Transitional Policy for Individual & Small Group Market Policies (11/14/13)

MHPAEA

Articles and Materials

Report to Congress on MHPAEA Released by Federal Agencies (2/27/25)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

Agencies Solicit Comments on MHPAEA, Issue Model and FAQs (6/30/17)

Mental Health Parity Compliance Checklist (6/29/16)

Mental Health Parity Compliance Checklist (6/29/16)

ACA FAQs (Part 31) Clinical Trials & MHPAEA (4/27/16)

MHPAEA and PPACA (9/29/10)

Official Source Documents

Biden Administration Releases New MHPAEA Regulation (8/25/23)

Parity of Mental Health & Substance Use Benefits with Other Benefits; Using Your Employer-Sponsored Health Plan to Cover Services (6/29/16)

Warning Signs-Plan or Policy Non-Quantitative Treatment Limitations that Require Additional Analysis to Determine MHP Compliance (6/29/16)

DOL MHPAEA Warning Signs: Plan or Policy NQTLs That Require Additional Analysis (6/22/16)

Determining Mental Health Parity Compliance (6/2/16)

Nondiscrimination - Section 1557

Articles and Materials

Final Regulations Regarding Section 1557 Nondiscrimination Rules Recently Released by U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) (6/26/24)

New Laws Enacted by the Consolidated Appropriations Act of 2023 (CAA23) (1/30/23)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Christian Employers Case Section 1557 (7/5/22)

Official Source Documents

Background documents HHS ACA Section 1557 Nondiscrimination (6/26/24)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

Mini-Med Waivers

Articles and Materials

Annual Limit Waivers Filing Due (10/31/12)

Guidance Released by HHS for Annual Limit Waivers (7/12/11)

Health Reform: Guidance Released by HHS for Annual Limit Waivers (6/23/11)

Mini-Med Waiver Extension to 12/31/13 (6/20/11)

More Limited Benefit Plan Waiver Guidance- December 2010 (12/13/10)

Amendment to Grandfather Rules & Waiver Limits (11/16/10)

Mini-Med Waiver : HHS Issues Guidance September 2010 (9/7/10)

Mini-Meds and the Waiver Program (8/17/10)

Official Source Documents

Technical Instructions for Waivers as of 8/19/2011 (8/24/11)

Guidance: Exemption for Health Reimbursement Arrangements that are Subject to PHS Act Section 2711 (8/24/11)

Supplemental Guidance on Waiver December 2010 (12/13/10)

Sale of New Limited Benefit Plan Guidance (12/13/10)

Waiver Application Form (12/13/10)

Waiver Guidance November 2010 (11/16/10)

Mini-Meds Waiver & Annual Limits Guidance & Requirements Sept 2010 (9/7/10)

Nondiscrimination - HIPAA/GINA

Articles and Materials

Self-Inflicted Injury Clauses in Health Plans (9/10/22)

Nondiscriminatory Wellness Programs in Group Health Coverage (12/18/19)

Genetic Nondiscrimination Act (6/6/08)

Beware of Designing Wellness Programs with Penalties Rather than Incentives (5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule (5/21/07)

Plan Incentives for Healthy Behavior (5/11/07)

Rewards and Penalties for Disease Management Participation (5/11/07)

Article on HIPAA Nondiscrimination Final Rules (1/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan? (12/8/06)

Reducing Benefits for Active Workers (10/26/05)

Official Source Documents

September 2009 GINA Regs (10/2/09)

Federal Register Notice on the Genetic Information Nondiscrimination Act (11/17/08)

Final Rules on HIPAA Nondiscrimination & Wellness Programs (1/11/07)

Minimum Essential Coverage

Articles and Materials

Non-Major Medical Plans and Preventive Services (11/4/15)

Non-Major Medical Plan and MEC (10/24/13)

Official Source Documents

Rev. Proc. 2019-29 (7/22/19)

IRS Final Regs MEC (11/26/14)

CCIIO Guidance on Minimum Essential Coverage (11/4/13)

Nondiscrimination Rules - IRS

Articles and Materials

IRS Nondiscrimination Rules for Self-Funded Plans (12/10/24)

Nondiscrimination Issues: 105(h) and Issues Impacting Wellness Program; Ashley Gillihan (8/31/10)

Official Source Documents

IRS Nondiscrimination Rules for Self-Funded Plans (12/8/06)

Minimum Value

Articles and Materials

CMS Director Comments on Minimum Value at SPBA Meeting (4/30/15)

Final Rule Minimum Value includes "Substantial Coverage" (2/26/15)

Gillihan Memo on Minimum Value (11/12/14)

IRS Proposed Rules on Minimum Value and Wellness Incentives (5/28/13)

Official Source Documents

HHS Final Rule Minimum Value Released 2-20-2015 (2/22/15)

IRS Proposed Regulation on Minimum Value (5/3/13)

Minimum Value Calculator under Plan Management Regulations + Minimum Value Calculator Methodology under Plan Management Released on February 20, 2013 (2/25/13)

Plan Assets

Articles and Materials

Plan Asset Regulations (1/24/24)

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 Lifetime Limits No Longer Applying & Enrollment Opportunity (6/29/10)

Model Notice on Patient Protections (6/29/10)

Portability - HIPAA

Articles and Materials

Special Enrollment Question and DOL Response (1/30/19)

Dependents Losing Coverage and HIPAA Special Enrollment Periods (3/23/07)

Lifetime Maximums and HIPAA Special Enrollment Periods (12/8/06)

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)

Self-Compliance Tool for Part 7 of ERISA: HIPAA and Other Health Care-Related Provisions (3/26/13)

Model HIPAA Exemption Election for Non-Federal Governmental Plans (5/4/07)

Federal Register 2002: Non-Federal Governmental Opt-Out Requirements (12/8/06)

Federal Register 2004: Propsed Rules on Tolling Time Periods (12/8/06)

Nondiscrimination - HHS

Articles and Materials

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

HHS Proposes Revisions ACA Section 1557 Rule: Article + Regs + Fact Sheet (6/6/19)

District Court Injunction on ACA Section 1557 (1/5/17)

Transgender Benefits and Application to Employer Plans (6/29/16)

HHS Non-Discrimination Regulations (6/1/16)

Official Source Documents

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

Franciscan-Alliance v. Burwell (1/5/17)

Civil Rights: HHS FAQs: Section 1557 of ACA (6/29/16)

Nondiscrimination in Health Programs & Activities Proposed Rule: News Release + Fact Sheet + FAQs (9/9/15)

Opt-Out

Articles and Materials

Reminder on Opt-Out Rules for State and Local Government Plans (5/3/11)

HHS Releases Guidance on Opt-Out Rules for State and Local Government Plans (9/23/10)

Official Source Documents

HIPAA Opt-Out Model Election Form (5/9/11)

HIPAA Opt-Out Model Notice to Participants (5/9/11)

Prescription Drug Reporting (RxDC)

Prescription Drug and Healthcare Cost Reporting 10/25 @ 1PM ET (10/11/22)

Prescription Drug and Healthcare Spending (2/8/22)

Articles and Materials

House Subcommittee Holds Hearing to Examine Abusive PBM Practices (4/29/25)

PBM Executives Face Bipartisan Scrutiny at House Hearing (8/30/24)

CAA Prescription Drug Reporting Deadline is Looming (3/22/24)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year (3/27/23)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year (3/27/23)

Agencies Release Good Faith Relief on RxDC Reporting (12/27/22)

Agencies Release Interim final Rule - Prescription Drug and Health Care Spending (11/18/21)

TPA Client Newsletter: Agencies Release Interim Final Rule - Prescription Drug and Health Care Spending (11/18/21)

Official Source Documents

RxDC Reporting Instructions (2/27/23)

RxDC Interim Final Rule Text (2/27/23)

RxDC Reporting FAQs (2/27/23)

Webinar

Webinar: RxDC Reporting: What You Need To Know (5/1/24)

Over the Counter Drugs (OTC)

Articles and Materials

How Does the Revised Definition of Medical Expenses Relate to OTC Drugs (1/24/13)

FSA & HRA Debit Cards for OTC Purchases (12/29/10)

IRS Releases Guidance on OTC Drugs: Issue for Debit Cards (9/7/10)

Official Source Documents

Questions & Answers on Over-the-Counter Medicines and Drugs (Revised Version - 3/21/12) (12/1/10)

Over the Counter Drug Notice (IRS) (9/7/10)

Prescription Drugs

FDA Guidance on Importing Drugs from Canada (6/10/22)

Emerging Issues for Prescription Drugs in 2021 (12/3/20)

Articles and Materials

Specialty Drug Section & Drug Importation in this Presentation (9/12/24)

PBM Executives Face Bipartisan Scrutiny at House Hearing (8/30/24)

President Signs Executive Orders on Prescription Drug Costs (7/27/20)

FDA issues Proposed Rules on Importing Prescription Drugs from Canada (12/31/19)

Administration Released Limited Prescription Drug Importation Proposal (12/30/19)

HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs (8/2/19)

Medicare-for-all!!! Happy talk that lets everyone mislead themselves. (1/30/19)

Off-Label & Non-Approved Drugs & Treatments (12/18/07)

Canada Issues: Importing Drugs - Canada Drug Warning (again) (Nov 2003) (12/8/06)

PCORI

Articles and Materials

IRS Releases Updated PCORI Fee (11/15/22)

IRS Releases Updated PCORI Fee + Form 720 (March 2022) (1/3/22)

Updated PCORI Released (11/30/20)

Updated PCORI Fee Released (6/8/20)

Spending Bill Reauthorizes PCORI, Repeals Cadillac Tax (1/3/20)

IRS Releases Adjusted PCORTF Fee (11/6/18)

PICORI Fees (6/29/18)

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)

Insights on PCORI from Webinar (March 2013) (5/13/13)

Official Source Documents

IRS Notice 2018-85: PCORI Fee (11/6/18)

PCORI Fee IRS Notice 2017-61 (10/20/17)

IRS Webpage on Filing Due Dates & Applicable Rates (Link) (5/4/17)

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)

Privacy - GLBA

Articles and Materials

Gramm-Leach Bliley Act - New Financial Services Legislation (12/8/06)

Gramm-Leach-Bliley Act - Decision Tree and Sample Privacy Notice (12/8/06)

What TPAs Need to Know and Do about the Gramm-Leach-Bliley Act (12/8/06)

Penalties

Articles and Materials

Pay or Play Delayed for One Year, The Exchange Notice was NOT Delayed (7/8/13)

Preventive Services

Articles and Materials

Supreme Court Arguments on Preventive Services Seem to Divide the Court (4/29/25)

Withdrawal of Preventive Services Proposed Rule on Non-Religious Moral Objections (2/25/25)

FAQ 68 Preventive Services and WCHRA (12/17/24)

Proposed OTC Preventive Services Regulations (12/17/24)

New FAQ 54 Addresses Preventive Services in light of Supreme Court Roe v. Wade Decision (2/2/23)

Reminder: New and Updated Women’s Preventive Health Services Guidelines Apply in 2023 (2/2/23)

COVID-19 Vaccine Rollout and Payment (2/2/21)

Supreme Court Allows for Birth Control Exemptions Based on Religious and Moral Objections (7/8/20)

Final Contraceptives Rules Include Religious and Moral Convictions Exemptions (12/19/18)

Religious Exemption & Accommodation for Certain Preventive Service Benefits (10/13/17)

Religious Exemptions and Accommodations for Coverage of Certain Preventive Services under the Affordable Care Act (10/6/17)

FAQ Part 31 Questions on Preventive and Out-of-Network Emergency Services (4/27/16)

Preventive Services Final Regulations (7/29/15)

Preventive Services FAQ Part XXVI (5/28/15)

The Supreme Court Decision on Hobby Lobby’s Contraceptive Case (7/31/14)

Religious Contraceptive Issue (1/30/14)

Final Contraceptive Rules Include TPA Role for Providing Certain Contraceptive Coverage (7/29/13)

SPBA's Comment Letter to IRS on Contraceptive Coverage (4/23/13)

Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)

State Stop-Loss Legislation + HHS Issues Contraceptive Coverage Proposed Rule (2/4/13)

New Contraceptive Services Guidance Issued (9/12/12)

Contraceptives and Religious organizations: DOL seeks comments on implementing the preventive care mandate accommodation (4/18/12)

HHS Releases Interim Final Rule on Women's Preventive Services (8/2/11)

Preventive Services: Issues Abound - Companion Article: Comments Sought on Plan Design (2/7/11)

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

Withdrawal of Preventive Services Proposed Rule on Non-Religious Moral Objections (2/11/25)

Testing Price & Preventive - COVID IFC Reg (Federal Register - Nov 6, 2020) (12/1/20)

HHS Guidance: Revocation of Accommodation Notice (12/1/17)

Interim Final Rule on Certain Preventive Services under the ACA (10/6/17)

CMS New Release on 2015 released final regulations for Preventive Services (7/29/15)

Instructions for Model Notice - Accommodation Notice to HHS (8/27/14)

Proposed Rule to change definition of Eligibile Organization (8/27/14)

IFR-Notifying HHS of Accommodation Status (8/27/14)

Final Rule on Women's Preventive Services regarding Religious Employers Issued - July 2, 2013 (7/8/13)

CMS & CCIIO: Contraceptive Guidance - August 15, 2012 (11/1/12)

Preventive Services Covered under the Affordable Care Act (7/28/10)

Regulations Released Requiring New Health Insurance Plans to Provide Free Preventive Care (7/16/10)

Guide to Clinical Preventive Services (5/27/10)

Same-Sex

Official Source Documents

Attorney General Lynch Announces Federal Marriage Benefits Available to Same-Sex Couples Nationwide (7/30/15)

Reporting

Articles and Materials

IRS Releases Guidance on Affordable Care Act Reporting Requirements (4/28/25)

At Long Last, Congress Passes Needed ACA Employer Reporting Relief (12/16/24)

IRS Extends Due Date for ACA Employer Reporting (12/22/17)

Early DRAFT tax form instructions the 1095B and 1095C (9/28/17)

ACA Information Reporting Delayed (11/30/16)

IRS Proposed Rules on MEC Reporting (8/30/16)

ACA Information Returns Corrections Process (8/24/16)

IRS Comments on TINs and a Good Faith Effort (7/15/16)

IRS Video on the ACA Information Returns Corrections Process (7/15/16)

ACA and US Territories: Do the individual mandate & the employer mandate apply in the US territories? (2/29/16)

Reporting Offers of Coverage (1/29/16)

Impact of Measurement Periods on 6056 Reporting (1/29/16)

Small ALEs Eligible for ACA Employer Mandate Transition Relief Must Still File for 2015 (12/30/15)

Small Extension of Due Dates for ACA ALE and MEC Information Reporting (12/30/15)

COBRA and 1095-C Reporting (12/1/15)

1095-C Reporting for Employees on Medicare (11/4/15)

Multiemployer Plans and ALE Reporting (11/4/15)

HRA Integrated with Fully Insured ACA Reporting: SPBA Worked the Issue (9/25/15)

Penalty for Failure To File ACA Employer Reporting (7/25/15)

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)

Can a TPA File Form 1094-C on behalf of an Employer? (4/29/15)

Reporting for Controlled Groups on Form 1094-C (4/29/15)

Final Versions of 2014 ACA Employer/Plan Reporting Forms and Instructions (3/1/15)

IRS Releases Draft Forms for Reporting of Employee Health Coverage under ACA (7/31/14)

IRS Released Two Final Rules on Employer/Plan Reporting (3/25/14)

IRS Released Two Proposed Rules on Employer/Plan Reporting (10/24/13)

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)

Federal Register: Proposed Rule on MEC Reporting, August 2, 2016 (8/23/16)

IRS ACA Reporting Corrections ppt (6/29/16)

Extension of Due Dates for ACA ALE & MEC Information Reporting (12/29/15)

IRS Notice 2015-87: Variety of ACA Related Provisions (12/17/15)

Federal Register: Final Rules Information Reporting by ALEs (12/3/14)

IRS Notice 2012-32 (6/11/12)

IRS Notice 2012-33 (6/11/12)

Webinar

Webinar: ACA Employer and Plan Reporting Webinar for TPAs and TPA Clients (11/20/15)

Rescissions

Articles and Materials

Retroactively Cancel Coverage under PPACA (3/9/11)

Retroactive Rescission (12/21/10)

Rescissions: Reg Writers Provide Insights on PPACA Issues (Fall 2010) (10/19/10)

Schedule J

Articles and Materials

DOL Annual Report to Congress on Self-funded Health Plans (4/27/17)

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)

Official Source Documents

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries (2/10/21)

2017 DOL Annual Report on Self-insured Group Health Plans (3/1/17)

Sample Speeches

Articles and Materials

Political Overview & New Developments in PPACA: What's Going to Happen?? (4/5/11)

Report on Key PPACA Reg Developments and Attitude (4/5/11)

Is PPACA Rationing? (2/14/11)

Sample Speech: What the Fate of PPACA and What's Ahead (2/10/11)

Security - Cybersecurity and HIPAA

Articles and Materials

HIPAA Security Rule will Undergo Significant Revisions in 2025 (2/25/25)

New Security Risk Assessment Nov 2024 (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HHS Finalizes New Provisions to Enhance Integrated Care and Confidentiality for Patients with Substance Use Conditions (2/26/24)

Mitigate Cyber Attacks with Industry Standard Security Protocols (11/1/22)

2022 New Security Risk Assessment Tool (7/7/22)

Cyber Alert: Updates on Ransomware and Critical VMware Vulnerability (7/15/21)

OCR Issues Audit Report on Health Care Industry Compliance with the HIPAA Rules (12/30/20)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates (6/7/19)

NAIC Adopts Cybersecurity Model Law (11/28/17)

US CERT ALERT: Malware Infecting U.S. Businesses (11/17/17)

HHS Update: International Cyber Threat to Healthcare Organizations -- (5/15/17)

Great Ideas From Fall Meeting Sessions on Cyber Security (10/28/16)

Sharing Patient Data Subject to FTC Regulations, Not Just HIPAA (10/28/16)

UPDATED: Security Risk Assessment (SRA) Tool (9/30/16)

Protecting HIPAA Private Health Information (6/29/16)

Cybersecurity: Ransomware & Recent Variants (6/1/16)

OCR Cyber-Awareness Update (6/1/16)

Security Alert Updates from OCR, US-Cert and the FBI (5/6/16)

DHS Cyber Alert on Ransomware (4/6/16)

Cybersecurity Act of 2015 (1/29/16)

Security Update: Business Associates are a Priority (12/30/15)

HHS Releases Final HIPAA Rule (1/24/13)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

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)

Security Business Associate Addendum Memo (12/8/06)

HIPAA Security Compliance Strategies - Mariann Yeager, MBA, TruArx, Inc. (5/2/05)

HIPAA Security Standards Addendum (10/26/04)

Security Plan Document Amendment (10/16/04)

Official Source Documents

HIPAA Security Rule to Strengthen the Cybersecurity of ePHI NPRM (1/3/25)

HHS Office for Civil Rights Creates FAQ Webpage in Response to the Change Healthcare Cyberattack (4/22/24)

OCR Cybersecurity Newsletter: Defending Against Common Cyber-Attacks (4/28/22)

Controlling Access to ePHI: For Whose Eyes Only? (7/15/21)

2016 - 2017 HIPAA Audits Industry Report (12/21/20)

How to Manage Malicious Insider Cyber Threats (8/30/19)

Risk Analyses vs. Gap Analyses – What is the difference? (6/29/18)

HHS OCR Cybersecurity December Newsletter (12/28/17)

OCR Cybersecurity Newsletter: Insider Threats and Termination Procedures (12/1/17)

OCR April Cybersecurity Newsletter - Man in the Middle Attacks and more (4/27/17)

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 Audits Are Coming to Business Associates - NOW (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)

Cyber Incident Reporting: A Unified Message for Reporting to the Federal Government (8/30/16)

New HIPAA Ransomeware Guidance: Fact Sheet (7/21/16)

HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents. (7/21/16)

OCR Releases HIPAA Phase 2 Audit Protocols (4/8/16)

HIPAA Security Rule Crosswalk to NIST Cybersecurity Freamework (2/29/16)

NIST Cybersecurity Framework (1/28/16)

HIPAA Security Guidance for Remote Use of Electronic Health Information (2/26/07)

SCOTUS

Articles and Materials

Supreme Court Decision Upheld; Medicaid Provisions Must Be Reworked (6/29/12)

What's Next After SCOTUS (6/28/12)

The Morning After SCOTUS: A Reality Check & Prep (6/27/12)

Official Source Documents

Supreme Court Opinion - June 28, 2012 (6/28/12)

Specialty Drugs

Articles and Materials

B & C. Compliance Update I. Ashley Gillihan, Alston & Bird (9/24/24)

Specialty Drug Section & Drug Importation in this Presentation (9/12/24)

Specialty Drugs and Plan Design: Strategies and Compliance Issues (5/4/20)

Specialty Drug Webinar on Legal Challenges in Designing Plans - July 2016 (11/10/16)

Self-Funded Reports

Articles and Materials

Self Insured Health Benefit Plans (7/27/11)

Official Source Documents

Self Funded Report to Congress (7/27/11)

Group Health Plans Report: Form 5500 Annual Reports (7/27/11)

State Licensing

Articles and Materials

2024 SPBA Third Party Administrator State Licensing Statutes as of April 2024 (4/17/24)

2022 TPA License Corrections (10/11/22)

TPA License Change For Michigan (7/5/22)

Official Source Documents

Kansas TPA Act; SB22 (4/27/17)

Indiana Department of Insurance: Bulletin 236 - Nonresident TPA Licensing (4/27/17)

Self-Funding

Articles and Materials

Self-Funding: Myths vs. Facts (9/2/14)

Administrative Fix for Policy Cancelations (11/15/13)

Self-Funding: Self-Funding Will Flourish in ACA (1/28/13)

States

Articles and Materials

Alabama: Notice of Regulation Hearing on PBMs (10/10/19)

California Standing Strong to Fight Surprise Billing (9/11/19)

Nevada: Revised Statutes - Third Party Parental Guaranty & Notification Requirement (10/25/17)

Arkansas: TPA License Survey 2017 Corrections (10/24/17)

Nevada: Revised Statutes (10/24/17)

Minnesota Stop-Loss (2/1/17)

Texas Prompt-Pay Law (2/29/16)

Washington State TPA Legislation Update + Original Article from January's UPDATE (2/17/16)

Washington State TPA Legislation + Link to Bill (1/29/16)

Michigan: Determining Which Entity Must Pay (5/1/12)

Georgia - OCGA § 33-30-13.1 (11/5/08)

Indiana & Maine (11/5/08)

Iowa - 509.19 Claims & Premium Disclosure (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)

State Survey of Insurer Claims Data: Florida - 2007 Florida Statutes (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)

New Transparency Legislation in Texas for Health Care Plans (10/11/07)

State Health Care Reform (10/11/07)

Texas Loss Experience Legislation (10/11/07)

The 2007 Texas Legislative Session - Sam Francis, JI Companies (10/11/07)

Additional Questions on the NYHCRA (12/8/06)

Mississippi Starting Surcharge Applies to Insurers, Stop-loss + some TPA situations (12/8/06)

New State Surcharge Nicks Employer Health Plans (12/8/06)

New York Surcharge Impacts Employers (12/8/06)

NJ Law Turns Lemons to Lemonade (12/8/06)

Questions and Answers about the New York Health Care Act (12/8/06)

State TPAs: Together you stand. Divided you fall. (12/8/06)

Strategies on Massachusetts (12/8/06)

Third Party Administrator Statute (12/8/06)

Massachusetts Health Care Reform - James Stirling, Stirling Benefits (9/25/06)

State Legislatures Hurt Insurance Companies & Policyholders (11/2/02)

Frequently Asked Questions on the New York State's Health Care Reform Act (11/22/96)

Official Source Documents

Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions (11/5/18)

North Carolina: North Carolina General Assembly Conference Report (House Bill 649) (8/1/13)

Connecticut: Childhood Immunization Vaccine Assessment (8/1/13)

North Carolina General Assembly Conference Report (7/29/13)

Shared Responsibility

Articles and Materials

IRS Released Two Final Rules on Employer/Plan Reporting (3/26/14)

Transition Relief for 2014 (7/10/13)

Multiemployer Plans Transition Relief (5/29/13)

New Exchange Regulations Include Exemptions to Individual Shared Responsibility Provision (2/4/13)

ACA Premium Tax Credit Affordability (2/1/13)

Play or Pay in 2014 (Shared Responsibility for Employers Regarding Health Coverage) (1/2/13)

Minimum Value of an Employer-Sponsored Health Plan (5/29/12)

Health Care Reform: Employer Mandate and Federal Subsidies (8/17/11)

Official Source Documents

IRS Publication: Making a Shared Responsibility Payment... What you Need to Know (12/15/14)

IRS Publication: Health Care Law: What's New for Individuals & Families (Tax Year 2014) (12/15/14)

IRS Final Regulations on Individual Shared Responsibility (9/3/13)

IRS Proposed Regulation on Individual Shared Responsibility (5/7/13)

Individual Responsibility Q and A (Link) (1/31/13)

IRS Notice 2012-58 - Determining Full-Time Employees (9/4/12)

IRS Notice 2012-59 - Guidance on 90 Day Waiting Period Limitation (9/4/12)

Student Health Insurance

Articles and Materials

CMS Issues Final Rules on the Affordable Care Act Requirements for Student Health Policies (7/17/12)

Student health Insurance Coverage Subject to Certain PPACA Provisions (5/2/11)

Official Source Documents

Student Health Insurance Proposed Regulation (Federal Register, February 11, 2011) (4/28/11)

Subrogation

Articles and Materials

Subrogation News: Sereboff - What the Plan Did Right (12/8/06)

Supreme Court Case: Sereboff (12/8/06)

Summary of Benefits & Coverage

Articles and Materials

The New 2017 Summary of Benefits and Coverage (SBC) Template (4/28/16)

SBC Calculator is Developed - WEBINAR to Follow (6/5/12)

SBC Corrections, FAQs & Calculation Guidance Have Been Issued (5/29/12)

Summary of Benefits and Coverage and Uniform Glossary (4/18/12)

Agencies Issue FAQs for the Summary of Benefits & Coverage (3/20/12)

DOL Changes Compliance Date for the Summary of Benefits and Coverage (11/28/11)

DOL Changes Compliance Date for the Summary of Benefits and Coverage (11/21/11)

DOL Comment Letter on the Summary Benefit of Coverage (10/26/11)

Uniform Summary of Benefits and Coverage (7/12/11)

Official Source Documents

SBC Calculator Correction (7/27/12)

Link to the SBC Coverage Example Calculator (5/14/12)

FAQs Regarding the Implementation of Summary of Benefits & Coverage (5/14/12)

Corrected Sumarry of Benefits & Coverage Template (5/14/12)

Corrected Sample Summary of Benefits & Coverage (5/14/12)

Final Rules Released on the Summary of Benefits & Coverage & Uniform Glossary (Revised 4/12/12) (2/9/12)

Surprise Billing (see Transparency/Surprise Billing Resource Center on the homepage)

No Surprises Act - First Set of New Regulations (Webinar) (7/20/21)

Articles and Materials

No Surprises Act – Determining Cost-Sharing and Payment Amounts to Providers (12/13/24)

SPBA Reviews the Administration's Executive Order (7/15/21)

Future Rollout of Federal Guidance Planned (7/7/21)

Administration Releases Interim Final Rule on the No Surprises Act (7/2/21)

Advanced Explanation of Benefits in the No Surprises Act (5/28/21)

SPBA Submits Comments on No Surprises Act Regulations (5/26/21)

F. New Federal No Surprises Act & Related Transparency Requirements (4/7/21)

End of Year Spending and COVID Stimulus Package: A Summary (2/4/21)

No Surprises Act - Section by Section Summary (2/4/21)

Official Source Documents

Surprise Billing Model Notice (10/18/21)

Requirements Related to Surprise Billing; Part II - IFR (Fact Sheet) (10/4/21)

Requirements Related to Surprise Billing; Part II pdf (Federal Register IFR) (10/4/21)

No Surprises Act Bill Text (2/4/21)

Tax Credits for Premiums

Articles and Materials

Spouse Eligibility for Premium Tax Credits in the Exchange (10/24/13)

ACA Premium Tax Credit Affordability (2/1/13)

Health Care Reform: Employer Mandate and Federal Subsidies (8/17/11)

Treasury Releases Guidance on Health Reform Tax Credits (8/12/11)

Official Source Documents

Premium Tax Credit: Form 8962 + Instructions for Form 8962 (1/26/15)

IRS Weblink: Q&As on the Premium Tax Credit (1/26/15)

IRS Final Regulations on Premium Tax Credits (9/10/12)

Treasury Fact Sheet on Premium Tax Credits (8/12/11)

Premium Tax Credits - Proposed Reg (8/12/11)

Transgender

Articles and Materials

District Court Injunction on ACA Section 1557 (1/5/17)

Tax on Plans

Articles and Materials

Fees on Plans and Policies for the Patient-Centered Outcomes Research Trust Fund (May 2014) (5/29/14)

Transitional Reinsurance Fee, Exchanges & SHOP (2/27/14)

Text of HHS Notice of Benefit & Payment Parameters for 2015 (11/26/13)

Program Integrity Rule (11/1/13)

Transitional Reinsurance Fee: Changes in New Regulations (10/29/13)

PCORI Questions from SPBA Members (6/27/13)

Insights on PCORI from Webinar (March 2013) (5/13/13)

Reinsurance Fees Comment Letter (1/4/13)

Reinsurance Fee and the Impact on TPAs and Self-Funded Plans (12/17/12)

Official Source Documents

Dollar Amount 2015/2016 (IRS Notice 2015-60) (2/24/16)

Transitional Reinsurance 2013-28610 (11/26/13)

Transitional Reinsurance Regulation 10-30-13 (Federal Register) (10/31/13)

Final Rule (10/28/13)

Reinsurance Fees: Payment Notice Technical Summary (3/12/13)

Reinsurance Fees: Federal Register Proposed Regulations (12/18/12)

PCORI: Federal Register Final Regulations (12/10/12)

USERRA/Veterans

Articles and Materials

Veterans Affairs Requests Electronic Remittances (6/16/09)

Legislation Benefits for Military Personnel (Heroes or Heart Act) (6/27/08)

USERRA Final Regulations: Overview (12/8/06)

USERRA: Veterans Benefits Improvement Act of 2004 (12/8/06)

USERRA Final Regulations Wm. Kenan Torrans, DOL (5/3/06)

USERRA Overview - William Kenan Torrans, DOL VETS (5/19/05)

USERRA: Military Mobilization Impacts Employer Plans (1/1/03)

New Veterans Rights Law Highlights Employer Responsibilities (12/2/95)

Employee Benefit Impact of the Mobilization of Military Reserves for Operation Desert Shield and Operation Desert Storm (1/15/90)

Official Source Documents

USERRA: Final Regulations (12/8/06)

Transitional Reinsurance Program

Articles and Materials

Key Deadlines for Transitional Reinsurance Contributions (12/13/16)

Release of ACA Transitional Reinsurance Program Annual Enrollment & Contributions Submission Form (10/22/14)

Annual Enrollment & Contributions Submission Form Manual (10/22/14)

Supporting Documentation Job Aid Manual (10/22/14)

Official Source Documents

Proposed HHS Notice of Benefit & Payment Parameters for 2016 Fact Sheet (12/2/14)

Transitional Reinsurance Program Proposed Regulations (12/2/14)

Value Driven Initiatives

Articles and Materials

Be Prepared for Client Question on Value-Driven (5/4/07)

Purchaser Guide for Employers on Value-Driven Health Care (2/8/07)

Vouchers

Articles and Materials

Free Choice Vouchers (11/23/11)

Wellness

Articles and Materials

EEOC Proposes New Wellness Regulations (2/2/21)

Judge Dismisses Challenge to Wellness Program (8/15/19)

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)

Incentives in Employer Wellness Programs for Employees' Spouses to Provide their Current or Past Health Status Information (12/1/15)

SPBA Comments to EEOC on Proposed Wellness Rule (6/19/15)

EEOC Wellness Proposed Rule Article (4/28/15)

EEOC Fails to Resolve Wellness Issues in Final GINA Title II (12-21-10) (12/21/10)

Wellness - Developing as a Strategy (11/16/09)

EEOC Informal Letter on Health Risk Assessments (6/26/09)

Family Medical History Questions Problematic in Wellness Programs (5/20/09)

TPA Success in Wellness (11/5/08)

NCQA Releases Proposed Standards to Evaluate Health Promotion Programs (7/8/08)

Wellness Education Program (10/22/07)

Characteristics of Successful, Low Cost Wellness Programs (10/11/07)

Journal: Characteristics of Successful Wellness Programs (10/11/07)

Wellness Wizard - Determine Your Employee Health Risks, Costs, and Savings (10/11/07)

Beware of Designing Wellness Programs with Penalties Rather than Incentives (5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule (5/21/07)

Plan Incentives for Healthy Behavior (5/11/07)

Rewards and Penalties for Disease Management Participation (5/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan? (12/8/06)

Non-Plan Incentives for Healthy Behavior (Part 2), Howard Bard, Slevin & Hart, P.C. (ppt) (5/3/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule (5/3/06)

SPBA Comments to EEOC on Proposed Wellness Rule (6/19/15)

EEOC Wellness Proposed Rule Article (4/28/15)

Official Source Documents

Sample Notice for Employer-Sponsored Wellness Programs (7/22/16)

Q&As: Sample Notice for Employees Regarding Employer Wellness Programs (7/22/16)

Wellness Final Rules under ADA Title I - Federal Register (7/22/16)

HIPAA 2015 Privacy & Security Wellness Q&A (4/28/15)

EEOC Fact Sheet 2015 - Wellness Fact Sheet for Small Business (4/28/15)

Press Release 2015: EEOC Wellness Proposed Rule (4/28/15)

Federal Register: 2015 EEOC Wellness Proposed Rule (4/28/15)

Q&As on EEOC's Notice of Proposed Rulemaking on Employer Wellness Programs (4/18/15)

HIPAA Nondiscriminatory Wellness Programs: Final Regulation (5/30/13)

DOL-IRS-HHS Wellness FAQ - April 2015 (4/28/15)

HHS FAQs on Wellness April 2015 (4/28/15)

HIPAA Nondiscriminatory Wellness Programs: Final Regulation (5/30/13)

Webinar

Webinar: An Overview of Wellness Rules Governing Health Plans (10/2/23)

Webinar: An Overview of Wellness Rules Governing Health Plans (10/2/23)

W-2s

Articles and Materials

ACA IRS W-2 Presentation (3/6/12)

W-2 Reporting and Controlled Groups (2/29/12)

Double Hot News: W-2 Health Value Reporting Chart + Hospital Transparency (e-mail alert) (2/24/12)

Article on IRS W-2 Guidance in 2012 (2/3/12)

W-2 Health Care Value Reporting Updated (1/27/12)

W-2 Health Care Cost Reporting Interim Guidance (Article) (5/3/11)

History on W-2 Health Value Reporting (10/25/10)

W-2 Health Care Cost Reporting Optional for 2011 (10/19/10)

No Tax on Benefits $ on W-2 (8/20/10)

W-2 Health Care Cost Reporting (8/20/10)

W-2 Reporting on the Value of Health Coverage (6/10/10)

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)

COVID-19 Resource Center

Articles and Materials

Legislation to End National Emergency Likely Does Not Impact Outbreak Period (4/12/23)

HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health Emergency HIPAA Notifications of Enforcement Discretion (4/11/23)

How to Shape Legislative Proposals & Govt. Policy

Articles and Materials

How to Influence Your Members of Congress Roadmap (8/21/17)

Key Health Policy Committee Members (8/7/17)

Regulatory & Legislative Issues

Articles and Materials

Enforcement Relief for Gag Clause Prohibition Compliance Attestation (4/30/25)

Unleashing Prosperity Through Deregulation (2/25/25)

Ozempic, Wegovy Among 15 Drugs Selected for Medicare Price Negotiations (2/25/25)

Legislative Update – Prospects for Telehealth Movement in the Lame Duck Session (12/17/24)

Trump Administration Implications for Healthcare: The Issues and People to Watch (12/4/24)

House Committee Tees Up Telehealth Bill (10/24/24)

Health Subcommittee Examines Proposals to Extend Telehealth Flexibilities (4/25/24)

Richard Hardin Testimony for the Record (4/12/24)

SPBA submits comment letter to the House Committee on Education and the Workforce (4/5/24)

Bipartisan Group of Senators Introduce Legislation to Reduce Employer Healthcare Reporting Requirements (11/15/23)

National Emergency or Public Health Emergency Declaration (9/7/22)

Official Source Documents

President Trump Issues Executive Order Directing Efforts to Lower Prescription Drug Prices (4/28/25)

Trump Executive Order on Transparency (2/28/25)

Preemption and MEWA

Articles and Materials

MEWA Plan Contacts (1/20/16)

MEWA Reporting Under ACA Section 9010, The Health Insurance Providers Fee, IRS Form 8963 (12/4/14)

MEWA 2010 M-1 Form (1/31/11)

MEWA 2010 Form + Labor Department's Regulatory Agenda (1/31/11)

Double Warning on Employment Status (8/28/08)

Leasing & Independent Contractor Do's & Don'ts (12/8/06)

Plans sponsored by Governmental & Religious Groups are NOT Under ERISA (12/8/06)

What's the Regulatory Status of Government & Religious Plans? (12/8/06)

A Wishful Thinking MEWA Mindset (5/1/03)

MEWA & Association Health Plan (AHP) Background (3/1/99)

Leasing Do's & Don'ts (1/10/95)

Official Source Documents

MEWA 2018: Form M-1 + 10 Tips for Filing (12/11/18)

MEWA Form M-1 - Report for MEWAs & Certain Entities Claiming Exception (2/12/18)

MEWA: Form M-1: Report for MEWAs & Certain Entities Claiming Exception (ECEs) (12/22/14)

IRS Bulletin: 8963 Health Insurance Providers Fee (12/4/14)

MEWA Regs: Fillings Required of MEWA Arrangements and Certain Other Related Entities (3/1/13)

MEWA Regs: ExParte Cease and Desist and Summary Seizure Orders (3/1/13)

MEWA Regs: Final Revision & Publication of the 2012 Form M-1, Notice (3/1/13)

MEWA Regs: Revision of Annual Information Return/Reports (Form 5500) (3/1/13)

Size and Role of TPA Market + Stop Loss

Articles and Materials

Numbers: Describing the Number of TPAs & Distortions in Counting (10/12/20)

Everything You Wanted to Know About TPAs But Were Afraid to Ask (6/25/19)

Testimony Given by SPBA Board Chair at the DOL Advisory Council (8/25/14)

Goofy Views On Benefits, ERISA, Fiduciary, TPAs & ASO (1/23/12)

"Biggest" and "Independent" TPAs (11/8/11)

Frequently Asked Questions About TPAs (7/26/11)

What's Allowable Error Rate? (12/8/06)

What's the Regulatory Status of Government & Religious Plans? (12/8/06)

Stop-Loss Activity

Articles and Materials

State News: Colorado (5/27/15)

Stop Loss (5/27/15)

A. Stop-Loss Templet + Definitions + Self-Funding Myths vs Facts (2/27/15)

NAIC Committees Explore Stop Loss (9/5/13)

State Stop-Loss Developments: North Carolina (5/28/13)

Colorado House Approves Stop-Loss Legislation (4/26/13)