NFP's Insights from the Experts: Recent Episodes
NFP's Insights from the Experts
NFP introduces the Insights from the Experts podcast series. Each episode will showcase timely perspective from members of the NFP community, delivering information, analysis and solutions that address our clients’ most significant challenges.
You can find archived episodes of Innovation Conversations at https://soundcloud.com/user-939810789.
In this episode, Suzanne Spradley and Chase Cannon discuss the rise of value-based care (VBC) arrangements and break down the compliance considerations employers should consider when implementing them. Suzanne begins with a description of ERISA’s fiduciary obligations as they relate to VBC arrangements. Chase and Suzanne then discuss how a fiduciary checklist can assist with those obligations, as well as the other compliance rules that need to be reviewed in connection with VBC arrangements.
In this episode, Chase Cannon and Suzanne Spradley discuss the Department of Labor’s proposed new electronic disclosure safe harbor for ERISA group health plans. Chase begins with some background on the current DOL electronic disclosure rules. Then, the two discuss how the proposal could modernize the delivery of required health plan notices, reduce reliance on paper disclosures, and give employers a new notice-and-access option while preserving important participant protections. They also cover practical considerations for employers, including covered documents, website requirements, bounced electronic notices, privacy concerns, and what the final rule might look like.
In this episode, Suzanne Spradley and Chase Cannon discuss the usage of artificial intelligence (AI) in plan-related administrative tasks. Suzanne begins with an outline of how carriers, vendors, TPAs, and employers as plan sponsors are currently using AI. Suzanne and Chase discuss the impact AI might have on an employer plan sponsor’s ERISA fiduciary obligations, including the duties of prudence, loyalty, and monitoring, particularly in the context of adverse benefit determinations. The two close with a discussion on AI’s impact on other compliance laws, including HIPAA and the mental health parity rules.
In this episode, Chase Cannon and Suzanne Spradley discuss a recent HHS Office for Civil Rights settlement showing that self-insured employer-sponsored group health plans are not outside the reach of HIPAA enforcement — especially when ransomware, electronic PHI, and incomplete risk analysis are involved.
In this episode, Suzanne Spradley and Chase Cannon revisit the history and importance of the tax exclusion for employer-sponsored insurance (ESI) coverage. Suzanne takes us back to the 1940s to understand how the tax exclusion began. The two discuss the reasons for the longevity and stability of the ESI model and how it has impacted the accessibility and affordability of health insurance in the U.S. Suzanne closes by addressing a new U.S. Congressional proposal that could impact employers and the ESI model.
In this episode, Chase Cannon and Suzanne Spradley look at some common blind spots that employers, as plan sponsors, should review with respect to compliance. Chase outlines the first two blind spots that relate to the application of COBRA and COBRA initial notice distribution. Chase and Suzanne then discuss how employee counts can trip up employers when it comes to how certain compliance laws apply. The two close the podcast with a discussion of the impact of remote employees on state paid family and medical leave requirements.
In this episode, Suzanne Spradley and Chase Cannon discuss two recent circuit court decisions and their impact on employer-sponsored group health plans. Suzanne first discusses a Sixth Circuit decision involving a state law that attempts to regulate PBMs. Suzanne and Chase walk through Supreme Court precedent that appears to be driving states to enact PBM laws, and they explain how ERISA preemption is at the heart of it all. Suzanne concludes the podcast by outlining another federal decision relating to a fiduciary breach claim of an employer group health plan.
In this episode, Chase Cannon and Suzanne Spradley review three important upcoming compliance-related deadlines. Chase highlights the three requirements, including ACA reporting, an April 15 deadline related to HSA contributions and distributions, and RxDC reporting. Chase and Suzanne discuss some practical approaches to each of those deadlines and conclude with a summary of how recent DOL enforcement priorities and ERISA fiduciary litigation come into play.
In this episode, Suzanne Spradley and Chase Cannon review the outlook of health policy in the current Washington, DC environment. Suzanne leads off, setting the stage with a description of the narrow House Republican majority and its impact on enacting legislation. Suzanne and Chase discuss several pieces of legislation focused on transparency, including site-neutral payment reform and drug pricing. The two address regulatory activity that potentially targets PBMs and No Surprises Act issues. The episode concludes with a discussion of legislative and regulatory impact on employer group health plans.
In this episode, Chase Cannon and Suzanne Spradley review a recent DOL announcement that outlines the agency’s enforcement priorities for group health plans. Chase provides some background on DOL enforcement and the DOL’s efforts to increase employee benefit plan compliance, address abusive practices, and protect the rights of participants and beneficiaries. Chase and Suzanne go deeper on four of the priorities, including mental health parity, cybersecurity, abuse of contributory benefit plans, and surprise billing, including important takeaways for employers to consider going forward.
In this episode, Chase Cannon and Suzanne Spradley discuss a recent wave of litigation centered on ERISA’s fiduciary obligations for health and welfare plan sponsors. Suzanne begins with an explanation of the lawsuits and how the voluntary benefit plan exception from ERISA is core to the lawsuit allegations. Suzanne and Chase continue with a close look at the exception and the criteria employers should consider to meet the exception. The two close with a discussion on employer takeaways for ERISA fiduciary and voluntary plan exception purposes.
benefits, which may ease some compliance burdens. Suzanne and Chase discuss the cost aspects of fertility benefits and how an excepted benefit Health Reimbursement Arrangement could potentially help provide a benefit vehicle for employers. The two finish the episode talking about how employers should stay tuned for additional guidance on developing a compliant fertility benefit plan offering.
In this episode, Chase Cannon and Suzanne Spradley discuss recent and noteworthy guidance from the IRS despite the federal government shutdown. Chase and Suzanne dive into the recently announced IRS inflation-adjusted amounts for benefits-related items in 2026 and their impact on employer plans. The podcast winds down with a discussion on what employers should consider and a preview of the next podcast topic: fertility benefits.
In this episode, Suzanne Spradley and Chase Cannon discuss a September 2025 presidential announcement regarding tariffs on pharmaceutical products. Suzanne provides some background on the announcement and what it might mean for the U.S. and other countries. Suzanne and Chase explore the potential benefits and drawbacks of a new website relating to prescription drugs. Suzanne closes the podcast by outlining the potential impact on employer-sponsored group health plans and drug plans.
In this episode, Chase Cannon and Suzanne Spradley discuss a few HIPAA lessons that employers can glean from recent Health and Human Services (HHS) enforcement settlements. Chase begins with an outline of HIPAA’s obligations in the group health plan context and HHS enforcement trends. Chase and Suzanne discuss three different cases that resulted in monetary penalties, highlighting the importance of responding timely to participant requests for their personal information, running a risk assessment on internal systems, and protecting against and timely responding to cyberattacks and other breaches. The podcast winds down by highlighting the top five issues seen in HHS enforcement cases in recent years and includes a short discussion of NFP resources that can assist employers in complying with HIPAA.
In this episode, Suzanne Spradley and Carol Wood discuss the role of pharmacy benefit managers (PBMs) and the recent proliferation of state laws that regulate PBMs. Next, Suzanne explains how these state PBM laws interact with federal laws, which are supreme. Suzanne reviews ERISA preemption and the U.S. Supreme Court Rutledge case, and how state lawmakers continue to test the boundaries of their authority with PBM legislation. The conversation then turns to a controversial Arkansas PBM law and the related litigation that has gained national attention. Suzanne and Carol end by providing employer takeaways and explaining why it’s important for employers to continue to monitor developments in this complex benefits area.
In this episode, Suzanne Spradley and Chase Cannon discuss the No Surprises Act (NSA) and its impact on out-of-network (OON) billing, with the independent dispute resolution (IDR) process at its core. Suzanne starts with an outline of the NSA and OON billing, how surprise bills arise, and how the IDR process is meant to help with carrier and provider disputes on bill payment amounts. Suzanne and Chase discuss CMS’s involvement and the data gathered, shedding light on how IDR entities are selected, how disputes are handled, who’s winning, and the amounts being paid. The two close with a discussion of the fairness of the process and the impact on healthcare costs for employers and their group health plans.
In this episode, Suzanne Spradley and Chase Cannon break down the Senate’s version of the One Big Beautiful Bill, released on June 16, 2025. Suzanne outlines the budget reconciliation process and how the so-called “Byrd Rule” comes into play. Suzanne and Chase discuss the similarities and differences between the House and Senate versions of this bill and how the two can align on those differences. Suzanne outlines one major difference relating to the Senate’s exclusion of certain benefit-related provisions (HRA/CHOICE/ICHRA amendments and HSA expansions and flexibilities, to name a few) that were in the House’s version. Suzanne and Chase conclude with thoughts on what employers can expect in the coming weeks as the legislative process plays out.
In this episode, Chase Cannon and Suzanne Spradley outline the latest proposed bill from the U.S. House of Representatives, potentially up for a vote in the coming weeks. Chase outlines a key element missing from the proposed bill ‒ caps, cuts, or elimination of the so-called employer tax exclusions for health insurance ‒ and explains why it’s important for employer health plan sponsors. Chase and Suzanne spend the rest of the episode describing potential changes to HSAs and HRAs, including flexibility with HSA eligibility, increases on HSA contribution limits, and a new vehicle (called a “CHOICE arrangement”) for reimbursing an employee’s individual policy premium.
In this episode, Suzanne Spradley and Chase Cannon review a recent industry focus-study on the economic impact of capping or eliminating the tax benefits associated with employer-provided health plans. Suzanne begins by providing a background on the employer-sponsored insurance tax breaks, their impact on employers and employees, and why Congress is considering a potential cap or elimination of those tax breaks. Suzanne and Chase discuss a recent study that addresses the negative downstream impact of such a cap or elimination, including detrimental economic, health insurance coverage, and health outcomes. Employers should be aware of these impacts and outcomes as Congress continues to view healthcare tax benefits as a source of revenue to offset other tax credits and breaks, including those that Congress wants to extend as part of the Tax Cuts and Jobs Act (which is set to expire at the end of 2025).
In this episode, Chase Cannon and Suzanne Spradley discuss some interesting questions relating to health savings accounts (HSAs), including basic eligibility, impermissible coverage, and employer responsibility when determining an individual employee’s HSA eligibility. Chase jumps in on a response to a question about HSA eligibility regarding a health FSA grace period. Chase and Suzanne conclude with a discussion about Medicare enrollment and HSA eligibility and whether employers should automatically terminate HSA contributions when an employee turns 65.
In this episode, Suzanne Spradley and Chase Cannon discuss recently published proposed regulations relating to HIPAA’s Security Rule. Suzanne leads off with an overview of the HIPAA privacy and security rules generally, focusing on security — the usage of personal health information in electronic form. Suzanne and Chase discuss potential changes in definitions under HIPAA’s Security Rule, how the risk analysis requirement might be impacted, and what employers should be considering with their internal benefits, technology, and IT teams. Suzanne closes the podcast with her thoughts on the process and timeline for finalizing the proposed regulations.
In this episode, Suzanne Spradley and Chase Cannon discuss the debate relating to employer-sponsored group health plan coverage and insurance tax exclusion. Suzanne describes what is meant by employer-sponsored insurance (ESI) and the background on the tax breaks that employers and employees receive when it comes to ESI. Suzanne and Chase walk through the two sides of the debate on keeping or remodeling the ESI tax exclusion, which could become a bigger issue in 2025 with respect to tax and health policy under the constantly changing legislative environment in DC.
In this episode, Chase Cannon and Suzanne Spradley discuss the recent revival of vendor-promoted pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment. Chase leads off with a brief description of these programs and their purported claims on employment tax savings for both employees and employers. Chase and Suzanne review the various iterations of the programs, explain how their tax-free reimbursements are not allowed under the related rules, and discuss how the IRS has attempted to address their illegitimacy through several pieces of guidance. Chase closes out the podcast by identifying red flags to help listeners recognize these problematic programs.
In this episode, Suzanne Spradley and Chase Cannon review the current state and federal regulation of pharmacy benefit managers (PBMs), focusing on litigation surrounding recent state-enacted PBM rules. Suzanne starts off with a high-level description of PBMs and the role they play in the group health plan context. Suzanne and Chase discuss the plethora of state laws (proposed and enacted) focused on PBM regulation and the role courts have played in ERISA preemption of state laws, including in Arkansas, Oklahoma, and North Dakota. Suzanne concludes with a discussion of ERISA fiduciary obligations in the context of the J&J lawsuit, including a few employer takeaways on establishing a process for making plan-related decisions on pharmacy and other benefits and administration.
In this episode, Suzanne Spradley and Chase Cannon discuss the US importation policies and rules aimed at lowering domestic prescription drug costs. Suzanne walks through the legalities of drug importation generally and then outlines the specific programs by which states can develop importation plans. Chase and Suzanne discuss several state importation proposals and how they could potentially bring savings to US consumers. Suzanne closes by addressing Canadian concerns relating to potential US drug importation.
In this episode, Chase Cannon and Suzanne Spradley remind employers about important ACA employer mandate reporting deadlines with the IRS, including a change in electronic reporting in 2024 for smaller employers. Chase also outlines some updated numbers relating to the federal poverty line (FPL), ACA affordability calculations and ACA penalty amounts, which are all adjusted annually. Suzanne and Chase finish with a discussion on an IRS alert regarding wellness vendors that are erroneously claiming certain expenses are “medical care” under the IRS rules.
In this episode, Suzanne Spradley and Chase Cannon give an overview of the No Surprises Act (NSA) — a consumer health protection law that places certain requirements on providers and payers (insurers and group health plans). Suzanne describes the main requirements under the NSA and introduces the Independent Dispute Resolution (IDR) process, which is an integral part of the NSA’s implementation. Suzanne and Chase discuss the challenges facing the IDR in its first few years, as well as the legal challenges to the federal guidance outlining IDR procedures and practices. Suzanne closes with a discussion of what to look for in 2024 and how the NSA and IDR may impact employers.
In this episode, Chase Cannon and Suzanne Spradley discuss employer compliance with the HIPAA privacy and security rules via lessons learned from three new HHS HIPAA settlement announcements. Chase leads off with a high-level review of the HIPAA rules for both fully and self-insured plans and the importance of safeguarding protected health information (PHI). Chase and Suzanne discuss the background and scenarios that led to the HHS investigation, how unauthorized access to PHI arose in the three settlement scenarios, and the importance of employers running a HIPAA risk assessment to get ahead of potential HIPAA problems. Chase and Suzanne share practical tips on HIPAA compliance, including training employees, involving IT and Technology teams when developing policies and procedures, and controlling access points (servers, emails, etc.) to electronic and physical PHI.
In this episode, Suzanne Spradley and Chase Cannon discuss a recent circuit-level decision relating to employee termination and its interaction with a participant lawsuit based on ERISA Section 510 (which prohibits an employer’s interference with a plan participant’s right to benefits). Suzanne provides background on ERISA 510 and how it applies to employer’s group health plans. Suzanne and Chase analyze a case where an employer terminated an employee shortly after their return to work following a leave of absence for a medical procedure. The two close by discussing how the court weighed certain factors when determining the employer violated the participant’s Section 510 rights.
In this episode, Chase Cannon and Suzanne Spradley take a tour across the nation as they review several new regulatory developments in six states that could impact employers with employees or fully insured plans in those states. Chase outlines new or recently effective paid family leave rules in New York, Oregon, and Maine.
Chase and Suzanne delve into the impact of 2024 rate adjustments relating to San Francisco’s Health Care Security Ordinance and New York’s Paid Family Leave laws, including updated notices and other information on which employers need awareness. The two attorneys also highlight several new Texas laws that implicate multiple employer welfare arrangements (MEWAs) and fully insured plan coverage of prescription drugs and ground ambulance services.
In this episode, Suzanne Spradley and Chase Cannon address a recent appellate-level court case that addresses ERISA preemption of a recently enacted Oklahoma state law regulating pharmacy benefit managers (PBM). Suzanne begins by laying the groundwork and history of ERISA and ERISA preemption. Suzanne and Chase discuss the Oklahoma state PBM law and the players in the court case challenging the applicability of that state law. Suzanne details the court’s analysis on the circumstances required for ERISA to preempt (overrule) a state law, and she covers the court’s opinion and decision. Suzanne and Chase conclude the podcast by discussing the impact of the court’s decision on employers.
In this episode, Chase Cannon and Suzanne Spradley discuss recent enforcement on MHPAEA. Chase jumps in with a description of DOL’s enforcement approach, including working through TPAs to identify plans that have or had ABA therapy exclusions. Suzanne and Chase discuss the administrative challenges with reprocessing ABA exclusion claims, which the DOL is asking TPAs to assist plans with. The two close with a high-level review of the recent DOL Enforcement Fact Sheet and promise a more in-depth review of the recent MHPAEA proposed regulations and report to Congress on the next podcast.
In this episode, Suzanne Spradley and Chase Cannon review several new pieces of proposed federal legislation coming out of the House. Suzanne discusses the Transparency in Billing Act, which requires hospitals to have better and more accurate billing practices, policies and procedures with respect to outpatient departments. Suzanne and Chase dive into two other proposed bills aimed at PBMs and prescription drug pricing and creating a more shoppable healthcare system. Suzanne closes with some highlights on a proposed bill aimed at increasing transparency in fees from PBMs and TPAs.
In this episode, Chase Cannon and Suzanne Spradley discuss a recent IRS memo on wellness benefit payments via employer-funded fixed indemnity plans. Chase outlines the various iterations and structure of vendor-promoted wellness programs, which usually purport huge employment tax savings for employers. Chase and Suzanne outline the relevant tax rules and where these programs usually run afoul of those laws. The two close with a discussion on the recent IRS memo and what it means for employers considering these types of programs.
In this episode, Suzanne Spradley and Chase Cannon review the CAA’s prohibition on gag clauses in TPA and service provider contracts, as well as the employer’s obligation to attest to the removal of gag clauses (due December 31, 2023, for the first time).
Suzanne outlines the challenges employers and plans face when working with TPAs, and explores how recent guidance attempts to address those challenges. Additionally, Suzanne and Chase discuss two recent cases between plans and their TPAs. They examine how these cases may impact employers’ paths forward in complying with the CAA gag clause prohibition and attestation requirements.
In this episode, Chase Cannon and Suzanne Spradley discuss updates on the ACA preventive care mandate litigation, including a stay issued by the Fifth Circuit Court of Appeals. HSA contribution limits become a topic of discussion, as the IRS recently published updated numbers. Chase and Suzanne also discuss a common problem for employers filing Form 5500 with respect to missing Schedule A information from carriers.
In this episode, Suzanne Spradley and Chase Cannon have a look at the national debt and debt ceiling and how they impact employers and their group health plans. Suzanne leads off with a discussion on the national debt and how Congress sets the debt ceiling. Suzanne and Chase go in depth on what a failure to raise the debt ceiling and/or default on debt could mean for the healthcare industry. Suzanne closes with a discussion on mandatory and discretionary spending and how the tax exclusion for employer-provided benefits could potentially be at risk.
In this episode, Chase Cannon and Suzanne Spradley review several recent HIPAA violation settlements from the HHS Office for Civil Rights. Chase starts off by reviewing the general HIPAA obligations of fully and self-insured plans, including the importance of a HIPAA risk assessment. Chase and Suzanne discuss three real-life scenarios outlining ways in which companies experienced HIPAA breaches. Chase emphasizes the importance of a solid IT and technology team as part of a company’s HIPAA privacy and security strategy, including the development and implementation of certain policies and procedures. The two also discuss lessons learned from the settlements in the context of an employer group health plan.
In this episode, Suzanne Spradley and Chase Cannon discuss a recent Texas court ruling that invalidates a portion of the ACA’s preventive services coverage requirement. Suzanne provides a background of the plaintiffs and their arguments, including a Constitutional problem with the way the government appointed officers under the ACA and a religious freedom violation. Suzanne and Chase discuss the court’s decision, including the potential for a stay (hold) on the decision and the decision’s impact on fully and self-insured plans.
In this episode, Chase Cannon and Suzanne Spradley address recent IRS guidance that mandates electronic filing of certain tax forms – including Forms 1095-C – for smaller employers. Chase describes the background from Congress and the IRS and explains what it means now that any employer filing 10 or more forms (previously, this was 250) will be required to do so through the IRS electronic filing system. Suzanne and Chase discuss the impact on smaller employers, along with updated employer mandate penalties and certain state filing requirements for employers. Chase closes with an outline of a proposed bill in Congress addressing benefits continuation for employees locked out or participating in a strike.
In this episode, Suzanne Spradley and Chase Cannon discuss potential activity at the federal and state level relating to PBM transparency. Suzanne begins the discussion by outlining a few proposals from Congress that attempt to hold PBMs accountable for unfair and deceptive practices that may be driving up prescription drug costs. Suzanne then addresses a few state proposals that attempt to regulate PBMs. Suzanne and Chase close by discussing the potential impact on employers and their group health plans.
In this episode, Beth Allen and Chase Cannon look at several new developments for plan compliance in 2023. The two start with the recent announcement on the end of the COVID-19 public health emergency, which impacts the outbreak period and extension of timeframes for certain compliance deadlines. Chase then dives in on the CAA 2023 extension of relief for telehealth services in conjunction with HSA eligibility. Chase and Beth close by outlining several state compliance challenges, including state law interaction with telehealth services and the ever-evolving landscape of state paid family and medical leave laws.
In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take effect in 2023. Suzanne and Chase discuss state compliance challenges, including abortion travel coverage, paid family and medical leave, and new legislation aimed at providers (but could indirectly impact employers). Suzanne closes by addressing the extension of telehealth relief with respect to HSA eligibility and what to look for in 2023 on the mental health parity analysis requirement.
In this episode, Suzanne Spradley and Chase Cannon discuss several recent COBRA cases. Suzanne starts by outlining several class action lawsuits filed against employers and plan sponsors relating to deficiencies in an employer health plan’s COBRA election notice. Suzanne and Chase discuss the use of the DOL’s Model Election Notice and how that usage interacts with potential DOL regulatory fines and participant lawsuits, and how employers can get into trouble by not including the appropriate information in the model or other election notices. Suzanne then describes a lawsuit against a single employer relating to a COBRA election notice delivery failure, including the involvement of a TPA.
In this episode, Chase Cannon and Suzanne Spradley discuss three recent court rulings—all at the district court level. Chase outlines the first case relating to a COBRA election notice failure, including takeaways for employers to enhance their notice distribution procedures. Chase and Suzanne dive into an ACA-related case challenging gender-affirming care guidance published by HHS earlier in 2022. The two close with a review of a third case challenging certain aspects of the ACA’s preventive care mandate.
In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health services, such as required behavioral health monitoring for suicide ideations and the need for interventions such as detoxification for substance abuse. Suzanne and Chase walk through proposals from the House on coverage for forensic medical exams relating to sexual assault. Suzanne and Chase close with a discussion of provider network proposals and the Senate’s reauthorization of funding for the Jackie Walorski Maternal and Child Home Visiting Act, which promotes healthy pregnancy practices, language development and early learning at home.
In this episode, Chase Cannon and Suzanne Spradley discuss the benefits provisions of the recently-enacted Inflation Reduction Act. Chase walks through the extension of premium tax credit expansions through 2025, and the impact on employers with respect to the employer mandate penalties. Next, Chase and Suzanne discuss Medicare prescription drug cost reductions and a formalization of prior IRS guidance that allows HDHP coverage of insulin in certain circumstances without impacting HSA eligibility. The two close the podcast by outlining the new law’s increased funding of the IRS and how that might impact compliance enforcement on employer group health plans.
In this episode, Chase Cannon and Suzanne Spradley recap the past few weeks’ guidance relating to Post-Dobbs considerations on employer coverage and reimbursement of abortion-related services. Chase starts by comparing the approaches of two different states – Texas and New Jersey – with respect to the legality of abortion services. New laws and developments in each of those states highlight the challenge of navigating state law for employers. Suzanne and Chase then discuss the directives from the most recent executive order, aimed at protecting abortion access. Chase dives in on two new pieces of HHS guidance relating to abortion coverage. The two close with a discussion on the importance of time and patience and how court decisions will shape the future environment for employers and group health plans.
In this episode, Suzanne Spradley and Patrick Myers discuss recent guidance concerning the interaction between FMLA and mental health conditions. Suzanne provides some context for this guidance and a brief refresher on FMLA itself. Suzanne and Patrick then discuss how mental health conditions can apply in a FMLA context, including when a mental health condition is a “serious health condition” or a disability. Suzanne continues with a discussion about how mental health conditions and FMLA apply to an employee’s family members, FMLA military caregiver leave, and retaliation. Suzanne and Patrick close with a reminder that other state and federal laws may also apply in this context, and employers should review their FMLA and leave policies to make sure that mental health conditions are provided for.
In this episode, Suzanne Spradley and Chase Cannon discuss hospital prices and their impact on employer group health plans. Suzanne describes this issue as it relates to the new transparency in coverage rules. Suzanne and Chase review a recent study that reviews hospital prices nationwide, including Medicare-certified, short-stay and other facility types. Suzanne discussing the findings of the study, price consistency among the various states, and what it all might mean for employer-sponsored group health plans. Suzanne and Chase close with a discussion of what other means might be available for controlling healthcare costs.
In this episode, Chase Cannon and Suzanne Spradley look at the recent rise in so-called “point solution programs.” These add-on programs enhance or expand on a group health plan offering and have benefits such as mental health, musculoskeletal, life coaching and fertility. Chase explains some of the compliance challenges that arise from offering the programs, including ERISA, COBRA, and ACA issues when the programs include components of medical care. Next, Chase and Suzanne discuss the challenges surrounding HSA eligibility and taxation, and the two close with general comments on these types of programs.
In this episode, Suzanne Spradley and Chase Cannon update us on employer compliance obligations under the Transparency in Coverage (TIC) rules. Suzanne begins with an overview of the TIC rules and how they are meant to address consumerism and rising health care costs. Suzanne and Chase then hone in on the actual requirements, including posting of plan information, with both in-and-out-of-network rates. Next, Suzanne dives in on the different challenges for fully and self-insured plans, and the importance of employers working closely with their carriers and TPAs. The episode closes out with a discussion on provider and TPA contracting.
In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on March 22, 2022. Next, they address the impact of this decision on future mental health claims litigation and the Department of Labor’s MHPAEA enforcement efforts. The episode closes with MHPAEA compliance reminders for employer plan sponsors.
Join NFP’s own Head of Innovation, Mark Rieder, as he discusses what innovation looks like at NFP and how to start your own innovation journey with Naviant’s Ema Roloff on their “Digital Transformation Talks” podcast series. Discussion points include: • How to engage a team in innovation • How to support continual education within an organization • Tips on starting the innovation process
Take a listen to hear how innovation gets a strong foundation here at NFP.
In this episode, Patrick Myers and Suzanne Spradley review recent litigation and administrative action brought under the Mental Health Parity and Addiction Equity Act (MHPAEA). Suzanne begins the discussion by providing background on the requirements imposed on plans by MHPAEA, with a particular focus on non-quantitative treatment limitations (NQTLs). Suzanne then discusses the report submitted to Congress by the DOL, HHS and the IRS that highlighted several deficiencies they found when examining plan sponsors and insurance providers for MHPAEA compliance. She follows up by discussing a large civil case involving a behavioral health provider. And the episode closes with a discussion on two large settlements between the DOL and administrative service providers as part of the agency’s efforts to enforce MHPAEA compliance.
In this episode, Chase Cannon and Suzanne Spradley outline a few explanations on recently-asked benefits compliance questions. First, Chase describes the challenges relating to the requirement to provide a Medicare Part D creditable disclosure to CMS and individuals. Chase and Suzanne then dig into HSA eligibility where an employee has a spouse or dependent who is enrolled in Medicare, including the HSA contribution maximum and distributions from the HSA. The two close with a discussion about tricky scenarios on the COBRA Initial Notice, including the requirement to distribute the notice to newly enrolled spouses.
In this episode, Suzanne Spradley and Chase Cannon discuss the ACA provider nondiscrimination rules — the idea that individuals have the right to access health services from the full range of providers licensed and certified in their state. Suzanne leads off with a background on why Congress felt it necessary to include the provider nondiscrimination rules as part of the ACA. Next, Suzanne and Chase discuss prior state law and litigation in the courts and how the ACA rules attempt to address the related issues. The two go deeper into the rules themselves, the process, and then back and forth between the agencies (DOL, Treasury, etc.) and the Senate on the intent and purpose of the law. Suzanne closes by outlining a recent agency “listening session,” wherein providers and group health plans gave feedback on questions that future guidance should address.
In this episode, Chase Cannon and Suzanne Spradley break down the recent Supreme Court decision relating to the vaccine mandates for large employers and healthcare workers. Chase starts by outlining the large employer vaccine mandate, including the OSHA emergency temporary standard, or ETS rule, that was challenged in the courts. Next, Chase and Suzanne discuss the Supreme Court’s decision to halt enforcement of the OSHA ETS — what the ruling means from a legal and practical viewpoint and how state law could come into play. While the decision appears to be the end of the road for the OSHA ETS, Chase closes things out by discussing the CMS healthcare worker vaccine mandate (held valid by the Supreme Court) and the vaccine mandate for government contractors (held up in federal courts).
Join Mark Reider, NFP's own Head of Innovation, as he discusses the future of the ever-changing insurance marketplace with Denise Garth, Chief Strategy Officer at Majesco on their "The Future of Insurance: Industry Leaders" podcast. Discussion points include: • How employers can utilize innovative thinking to boost employee retention • What emerging tools and systems employers can offer to benefit their employees and how these technologies are shaping the future • How we try to look at insurance from the buyer's perspective today and how that will change tomorrow Thanks for coming on this journey with us.
In this episode, Chase Cannon and Suzanne Spradley break down the recent OSHA guidance (emergency temporary standard, or ETS) relating to the employer COVID-19 vaccine and testing mandate. Chase outlines the general requirement for employers with 100 or more employees to ensure employees are vaccinated or tested regularly. Suzanne and Chase discuss legal challenges to the ETS guidance at the federal and state level. The two outline the ETS requirements relating to counting employees, vaccination policies, proof of vaccination status, alternative testing, employee notification and penalties. The two close by discussing some practical planning tips, and the importance of engaging outside counsel to assist with mandate compliance.
In this episode, Suzanne Spradley and Patrick Myers discuss the growing trend of HIPAA breaches, particularly those that involve ransomware attacks and employee errors. Suzanne points out how the pandemic and the increased use of telehealth encouraged a growing reliance on electronic transmission and data. Suzanne and Patrick discuss HIPAA privacy law, recent updates to the law, its notification requirements, and the Health Risk Assessment requirement. Finally, the two close by discussing enforcement actions, penalties, and common violations that result in fines imposed by the federal government.
In this episode, Kim Bell, EVP, Head of Health and Benefits and Dale Sagen, VP and Leader of Group Captive Solutions focus on NFP’s newest launch, our Medical Stop Loss Captive, sharing an overview of our captive practice, and the benefits of leveraging this type of program.
In this episode, Chase Cannon and Patrick Myers provide an update on vaccine mandates and surcharges, including some helpful governmental guidance on HIPAA wellness program rule application to vaccine surcharges. Chase then digs in on some end-of-year and open enrollment considerations for pandemic-related compliance obligations. Chase and Patrick discuss the mandatory and optional plan design changes and what employers should consider communicating to employees during open enrollment. The two close by addressing the temporary telehealth exception relating to HSA eligibility, currently set to expire at the end of the 2021 plan year, and whether we can expect any Congressional extension.
In this episode, Chase Cannon and Suzanne Spradley discuss the history of, and legal challenges to, OSHA's Emergency Temporary Standards (ETS), the format for the Biden administration’s recently announced vaccine mandate and COVID-19 testing alternative for employers. Suzanne begins with an overview of the likely legal challenges to the use of the ETS process, the historical use of OSHA's ETS instead of the standard rule-making process and prior court rulings that generally did not support the use of the ETS. Suzanne and Chase review the questions that will likely be raised considering the prior COVID-19-related ETS limited to healthcare workers and evidence that may be used to support a more expansive ETS.
In this episode, Chase Cannon and Suzanne Spradley outline the Biden administration’s recently announced vaccine mandate and COVID-19 testing alternative for employers. Chase begins with an overview of the mandate, the testing alternative and which employers are impacted by the requirements. The two spend the rest of the podcast issue spotting for employers — discussing questions that will hopefully be answered in upcoming OSHA guidance. Suzanne and Chase close with a discussion of the vaccine mandate’s impact on benefits compliance, including vaccine surcharges and paid time off for vaccines and testing.
In this episode, Chase Cannon and Suzanne Spradley discuss the compliance angle of employer-initiated vaccine mandates and incentives. Chase begins by outlining the ADA and EEOC rules relating to vaccine mandates, while Suzanne jumps in for a discussion on reasonable accommodations for those that have legitimate medical or religious objections to taking the vaccine and the confidentiality and administrative challenges relating to vaccine inquiries. Chase and Suzanne then turn their attention to other alternative strategies, including the pros and cons and compliance challenges relating to plan design exclusions and vaccine incentives. The two close with their thoughts on the huge hurdles surrounding vaccine surcharges or other incentives tied to the group health plan.
In this episode, Chase Cannon and Suzanne Spradley review and discuss three upcoming mid-summer compliance obligations with a July 31 due date: Form 5500 (an oldie), PCOR Fee (a revival) and ARPA COBRA subsidy tax credits (a newbie). Chase outlines the requirements, forms and challenges relating to those obligations as Suzanne relays some frequently asked questions that employers ask as they seek to comply. The two close by discussing a quick scenario relating to the ARPA tax credit filing process.
In this episode, Chase Cannon and Patrick Myers discuss the interim final rules relating to the federal No Surprise Billing Act. Patrick begins with an explanation for the need for these rules. Patrick and Chase then look at how the rules address the problem of balance billings. Patrick closes with a discussion of the interaction between the rules and state laws and looks forward to the next wave of rules.
In this episode, Suzanne Spradley and Patrick Myers discuss the Supreme Court’s ruling in the latest challenge to the ACA. Suzanne begins with a history of legal challenges to the ACA, and then discusses the Supreme Court’s recent opinion. Patrick and Suzanne then look at how the Supreme Court’s decision impacts employers and what we can expect from the current administration in response. Suzanne closes with a discussion of the future of health care reform, both at the state level and the federal level.
In this episode, Suzanne Spradley and Chase Cannon discuss rising prescription drug costs as a challenge for employers and consumers. Suzanne begins with an overview of the issue at a federal and state level, and then digs into state proposals addressing drug price transparency and affordability review boards. Chase and Suzanne then look at drug importation and other programs aimed at sourcing drugs in different countries, primarily Canada. Suzanne closes with a discussion on the role pharmacy benefit managers play in prescription drug pricing and costs.
In this episode, Chase Cannon and Suzanne Spradley discuss the recently published IRS FAQ guidance on ARPA COBRA premium subsidies. Chase gives an overview of six steps employers need to take to ensure compliance. Chase and Suzanne discuss IRS FAQs addressing what constitutes a reduction in hours or involuntary termination, including employment contract and severance situations. Chase outlines the IRS guidance on employer involvement in claiming the tax credit, including documentation and substantiation issues. The two close with thoughts on the overall process for employers.
In this special episode, Suzanne Spradley and Chase Cannon discuss the COBRA subsidies that are a big part of the recently-enacted ARPA. Suzanne starts the discussion with a history of past COBRA subsidies, including in 2002 and 2008/09, comparing them to the ARPA subsidies. Suzanne then answers Chase’s rapid fire questions on the ARPA COBRA subsidies, including the amount and duration, who is eligible, employer involvement, notice requirements, and interactions with COBRA administrators and vendors.
In this podcast, NFP’s John Deem, regional VP Benefits Compliance, and Lucia Fan, VP Corporate Benefits in Mid-Atlantic, wrap up the ins and outs of Medicare and how to enroll.
In this podcast, NFP’s John Deem, regional VP Benefits Compliance, and Lucia Fan, VP Corporate Benefits in Mid-Atlantic, dive into what Medicare is, the different types of Medicare plans, what each plan covers, and how to know what you're eligible for. This is a two-part podcast — look for Understanding Medicare Pt.2 to hear the rest of the deep dive.
In this episode, Chase Cannon and Suzanne Spradley look at recently published DOL guidance establishing new parameters relating to deadline suspensions for COBRA notices, elections and payments, HIPAA special enrollment elections, and appeals/claims filings. Chase outlines the background and examples on the DOL’s new approach to the one-year suspension period, which is now based on the individual’s or plan’s deadline itself (not a hard stop on February 28, 2021, as many had thought). Chase and Suzanne then dig into the newest federal COVID-19 relief bill that is through the House and with the Senate, focusing on potential COBRA subsidies that could create additional employer (and COBRA administrator) compliance obligations
Grow your revenue while protecting your lending portfolios. Despite an uncertain climate, our team's risk transfer programs will allow you to offer your members expanded lending products, building and strengthening your consumer relationships and community value.
In this episode, Suzanne Spradley and Chase Cannon look at new mental health parity requirements for plan sponsors under the recently-enacted Consolidated Appropriations Act of 2021 (CAA of 2021, the most recent pandemic-related legislation, signed into law in December 2020). Suzanne outlines the new requirements in connection with current law (Mental Health Parity and Addiction Equity Act — MHPAEA), and related enforcement. Suzanne and Chase discuss the details of the new requirements, the rapidly-approaching compliance date (February 10, 2021), the lack of specific guidance, and the challenges in working with vendors (including carriers and TPA/ASO providers) in gathering necessary information.
Companies have expanded their view of well-being and they’re investing in resources that improve the lives of their employees. The return on this investment – healthier, more productive employees, and an enhanced ability to attract and retain talent – depends on the well-being strategy. A plan that understands employee wants and needs, key trends, and the importance of effective communication is critical to achieving key objectives. Our latest trend report podcast provides expert insights for developing and executing the right plan.
In this episode, Chase Cannon and Suzanne Spradley review newly inaugurated President Biden’s pandemic response proposal, the American Rescue Plan. Chase outlines the proposal overall, then turns his attention to the proposal’s expansion of FFCRA leave to all-sized employers until the end of September 2021. Chase and Suzanne discuss additional leave expansion, and the proposal’s COBRA subsidies for those impacted by a pandemic-related furlough or layoffs, and the expansion of premium tax credits. The two close with a short discussion of potential Biden executive orders and their impact on proposed regulations regarding wellness programs, independent contractors and more.
In the latest installment of the Washington Update Election Series podcast, Finseca’s VP of Government Affairs, Armstrong Robinson, and NFP’s SVP of Strategic Resources, Kristin Bulat, are joined by Jeff Driscoll, VP Product Intelligence & Carrier Management. Jeff, Army and Kristin discuss the changes to 7702 instituted by the Consolidated Appropriations Act of 2020 and the impact those changes might have on accumulation life insurance sales.
In this episode, Suzanne Spradley and Chase Cannon look at a recent Supreme Court decision on ERISA preemption and state laws relating to pharmacy benefit managers (PBMs). Suzanne starts with a description of PBMs and state law regulation of PBMs. Chase and Suzanne discuss the meaning and application of ERISA preemption, and Suzanne outlines how lower courts and the Supreme Court have treated ERISA preemption previously. Suzanne tracks the background and arguments in the Rutledge case, and digs into the Supreme Court’s holding that ERISA does NOT preempt Arkansas’s PBM law. Chase and Suzanne close by discussing the potential implications of the holding for group health plans, both in and out of the PBM context.
In this episode, Suzanne Spradley and Chase Cannon look at the brand new COVID-19 relief bill, called the Consolidated Appropriates Act of 2021. Suzanne starts with a provision of the bill that allows (at the employer’s discretion) employees to rollover unused amounts in their FSAs (health and dependent care) from 2020 to 2021 and from 2021 to 2022. Suzanne and Chase then talk about practical implications of the act, including employee notification, administration, and plan document updates before digging into provisions of the law that apply to individuals, including unemployment benefits and stimulus checks. Suzanne outlines the items in the law relating to small businesses, including extensions of employee retention and FFCRA tax credits and additional amendments to the PPP loan program. Suzanne and Chase close with a discussion of new prohibitions on certain surprise billing practices and on new requirements for plans and carriers on price transparency.
In our latest US Benefits Trend Report podcast, Kim Bell, SVP, head of health and benefits, has a conversation with Kim Heald, NFP’s national practice leader for voluntary benefits. Kim Heald shares her perspectives on how the one-size-fits-all approach to benefits is increasingly ineffective, especially for multigenerational workforces, and the risks for employers if they don’t adapt by integrating supplemental health and lifestyle benefit options. The discussion also includes an overview of major challenges (70% of Americans are unable to save $1,000 to pay for unplanned medical expenses), how voluntary benefits can enhance employee financial stability and productivity, and an example of how voluntary benefits make a meaningful difference. Listen to the full podcast here.
In this episode, Chase Cannon and Suzanne Spradley review the compliance obligations employers must review and complete prior to the end of the year, for both calendar and non-calendar year plans. Chase digs into the basis of imputed income for domestic partner coverage and group term life insurance, and the importance of calculating and adding imputed income before the end of the year. Chase and Suzanne review the notices, tests and filings that must be completed by years’ end, including the Massachusetts HIRD filing requirement. Chase then looks forward to 2021, investigating the federal and state reporting requirements for employer mandate and state individual mandates. As the pandemic – and remote work – continues into 2021, Chase and Suzanne discuss the importance of state tax nexus and employment and income tax withholding for those working from home in a different state. The two conclude with a quick recap of the continued administrative challenges created by the DOL’s extensions to COBRA and HIPAA special enrollment deadlines via the so-called “outbreak period.”
It’s been a whirlwind since Election Day and while the Electoral College vote isn’t until December 14, results are coming into focus. In our final Election Update podcast, NFP’s Suzanne Spradley, Chase Cannon and Kristin Bulat recap the election process, discuss pending litigation and look ahead to what we might see over the next few months. Our experts also offer insights on the US Supreme Court’s consideration of California v. Texas, which challenges the Affordable Care Act’s individual mandate. We’re finishing strong with an episode that’s not to be missed.
As we look ahead, specialized expertise will be increasingly critical to navigating complex challenges and risks. In December, NFP will be hosting a three-part post-election webinar series to offer perspectives on the impact of the results. In the coming weeks, look for details on the webinar dates and times, as well as information on our speakers, all of whom offer unique insights on client solutions and the broader political and economic landscape.
In this episode, Suzanne Spradley and Erin Ziaja offer insight on litigation against insurance carriers that have denied business interruption (BI) claims for COVID-19 issues, including the recent decision where the court ruled in favor of the plaintiffs. The podcast also provides an overview of state proposals that extend BI coverage to COVID-19 related claims and other state laws enacted to provide immunity for businesses in cases alleging COVID-19 exposure. The podcast concludes with a brief discussion of the federal proposal for pandemic relief and the liability protection in the next stimulus package.
In the latest episode of our Election Update podcast mini-series, Armstrong Robinson, chief advocacy officer at Finseca, and NFP’s Kristin Bulat discuss the factors driving unprecedented early voting, how it might affect when we have final results and implications for future elections. Army and Kristin also contrast the uncertainty surrounding the election with the certainty provided by life insurance and financial planning.
In this episode, Suzanne Spradley and Chase Cannon discuss the lawsuit challenging the ACA that is set for Supreme Court oral arguments on November 10, 2020. Suzanne outlines the basis for the lawsuit—a claim that the ACA’s individual mandate is unconstitutional, and that the individual mandate is not severable from the remainder of the ACA. Suzanne details the history of the case, the arguments made on either side, and the potential impact of a decision either way. Suzanne and Chase discuss Justice Amy Coney Barrett’s very recent appointment to the Supreme Court, and how her views on the role of the judiciary branch might impact the outcome of the ACA case.
In our latest Insights from the Experts podcast, Mark Rieder sits down with Gina Bartasi, CEO of KindBody, to discuss their global end-to-end family building benefit for all. KindBody’s mission is to offer best-in-class care, accessible pricing and a seamless experience for fertility, gynecology and wellness services. Learn how their emphasis on personalized, human-centered care supported by modern tech is on the leading edge of family building support.
Our latest US Benefits Trend Report podcast features a conversation with Mark Rieder, NFP’s head of innovation. Mark talks with Kim Bell, SVP, head of health and benefits, about opportunities in the employee benefits space, the acceleration of innovation in response to COVID-19, and innovating to solve big problems and improve lives. Mark also discusses how living in a digital world requires that employers embrace digital transformation in how they deliver benefits to employees. He closes with insights on relationships with startups (partnership vs. disruption), applying existing technologies to evolving problems, and the importance of adaptability and a long-term view. Listen to the full podcast here.
In this episode, Chase Cannon and Suzanne Spradley address some confusion on recent HHS announcements extending their emergency declarations. Chase begins by describing two pandemic-related requirements — one relating to FFCRA/CARES Act COVID-19 testing/diagnosis, and one relating to the deadline extensions for COBRA notices and premium payments, HIPAA special enrollment windows, and claims appeals. Chase and Suzanne describe the differences in the HHS and White house declarations of national emergencies, which drive the effective time periods for the requirements themselves. Suzanne finishes with lightning-round questioning of state developments, as Chase describes recent developments in California, Colorado, Pennsylvania, New York and Washington
The latest episode of the Election Update podcast mini-series features insights from David Carter, chief investment officer at Lenox Wealth Management, and Michael Moriarty, chief investment officer at Wealthspire Advisors. Kristin Bulat moderates a discussion on market volatility, lingering uncertainty and the impact of the upcoming election. David and Michael detail factors affecting the markets, including stimulus spending and federal monetary policy. They also share how market volatility is actually positive for investors, particularly those with financial plans designed to accommodate market fluctuations. The takeaways? The markets will be just fine, regardless of the election outcome, and as long as there’s uncertainty, there will be volatility.
With just four weeks until Election Day, and one formal presidential debate under our belts, Suzanne Spradley and Chase Cannon take a fresh look at Joe Biden’s healthcare proposals in the latest episode of our 2020 Election Podcast mini-series. Episode highlights include insight on: - The advantages and challenges of Biden’s initiative to add a public option, and how that might interact with the current private and marketplace plans. - Several past state initiatives relating to public options, and the challenges those states faced with affordability and solvency. - Biden’s plan to expand Medicaid and improve the ACA. - A comparison of some of Biden’s initiatives to the employer-sponsored insurance market, which shows the employer model is working well and should be preserved.
NFP’s own Suzanne Spradley, Chief Compliance Officer, and Chase Cannon, VP, Benefits Compliance and Counsel, have dedicated the second episode of the Election Series on NFP’s Insights from the Experts Podcast to a thorough discussion of the nomination process and the impact that an open seat in the Supreme Court could have on the election and on cases currently before the Court.
You can read a full analysis on this podcast on nfp.com
Helping employers thrive in an increasingly complex benefits compliance landscape
In the face of more rules and regulations, employers are working harder than ever to keep up. In our latest podcast, our benefits compliance expert shares insights on tracking new developments, assessing their impact and being flexible to position your organization for continued success.
As the presidential election gets closer, our very own Suzanne Spradley, Kristin Bulat, and Chase Cannon will be regularly delivering updates and analysis you can share with clients through a new mini-series the 2020 Election Series. Check out our first episode, where Kristin Bulat, SVP of Strategic Resources and Armstrong Robinson, SVP of Government Affairs, AALU/GAMA dive in and compare the candidates tax proposals to current law.
In this episode, Suzanne Spradley and Chase Cannon look closely at newly revised DOL regulations relating to the FFCRA. Suzanne outlines the holding in the NY court case that led to the DOL’s revisions. Suzanne and Chase outline how the DOL’s revised regulations respond to the court’s position that the FFCRA’s “work availability” requirement was unreasoned and inconsistent. Suzanne continues with an explanation and discussion on how the revised regulations reiterate that work availability and employer agreement for intermittent leave are both grounded in longstanding FMLA rules. Suzanne and Chase break down the updated definition of “health care provider” in the context of exceptions from FFCRA leave. The two then close by outlining the DOL’s revised position on employee documentation of FFCRA leave.
In this episode, Chase Cannon and Suzanne Spradley review new DOL guidance on FFCRA (emergency paid sick leave and emergency family and medical leave) leave relating to the new school year. Chase outlines a few scenarios on school re-openings, including full and partial openings and virtual learning, and how an employee might or might not qualify for FFCRA leave. Chase and Suzanne then jump into a recent New York lawsuit challenging several provisions of DOL FFCRA guidance. The two close the podcast discussing the lawsuit’s potential impact on employers in and out of New York.
In this episode, Suzanne Spradley and Chase Cannon look at Joe Biden’s health care proposals, now that election season is formally upon us. Suzanne leads off by addressing the advantages and challenges of Biden’s initiative to add a public option, and how that might interact with the current private and marketplace plans. Suzanne and Chase discuss several past state initiatives relating to public options, and the challenges those states faced with affordability and solvency. Suzanne address Biden’s plan to expand Medicaid and improve the ACA, including restoration of the individual mandate. Suzanne and Chase close with a comparison of some of Biden’s initiatives in comparison to the employer-sponsored insurance market, and conclude that the employer model works well and should be preserved.
In this episode, Chase Cannon and Suzanne Spradley discuss several compliance challenges relating to remote workers in the pandemic environment. Chase starts by outlining employee eligibility – usually based on work location – in connection with state paid family and medical leave laws. Chase and Suzanne dig in to some recent guidance from Massachusetts regarding employee withholding for state paid family and medical leave for employees temporarily working both inside and outside Massachusetts. The two also discuss how other states’ rules might impact employees working remotely, and how the extension of work from home arrangements might play out with respect to state leave protections. Chase closes by addressing distribution of notices for remote workers, both at the federal and state level.
In our latest Insight from the Experts podcast, NFP's Head of Innovation, Mark Rieder, sits down with Susan Van Klink, chief revenue officer at League, to discuss their data-driven platform designed to provide a single access hub for employees to engage with their health, lifestyle and benefit programs. This new “front door” to healthcare eliminates the current sea of point solutions via an integrated ecosystem of over 100 insurance carriers, healthcare partners and HRIS systems. Customers like Unilever, Uber, Shopify and Lush Cosmetics are among the hundreds of employers currently using League to revolutionize their employee experience, drive better benefit utilization and reduce costs.
Personalization is making its way into employee benefits and League is here to help revolutionize the employee healthcare experience with enterprise technology and data.
In this episode, Suzanne Spradley and Chase Cannon look at the definitions and history of telehealth, and the federal and state policies that helped spur its popularity. Suzanne discusses the recent surge, both prior to and during the COVID-19 pandemic, of telehealth usage. Suzanne and Chase discuss the policies and rules promulgated, both at the federal and state level, that helped facilitate that surge. Suzanne closes by outlining five policy suggestions to consider post-pandemic to keep the momentum going on usage and convenience of telehealth for group health plans, employers and employees.
In this episode, Chase Cannon and Suzanne Spradley look at recent DOL FFCRA guidance. Chase outlines new DOL FAQs on how the FFCRA impacts coverage of COVID-19 testing without cost sharing and expansion of telehealth coverage. Chase and Suzanne dig in on some new guidance for wellness programs in the pandemic environment. The two discuss a new DOL field assistance bulletin on whether summer camps can be considered “places of care” for purposes of FFCRA-protected leave. Chase closes with a short recap of a recent New York order denying state-protected COVID-19 leave for individuals who take personal trips to COVID-19 hot spots.
In this episode, Suzanne Spradley and Chase Cannon review policy recommendations to Congress relating to employer sponsored coverage, emphasizing ideas that would help employers get back to work during the COVID-19 pandemic. Suzanne leads off discussing COBRA subsidies for those who lost or will lose employer coverage due to a furlough or layoff. Suzanne and Chase then turn their attention to direct primary care, on-site clinics and telehealth, all of which could use policy changes to help with ease of access and cost. Suzanne then dives into changes to health and dependent care FSAs and surprise medical bills that could be memorialized by Congress. The podcast closes with a discussion on coverage for COVID-19 testing and treatment, as well as recent guidance on antibody tests as a requirement for employees to return to work.
In our latest Insight from the Experts podcast, NFP's Head of Innovation, Mark Rieder, sits down with Jason Hellickson, CEO of Regenexx, to discuss their proprietary orthobiologic procedures that have created a new medical specialty platform called interventional orthopedics. This orthopedic healthcare innovation is less costly, less invasive and less risky than traditional orthopedic surgery.
Planned orthopedic surgery costs have increased 44% in eight years and are constantly in the top 10 of employer spend within their health plans. Interventional orthopedics can offer employees a choice and greatly reduce orthopedic spend on individual procedures that they choose a majority of the time.
In this episode, Chase Cannon and Suzanne Spradley recap the 10-year extension of the Patient-Centered Outcomes Research (PCOR) fee, which is now set to run through 2029. Chase digs into the background of the PCOR Institute, the non-profit organization funded by the PCOR fee, which supports clinical effectiveness research, including studies on treatments and outcomes for a wide variety of conditions and illnesses. Chase and Suzanne discuss several examples of studies and spotlights on the PCOR Institute webpage, including several studies relating to diabetes treatments. The two also discuss the revival of the PCOR fee and the IRS’s recent announcement of the adjusted fee amount, and then close by addressing several questions that have arisen from employer failures to pay the fee in past years.
We all agree that our greatest assets are our people. So, are you providing the value-creators in your organization with the programs that will keep them coming back? Are you ensuring that you can recruit top talent? Are you helping your highly-compensated population prepare for a successful retirement? Are you providing them with benefits that are proportional to the compensation they earn? Learn how to build programs that help lock in the key talent your company needs to weather the current storm and thrive in the future.
In this episode, Suzanne Spradley and Chase Cannon revisit the single payer debate in the context of the COVID-19 pandemic. Suzanne starts by exploring whether support for a single payer system in the US has waxed or waned during the pandemic. Chase and Suzanne then discuss articles from experts, and comparisons across different countries, regarding governmental versus private company response to the pandemic. Suzanne dives into the history behind US governmental stockpiles of protective gear and ventilators, and draws comparisons between the US and other countries in pandemic preparedness. Suzanne and Chase close with a review of presidential nominee Joe Biden’s views towards single payer system and how Congress’s potential Phase Four legislation might impact access to coverage.
FDA Commissioner Stephen Hahn was quoted at a recent White House Coronavirus Task Force press briefing emphasizing that in the “sea of new treatments” we need to connect “the right drug to the right patient at the right dosage at the right time. As an example, we may have the right drug, but it may not be in the appropriate dosage form right now, and that may do more harm than good. Those are the things that that’s our job to look at.” In our latest Insight from the Experts podcast, NFP's Head of Innovation Mark Rieder sits down with Joe Spinelli, chief marketing officer of MedTek21, to discuss how risk management using genomics can bring personalized medicine to every patient.
In this episode, special guest Geoff Seibel, VP of NFP Actuarial Services, joins Chase Cannon to discuss the impact of COVID-19 on fully and self-insured plan costs. Geoff starts by addressing the cost impact for fully insured plans, including differences for small and large group markets. Chase and Geoff then discuss actual COVID-19-related costs, including the difference in costs for COVID-19 patients who are hospitalized, and those who are placed in the ICU. Geoff explains the differences in averages across the general populations versus employer groups, and the differences between explicit and implicit costs (and how both impact overall costs). Geoff and Chase close by discussing best methods for tracking changes (since models and costs change daily) and how modeling tools and other resources can help employers better understand impacts on their own populations and plans.
Employers across the country are busy crafting their Return to Work strategies. Strategies which include things like PPE, office spacing, testing, assessments and vital sign monitoring. But what about planning for an increase in workplace violence? These are unprecedented times and “business as usual” has been replaced by fear, uncertainty and doubt.
In our latest Insight from the Experts podcast, NFP's Head of Innovation, Mark Rieder, sits down with Ty Smith, founder and CEO (and Retired Navy SEAL) of Vigilance Risk Solutions, to discuss how fear, uncertainty and doubt could lead to violence in the workplace, and what VSR is doing to help organizations ensure the safety of their employees as they return to work.
In this episode, Suzanne Spradley and Chase Cannon look at benefits issues relating to returning to work, as companies begin mulling reopening and bringing back employees. The two start with a discussion of benefit eligibility, COBRA and premium payments relating to furloughs and layoffs, as the employer’s decisions then impact issues to consider upon returning to work. Suzanne then outlines some issues employers should consider when collecting premium payment from employees in arrears, how to handle waiting periods for rehires and what to do with employee FSA (both health and dependent care) elections upon return. The two close with a short discussion on plan amendments and employee communications.
One Key Takeaway: Status matters when deciding whether to furlough or terminate employees during this pandemic. SME/Speaker: Chase Cannon and Kyle Healy
futureWork captures and interprets the data that surrounds every worker to improve health and safety. And now with COVID-19 they are now helping companies record and report employee temperatures. Join us for this episode as Head of Innovation Mark Rieder, sits down with Lars Skari, cofounder of futureWork, to discuss how wearables can help Americans get back to work.
In this episode, Chase Cannon and Suzanne Spradley dive back into common COVID-19 questions. The two start with process and documentation of employee leave requests under the FFCRA, including recordkeeping for employers to claim the FFCRA tax credits. Chase then outlines several different buckets of developments at the state level, including paid sick, family, and medical leave changes on account of COVID-19. The two close with a look ahead at potential additional changes Congress could introduce in so-called “Phase 4 Legislation”, including COBRA subsidies and mandates for group health plan coverage of COVID-19 treatment.
In this episode, Suzanne Spradley and Chase Cannon discuss recent questions popping up from employers regarding the FFCRA, COVID-19 and furlough situations. Suzanne outlines the issues to consider in determining if FFCRA applies, including factors in employee counts to determine if an employer is above or below the 500-employee threshold and whether the 50-employee small exception is automatic. Suzanne and Chase discuss furloughs, and whether FFCRA applies to furloughed employees. The two then discuss unemployment insurance, and whether furloughed or laid off employees might qualify for unemployment benefits (and how the newly enacted CARES Act expands unemployment benefits). The two close with a discussion on the P&C side — business interruption insurance, and how state and federal legislation might impact how business interruption insurance works in the COVID-19 environment.
In this episode, Elizabeth Allen and Patrick Myers address some of the benefits compliance questions swirling around the issue of the coronavirus pandemic. The two briefly discuss the virus and go into more detail on the employee benefits laws that employers must consider as they make business decisions concerning the virus. Specifically, they discuss the coronavirus and its implications under the HSA rules, HIPAA, FMLA, ACA, Section 125 and COBRA.
In this episode, Suzanne Spradley and Chase Cannon address the hot issue of surprise medical billing. Suzanne outlines what is a surprise medical bill and how common of an issue it is to receive one. Suzanne and Chase discuss the challenges for patients that receive out-of-network provider services and bills at in-network facilities. Suzanne outlines three different bills that address surprise medical billing that have been discussed by Congress at the federal level, as well as state legislative action. Suzanne and Chase round out the podcast by talking about different approaches in each proposal, and what to expect down the road in 2020 from states and Congress.
In this episode, Chase Cannon and Suzanne Spradley address two lawsuits, and discuss some new state employer reporting obligations. The first lawsuit relates to one covered in Episode 66 on COBRA notice failures—the Sixth Circuit weighed in and overturned the District Court on whether a change in the premium payment turns constitutes a COBRA triggering event. The second lawsuit relates to the ACA’s employer mandate. A court recently approved a settlement in a case where the employer intentionally reduced hours for employees who were previously eligible for or enrolled in the company’s group health plan; the employer’s intent was to avoid offering those employees affordable coverage under the mandate. Chase outlines the settlement, and the reasons why the employees in the case were able to assert an ERISA 510 claim against the employer to the point of a settlement, even if the court did not ultimately resolve the 510 legal issue. Chase and Suzanne discuss the importance of continued compliance with the mandate and reporting, and dig into several states’ new requirements for employers to report in conjunction with state individual mandates.
In this episode, Suzanne Spradley and Chase Cannon look at three recent lawsuits, two of which are class action suits, against employers relating to COBRA notice failures. Suzanne describes the lawsuits, and explains that the failures related to the content of the notices themselves, rather than the more common issue of failure to send COBRA notices. Suzanne outlines the particular failures, and how the employer could’ve avoided the issue. The two discuss the importance of using model notices and things to consider when working with a third party vendor for COBRA administration
In this episode, Chase Cannon and Suzanne Spradley review the end-of-2019 spending bill, which includes several provisions relating to employee benefits and group health plan/employer compliance. Chase starts by describing the bill, and then jumping in on a discussion relating to the full repeal of the Cadillac Tax. The two then discuss the health insurance tax (HIT), and the impact of its repeal beginning in 2021. Chase outlines three other provisions that are less directly impactful — the repeal of the medical device tax, the repeal of a commuter benefit tax for tax-exempt organizations, and a one-year extension of the tax credit for employers that provide paid medical and family leave. Chase and Suzanne then turn their attention to a surprise in the bill: A 10-year extension of the PCOR fee. The two close with a discussion of things employer might’ve wanted in the bill, and a look at what’s ahead in 2020.
In this episode, Suzanne Spradley and Chase Cannon dig in to the issue of health care costs in the U.S. as compared to other countries. Suzanne begins the discussion by outlining the Organization for Economic Cooperation and Development (OECD) data that has been tracking the cost of health systems in the world since 1986. Suzanne explains the different factors and variances, and the importance of defining terms when it comes to making such comparisons. Suzanne and Chase discuss the OECD findings that the U.S. spends far more than other countries, and they outline the exact dollar numbers and percentages. Suzanne digs in on the different areas where the U.S. spends more, and the two conclude the episode discussing the relationship between health care spend, health care resources, and health care outcomes.
In a welcome turn of events, the DOL has proposed a new rule that would allow for electronic disclosure of many retirement plan documents. Beth Allen and Carol Wood discuss the proposed rule — beginning with how the DOL got to this point, explaining the details of the rule, and highlighting the rule’s limited application. Ultimately, the discussion will give retirement plan sponsors a better idea of how they may be able to distribute documents, should this rule be adopted.
In this episode, Chase Cannon and Suzanne highlight four considerations to help avoid compliance issues resulting from open enrollment periods. First, Chase outlines the importance of documenting offers and waivers of coverage, and how that can help employers avoid IRS scrutiny and employee misunderstandings. Second, Chase and Suzanne discuss challenges that can arise during open enrollment on HSA eligibility, and how employees can easily step into excess contribution issues when enrolling in benefits. Third, Chase describes challenges in open enrollment relating to absent and remote employees, including those out on FMLA or state-protected leave, and those that are working from different locations or from home. Chase and Suzanne close with a discussion of important notices that must go out during open enrollment, and how to distribute those notices.
In this episode, Suzanne Spradley and Chase Cannon dig in to a trending topic, particularly for self-insured plans: reference-based pricing (RBP). Suzanne begins with a description of RPB, including an example to help illustrate how it works. Next, Suzanne explains the process and the pros and cons of RBP, which leads to a discussion on pricing and billing, including balance billing to unsuspecting plan participants. Suzanne outlines employer considerations when implementing an RBP design, including several issues with respect to the ACA and out-of-pocket maximums, and lessons learned from litigation relating to RBP strategies (including one case that made it to court with over $300K in claims at stake). The two close by discussing related ERISA fiduciary issues and administrative practicalities for employers to consider when adopting an RBP design.
In this episode, Chase Cannon and Suzanne Spradley look at a few ACA topics that are a bit up in the air. The first is the health insurance tax (HIT), a tax on health insurance carriers that has been on and off moratorium the past few years, but is coming back into effect for 2020. Chase breaks down the HIT, its impact on health insurance rates and on employers and employees, and whether Congress might add a moratorium for 2020 or repeal the HIT entirely. The second is the Cadillac Tax, a tax on plans that provide richer benefits. Chase and Suzanne discuss the potential issues and burdens associated with the Cadillac tax, why it was enacted, and whether the Senate might follow the House’s lead on repealing it. The third is Texas vs. the U.S., the lawsuit challenging the constitutionality of the ACA’s individual mandate. Chase breaks down the lawsuit, the validity of the arguments on either side, and gives a prognosis on how and when the Fifth Circuit might rule on the case. The two close the podcast by looking to the case’s potential impact on the 2020 elections.
In this episode, Suzanne Spradley and Chase Cannon examine one argument that is put forth by proponents of a single payer system — that because Medicare is purportedly more administratively efficient, that a single payer system in the U.S. would reap huge savings and reduce overall health care costs. Suzanne breaks down the estimated administrative costs of Medicare (claimed 2% of total costs) versus private insurance (claimed 12% to 15% of total costs), and the reports upon which they’re based. Suzanne explores whether comparing administrative costs versus total costs is the best method, and how a per-beneficiary comparison might be more meaningful. Suzanne and Chase discuss some of the costs that shouldn’t be included in an administrative costs comparison, including profits and taxes. The two wrap the episode with a discussion on how some administrative costs actually reap huge benefits, and why administrative costs may not impact overall health care costs — ultimately concluding that the current comparison and claims on single payer administrative cost savings may not be all they’re cracked up to be.
In this podcast, Beth Allen and Chase Cannon discuss the Setting Every Community Up for Retirement Enhancement (SECURE) Act. Beth highlights the last major retirement legislation that's passed and briefly discusses what has taken place to bring the SECURE Act to this point. That discussion leads into a conversation about what all the SECURE Act entails, including what the act would mean for retirement plan participants, plan sponsors, and industry organizations. They end with a discussion of where the bill is now and what could happen next.
In this episode, Chase Cannon and Carol Wood, in her podcast debut, discuss updates and considerations regarding state family and medical leave laws. The two discuss leave protections that have been enacted in new states in the past few years, as well as states that previously had such laws and protections in place. Chase outlines, at a high level, some of the differences in duration of leave, benefits, and family members for whom an employee can take leave (including domestic partners, who employers often forget about). Chase and Carol wrap up the discussion by outlining several key points employers should consider when developing their employee leave policies, with a focus on the benefits considerations.
In this episode, Suzanne Spradley and Lauren Fischer discuss criminal enforcement actions by the DOL and IRS involving employee benefit plans. Specifically, the two discuss the latest development in the action involving The Total Financial Group, Inc., which promoted the Classic 105 program. Suzanne and Lauren then discuss other enforcement actions involving an HRA administrator, an internal employee benefit administrator and a program that sought to carve-out high claimants from a self-insured plan.
In this episode, Suzanne Spradley and Jill Brooking discuss surprise medical bills and what laws have been enacted or proposed at the state and federal level. The two address situations in which surprise medical bills occur, the two ways that the individual is financially impacted, polling and claims data concerning the extent of this issue, and which states are taking a comprehensive approach to resolving this issue for fully insured plans in their states. Suzanne and Jill then discuss recent proposals by three bipartisan groups in the Senate.
Continuing discussion of single-payer system proposals, Suzanne Spradley and Chase Cannon review the recent report from the Congressional Budget Office (CBO) on a single-payer system in the US. Suzanne starts off by describing the purpose of the report and some high-level takeaways, including that the report does not specifically address funding of a single-payer system (one of the major challenges in establishing a single-payer system). Suzanne and Chase discuss the report’s findings on the administration of a single-payer system (state- versus federally-run), the types of benefits and cost-sharing, eligibility for single-payer plans, and the potential roles of private insurance (including employer-sponsored coverage) alongside a single payer (in a multi-payer system). Suzanne wraps things up by discussing the report’s take on approaches to setting provider rates, and some of the conclusions reached by the report.
In the fifth part of the single-payer system mini-series, Chase Cannon and Suzanne Spradley look at single-payer systems at the state level, specifically reviewing Vermont’s failed attempt at establishing a single-payer system. Chase walks through the political environment leading up to the passage of the state’s single-payer bill, the proposed plan, and the events that transpired in the years following the passage of the bill. Chase and Suzanne walk through several of the factors that prevented Vermont from implementing their single-payer proposal. They’ll cover funding, tax increases and exemptions, barriers to purported savings, and public education. The two close with a discussion on how Vermont’s struggles might impact single-payer efforts on both the state and federal level moving forward.
In the fourth part of this mini-series on single-payer systems, Suzanne Spradley and Chase Cannon look at four versions of single-payer system legislation introduced by the Democrats. The two walk through the four versions from least to most intrusive to the current system, which is based on employer-provided coverage. The four versions are a Medicaid buy-in (also called a “State Public Option”), Medicare buy-in (also called “Medicare for More”), Medicare-X Choice Act (which includes an expansion of the current premium tax credits administered through the state health insurance exchanges), and the full blown Bernie Sanders-style Medicare for All (true single payer, nationalized health care). Suzanne discusses the terminology, definition, structure, funding, provider impact, consequences, and potential challenges to each of the four versions. Suzanne and Chase conclude with a look at what all this could mean for the 2020 elections.
In this episode, Chase Cannon and Suzanne Spradley break down last week’s D.C. district court ruling that invalidates the DOL’s 2018 rules on association health plans (AHPs, which are also considered multiple employer welfare arrangements, or MEWAs). Chase gives a high level outline of the original and 2018 DOL AHP rules, and how the two differ. Suzanne and Chase discuss the lawsuit filed by a coalition states – led by New York and Massachusetts – and the arguments presented: That the DOL went beyond its authority be expanding access to AHPs through a loosening of ERISA’s rules on commonality of interest, primary purpose, and working owner participation. The two analyze the court’s reasoning in concluding that the 2018 rules are invalid as a regulatory overreach in conflict with ERISA’s statutory design. Chase and Suzanne prognosticate on next steps in the challenge and lawsuit, and what it all means for AHPs.
In the third part of this mini-series on single-payer systems, Suzanne Spradley and Chase Cannon focus on the challenges of funding a single-payer system, with a focus on the single-payer proposal put forth by Senator Bernie Sanders. Suzanne explains that the Sanders plan is a comprehensive first-dollar government-financed health insurance plan for all Americans, and is therefore very expensive. Suzanne outlines the taxes that would have to be raised and to what extent, and discusses studies that outline the total amounts of tax increases for both individuals and businesses. Suzanne and Chase discuss the different purported savings and efficiencies under the Sanders proposal, and how various studies dispute them. The two address different aspects of current inefficiencies in US-run programs, including waste, fraud and abuse in the current Medicare system. The two conclude that funding a single-payer system in any form will be a huge challenge; one that will be extremely difficult, if not impossible, to overcome for those that support such a system.
Chase Cannon and Suzanne Spradley focus on the parts of the US system that are working well, focusing on the employer-sponsored group health insurance market. Chase orates a brief history of the employer-based insurance model, including why employer groups were originally (and still today) the ideal group market target for insurance companies. Chase explains that between 180 and 185 million people (or 55 to 60 percent of the US population) are currently covered through an employer group health plan; the vast majority of whom are happy with their plan and benefits. Chase and Suzanne outline the importance of employer engagement in employee’s health care benefit coverage, and how the employer market has seen lower cost increases than the individual market. Chase describes the built-in incentives for employers and carriers to develop innovative plan design and cost-saving strategies, and how the private market (as compared to the government) is better suited to stoke the embers of further innovation. The two conclude that the employer model is working well: It’s a stable system that has lower premium rate increases, less adverse selection, more incentives for innovation, and that already covers the majority of US citizens. The better approach is to develop fixes for the more problematic individual market.
In this episode, Suzanne Spradley and Chase Cannon announce a three-part mini-series aimed at better understanding the challenges facing a single payer system (sometimes called “Medicare for All”) in the US. In the first part, Suzanne re-sets the discussion on single payer systems and describes some of the different arrangements and titles that fall under that general term. Suzanne describes the challenges facing different single payer systems in the UK and in Canada, including information on wait times and quality of care outlined in recent studies. Chase and Suzanne discuss funding of single payer systems, and how single payer systems generally result in higher taxation across the board. Suzanne finishes with a description of the challenges facing the Veterans Affairs (VA) program, which is a version of a government-run health care system right here in the US. The two outline the next two parts to the mini-series: part two will focus on parts of the US system that are working, including the employer-sponsored group health insurance market, and part three will dig deeper into the financing and funding of some of the proposals thrown around in US political debates.
In this episode, Jill Brooking joins Chase Cannon to discuss the impact the government shutdown may have on employer group health plans, particularly for governmental contractors, whose employees may be out of work due to the shutdown. Jill breaks down the benefits issues employers should look at for employees that are out of work or on furlough as a result of the shutdown, including plan eligibility terms and carrier (or stop-loss) contracts, and the risks in covering employees outside the plan’s eligibility terms. Jill describes how the ACA’s employer mandate may impact an employer’s offer of coverage, depending on whether the employer is using measurement/stability periods for employees. Jill also discusses premium payment options for employers and employees during an unpaid leave of absence, and at what point COBRA comes into play. Lastly, Jill and Chase discuss what should happen when – if ever – the government shutdown ends, including collecting premiums in arrears and the rehire rules under both Section 125 and the ACA’s employer mandate.
In this episode, Suzanne and Chase review the recent district court ruling that the individual mandate is unconstitutional and, as a result, the entire ACA is invalid. While the ACA remains in place pending appeal, Suzanne outlines the basis for the case, the reason why intervening states had to step in for the DOJ, and why the individual mandate may or may not be “inseverable” from the rest of the ACA. Suzanne gives a basic overview of civil procedure and appeals, and describes the process by which the case here will be appealed. Suzanne and Chase also discuss a bit of constitutional law and the balance of powers — the limitations on courts as they interpret and decide the constitutionality of legislation passed by Congress. The two close with important points on employer obligations while the case is appealed and the potential political fallout with a split Congress and the looming 2020 elections.
In this episode, Suzanne and Chase review the Office of Civil Rights (OCR, a subdivision of HHS) list of HIPAA violation settlements that occurred in 2018. To lead off, though, Chase breaks down the purpose of the HIPAA privacy and security rules, and what the basic HIPAA requirements are for employers. Suzanne and Chase then discuss several OCR investigations of employer HIPAA violations that eventually led to settlements. Chase breaks down HIPAA violations resulting from several situations. First: a doctor’s response to media inquiries regarding a patient’s complaint. Second: a hospital group that developed policies and procedures, but failed to implement them and later experienced a breach when unencrypted USB drives were lost and an unencrypted computer was stolen. Third: a document retention company that left a box of files containing sensitive information in an unlocked truck in its parking lot. The final case involves hospitals that failed to obtain authorization from patients while filming a TV mini-series. Chase and Suzanne close with a discussion of HIPAA compliance learning points for employers and their group health plans.
In this episode, Suzanne and Jill discuss year-end considerations for employer plan sponsors. Many employers are currently in or have just completed their open enrollment process. Jill and Suzanne answer the question of whether an employer should accept enrollment requests after open enrollment has ended. They also remind employers about which notices need to be distributed, including the frequently forgotten COBRA Initial Notice for employees and spouses who newly enroll during open enrollment. Lastly, they discuss how employers should prepare for upcoming reporting obligations.
In this episode, Suzanne and Chase look at the benefits compliance environment since the midterm elections. The two start off with a recap of election results and then immediately dive into the impact a divided Congress could have on the ACA. There could be bi-partisan support on simplified reporting and on repeal of the Cadillac tax. The two also discuss the Texas v. United States case involving the Republican challenge to the constitutionality of the ACA in consideration of the 2019 repeal of the ACA’s individual mandate and assess how a divided Congress might react to a loss of protections for those with pre-existing conditions. Chase outlines issues to consider post-election on prescription drug prices, medical tourism, the issues of a single-payer system (sometimes referred to as “Medicare for All”) and Medicaid expansion (and how that might interact with the employer group market). The two close with post-election impact on the court challenge of the DOL’s association health plan regulations.
In this episode, Suzanne and Chase address the advantages and disadvantages of medical tourism, and how an employer’s compliance obligations may be impacted if they incorporate some type of medical tourism into the group health plan. Suzanne leads off with a definition of ‘medical tourism,’ including travel for medical services and procedures both within and outside the US. Suzanne delves into some of the costs and coverages, including travel costs, that are generally included in medical tourism, issues regarding quality of care for treatment received in foreign countries, and how the tax consequences may play out for both the employer and the employee. Suzanne addresses transportation of foreign drugs back into the US following a foreign-performed surgery, and how the FDA may treat that drug transportation. Chase and Suzanne close with some of the practicalities in administration and compliance, including HIPAA, ERISA and vendor relations.
In this episode, Suzanne Spradley and Chase Cannon discuss different delivery methods available to employers when distributing health plan notices and disclosures to employees. The two address hand delivery, delivery by mail, email and intranet delivery, and building the notices into online enrollment systems. Chase outlines which notices are best suited for electronic delivery, and how electronic delivery requires special accommodations for some populations of employees—those who may not have phone or email access as a big part of their job. Suzanne and Chase then discuss a recent White House executive order that could impact the DOL as it formulates electronic disclosure rules, as well as industry groups that may be opposed to an all-electronic disclosure regime. They close with an overview of what it all means for employers.
In this episode, Chase Cannon and Suzanne Spradley hit refresh on the single payer health care discussion in the US. Suzanne breaks down the different terms that are used in the discussion, including ‘single payer system,’ ‘Medicare for all,' ‘universal health coverage,' ‘national health plans’ and ‘socialized medicine.’ Chase and Suzanne describe the importance of understanding those terms and the marketing behind them during this election season as the debate marches towards November. Suzanne describes and compares legislation at the state level in California and New York, and how similar legislation has fared in other states such as Colorado and Vermont. Suzanne and Chase outline the primary barriers to single payer systems in all their forms, including increased taxes, resistance from insurance carriers and health care providers, and a Republican-led federal government. The two close discussing what it all means for employers, and how the employer-provided health insurance might have a place in a single payer system.
In this podcast, Beth Allen and K.C. Barner discuss some of the current events on the retirement side of employee benefits. They’ll talk about the recent IRS private letter ruling that may allow employees to receive 401(k) matching contributions that coincide with their student loan payments. They’ll also review Pres. Trump’s recent executive order on retirement plans and comment on the retirement legislation that’s currently making its way through Congress.
In this episode, Podcast originals Suzanne Spradley and Chase Cannon discuss wellness and other employer programs that advertise big employment and income tax savings to employers and employees. Suzanne and Chase discuss the various names and iterations of these types of programs – including the Classic 105, Freedom Plan, Section 105 Reimbursement Plans and Premier 105 – and how they vary in plan design. Chase outlines the basic iteration: an employer takes some amount as pre-tax deduction from the employee for a type of basic wellness program, the employee participates in the wellness program (completes a health screening, sits in on educational webinars and so on), and the employer provides a tax-free wellness program “reward” that happens to be very close to the pre-tax deduction amount. Chase and Suzanne discuss the federal income and employment tax ramifications and why these types of programs don’t meet the standard tax exclusion requirements of IRC 105. The two then close with a discussion of IRS guidance that prohibits these types of tax-free wellness program rewards and a shocking federal indictment of the promoters of the Classic 105 program.
In this episode, Mark Rieder, NFP’s SVP of HR Technologies and Benefit Administration Services, makes his Benefits Compliance podcast debut. He joins Suzanne Spradley to discuss various hot tech ideas and applications in the HR and benefits administration space. Mark describes NFP’s Innovation Lab and then discusses recent technology applications, including mobile apps, that are available to employers for benefits and benefits administration. Applications and other tech tools relating to group health plan data, senior care treatment, overall care and quality of care management, student loan and other financial wellness, mental wellness and more have become big for employee well-being. Mark and Suzanne also discuss employee engagement, data collection and employer strategy in the tech space for benefits administration, as well as innovation and its impact on small and large employers. They close with a discussion of tech tools for benefits compliance issues.
Join Jill Brooking and Suzanne Spradley as they discuss the new joint venture among Amazon.com Inc., Berkshire Hathaway Inc. and JP Morgan Chase & Co. — a company that was formed to develop ways to improve health care for their employees and to make those innovations available to other employers.
In this episode, Beth Allen and K.C. Barner discuss the different changes to the ACA imposed by the Trump administration, Congress and the courts. They’ll highlight the major policy shifts, like the upcoming repeal of the individual mandate and the issuance of new regulations on association health plans (AHPs). They’ll also talk about possible changes to come. By the end of the podcast, listeners should have a good understanding of where the various provisions of the ACA stand
In this episode, Suzanne Spradley and Chase Cannon work through benefits compliance issues that arise as a result of common ownership and controlled groups. Suzanne grills Chase on the different types of controlled groups under Internal Revenue Code Section 414 — and how those rules impact employers’ obligations under the ACA's employer mandate, nondiscrimination testing, Form 5500, FMLA and other federal requirements. The two also discuss mergers and acquisitions, and how the change in ownership might impact COBRA and nondiscrimination obligations. The discussion closes on common ownership and MEWAs – some employers may inadvertently create a MEWA – and how employer compliance obligations might be affected by federal and state law.
In this episode, Suzanne Spradley and K.C. Barner discuss the newly released final rule related to the creation and maintenance of association health plans (AHPs) under ERISA. The DOL’s final rule is a long-awaited response to the Oct. 12, 2017, executive order from Pres. Trump directing the DOL and other agencies to (among other things) expand the availability of AHPs. Suzanne breaks down the DOL’s final rule, which loosens restrictions on AHPs to allow more groups of employers to qualify as associations for the purpose of sponsoring group health plan benefits. The two discuss the impact on sole proprietors and other self-employed individuals, and how state and federal (including ACA) regulation of an AHP would work.
In this episode, with mental health trending as a national discussion, Chase Cannon and Suzanne Spradley discuss mental health parity in health insurance coverage. As background, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance abuse disorder benefits be no more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits. Chase quizzes Suzanne on some details relating to quantitative treatment limits (dollar and limit visits) and non-quantitative treatment limits (pre-authorization, reimbursement rates, cost sharing, etc.), including some examples outlined in recent federal guidance on MHPAEA. Suzanne outlines several examples of NQTL treatment limits. The two then discuss two recent cases involving mental health coverage issues, one of which ends in favor of the plan and one of which ends in favor of a participant.
In this episode, K.C. Barner and Beth Allen discuss the status of the DOL’s Fiduciary Rule. Since the U.S. Court of Appeals for the Fifth Circuit vacated the Rule, there’s been some action on the part of the DOL, the states and the SEC. Specifically, the DOL has indicated that it won’t enforce the Rule, while the SEC has proposed its own rule. The states are even joining the party, through litigation and regulation. The two discuss what all this action ultimately means for employer retirement plan sponsors.
In this episode, Chase Cannon and K.C. Barner – in his podcast debut – discuss some recent announcements and adjustments from the #IRS on #HSA contribution limits. The two discuss the mid-year changes to the 2018 maximum family HSA contribution limits — and what employers and HSA account holders should do in response to those changes. Then Chase and K.C. dive into some legislation that’s been introduced in Congress regarding changes to the HSA rules, including:
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Clarifications on what constitutes “impermissible coverage” (including telehealth and onsite medical clinics)
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A clarification that expenses for dependents up to age 26 can be reimbursed from an HSA
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Some expansion on the types of expenses that can be paid out of an HSA (including gym memberships and home gym equipment)
Chase closes with a discussion of issues that aren’t currently included, but which would be nice to include in the final version, including how HSA eligibility interacts with #Medicare entitlement and direct primary care #DCP arrangements.
In this episode, Beth Allen and Chase Cannon break down a recent case (Stein v. Atlas Industries, Inc.) being litigated in federal court. Beth outlines the facts of the case, which involve an employee who had two events going on — his son’s extremely serious medical event and his own torn meniscus, which led him to be out on an FMLA-protected leave. Eventually, the employer terminated the employee for not following proper employer-outlined protocol with regard to employee notification for absences from work. Beth describes the employee’s claims against the employer, which were based on the employee’s FMLA protections and on ERISA Section 510, which generally prohibits an employer from retaliating against an employee (including terminating them) for exercising a right granted under ERISA. The employee claimed that the employer was terminating him due to the high claims and costs associated with his son’s medical event. Beth unpacks the arguments of both the employee and employer and explores why the court allowed the case to proceed to the jury. Beth also expertly describes the important takeaways for employers, including the importance of separating employment decisions from employee benefit plan decisions, keeping protected health information private, establishing definitive FMLA and leave policies and procedures, and consulting with legal counsel in tricky situations.
In this episode, Chase Cannon and Suzanne Spradley discuss a topic that seems to be less pressing, but ever recurring: employer contribution strategies.
In this episode, Suzanne Spradley and Chase Cannon delve into the health care delivery side of things with a discussion on direct primary care (DCP) arrangements, a type of clinical practice in which a physician offers primary care services to patients who pay a monthly membership or subscription fee. Suzanne further describes the details and history of DCP arrangements, how employers play in to the equation, the pros and cons of DCPs, and the state and federal regulatory considerations. Suzanne and Chase finish by discussing what to look for in 2018 as DCP arrangements continue trending upward.
In this episode, Beth Allen, former DOL enforcement attorney, discusses the DOL’s fiduciary rule and how it changed the definition of “fiduciary” to include more investment advisors. Then she highlights the recent Fifth Circuit Court decision that could result in the Fiduciary Rule's demise.
Podcast Episode 25: Study Outlines Possible Reasons for Individual Market Premium Increases by NFP's Insights from the Experts
In this episode, Suzanne Spradley quizzes Chase Cannon on the most recent reminders and issues regarding employer mandate reporting. The two hit on the basics of reporting (including 2018 due dates) and how the 2019 repeal of the individual mandate may impact reporting obligations.
In this episode, Suzanne Spradley and Chase Cannon discuss IRS Letter 226J—the IRS’s first wave of ACA employer mandate penalty notices.
This week Suzanne Spradley and Chase Cannon give a quick update on the fate of the Better Care Reconciliation Act. The two further explore one aspect of the Republican effort to stabilize the individual market, called the invisible risk sharing pool, which is meant to help insurers take on the increased costs associated with covering high-risk individuals.
Podcast Episode 11: The Senate’s ACA Replacement Bill by NFP's Insights from the Experts
Ep 8: Pre-Existing Condition Exclusions and the AHCA by NFP's Insights from the Experts
Ep 7: HSAs: History, Usage and Potential Expansion under Republican’s ACA Repeal/Replace Plan
Episode 6: R&R Regulatory Hurdles, State & Federal Tensions Rise Regarding ACA Essential Health Benefits Requirement
Episode 4: GOP's Proposal, American HCA & Repeal of Employer/Individual Mandate Penalties
Episode 3: The Latest on ACA Replacement and Selling Health Insurance Across State Lines