Nfp Benefits Compliance Podcast



NFP Benefits Compliance Podcast channel.


  • Ep 130: More COBRA Cases — Class Actions and COBRA Election Notices

    08/11/2022 Duração: 18min

    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.

  • Ep 129: Recent Court Rulings on COBRA and the ACA

    25/10/2022 Duração: 22min

    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.

  • Ep 128: Fall Bills: Congress Considers Mental Health Services Proposals

    27/09/2022 Duração: 20min

    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.

  • Ep 127: Benefits Aspects of the Inflation Reduction Act

    13/09/2022 Duração: 17min

    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.

  • Ep 126: Post-Dobbs Executive Orders, HHS Guidance and State Developments

    19/07/2022 Duração: 18min

    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.

  • Ep 125: FMLA and Mental Health

    07/06/2022 Duração: 16min

    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.

  • Ep 124: Hospital Prices and Group Health Plan Costs

    24/05/2022 Duração: 17min

    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.

  • Ep 123: Point Solution Programs and Compliance Issues

    11/05/2022 Duração: 21min

    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.

  • Ep 122: Transparency in Coverage Updates

    26/04/2022 Duração: 24min

    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.

  • Ep 121: Looking Ahead: The Impact of the 9th Circuit’s Reversal on Wit v. United Behavioral Health

    29/03/2022 Duração: 21min

    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.

  • Ep 120: Mark Rieder Visits Naviant’s “Digital Transformation Talks: Start Your Innovation Journey”

    24/03/2022 Duração: 12min

    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.

  • EP 119: Mental Health Parity Civil Litigation and Administrative Action

    15/03/2022 Duração: 18min

    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.

  • EP 118: Explanations on Recently Asked Compliance Questions on Part D Disclosures/HSAs/COBRA Notices

    01/03/2022 Duração: 23min

    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.

  • Ep 117: The Agencies Revisit the ACA’s Provider Nondiscrimination Rules

    01/02/2022 Duração: 17min

    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.

  • Ep 116: US Supreme Court Weighs in on Vaccine Mandates

    19/01/2022 Duração: 20min

    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).

  • Ep 115: Majesco Podcast Features NFP’s “What If” Mindset, Insights on Voluntary Benefits

    15/12/2021 Duração: 21min

    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.

  • Ep 114: OSHA’s Guidance (ETS) on Employer COVID-19 Vaccine and Testing Mandate

    09/11/2021 Duração: 32min

    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.

  • Ep 113: HIPAA Violations and Recent Enforcement Actions

    27/10/2021 Duração: 14min

    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.

  • Episode 112: NFP’s CaptivePlus Group Medical Stop Loss Captive

    22/10/2021 Duração: 31min

    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.

  • Ep 111: Vaccine Mandate/Surcharge Updates and COVID-Related Notices for Open Enrollment

    12/10/2021 Duração: 19min

    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.

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