America's Benefit Specialist July 2023

LEGISLATIVE AND COMPLIANCE ISSUES

A nationwide injunction has been issued, halting certain preventative-care coverage. What this means for your clients will depend on whether they are fully insured or self-funded. The injunction will not have any immediate impact on em ployers with fully insured plans as those plans are approved by the state and the terms are likely locked in until renewal. Addi tionally, those fully insured policies may be subject to certain state preventive care mandate requirements. For employers with self-funded group health plans, the injunction allows employers the option to amend their plans to make changes, such as implementing cost sharing for the preventive-care services impacted by the decision, includ ing screenings for cancer, mental health, HIV and diabetes, colonoscopies, pap smears and tobacco-cessation services. These employers have the option to implement cost sharing for some or all of these screenings, but are not required to do so, nor is there a time frame in which they must decide. The Justice Department is appealing the judge’s decision, so it is possible that this decision will be reversed. If appeals continue to the Supreme Court, as many ACA challenges do, a final decision may not come until some time in 2024. What it means for you: Reach out to both fully insured and self-funded clients to make sure they are aware of the ruling and understand whether or not it applies to them. Employers with self-funded plans should not feel rushed to amend plans; changes come with their own complications around informing employees and managing their reactions. Employees who have become accustomed to accessing

screenings and preventative care without cost sharing may react negatively to the takeaway of expected benefits. Addi tionally, preventative screenings enable patients to iden tify and address issues early, potentially avoiding invasive, expensive treatments later. For employers that self-fund, the implications of delayed diagnoses and care can be costly. While these are not the only legislative and regulatory issues to watch in the latter half of the year, they are a good starting point for client conversations. Your clients will ap preciate your guidance in navigating compliance issues and understanding their responsibilities.

Misty Baker is a compliance and agent advocate, specializing in ACA, ERISA, FMLA, COBRA and legislative advocacy for over 20 years. She was a registered lobbyist in Texas for four years and is a strategic leader focused on compliance, agent knowledge, legislative advocacy and ultimate client understanding of how to be successful in the changing world

of compliance. Her passions include agent education, insurance advocacy inside and outside of the Capital, and compliance. Misty was awarded one of the most influential women in employee benefit advising by Employee Benefit Advisor in 2015. She’s been a member of NABIP since 1999 and she chairs its Legislative Council.

INDUSTRY EVENTS

JULY 17-19 VOLUNTARY ADVANTAGE VIRTUAL CONFERENCE Online Event https://voluntary-advantage.com/conference-2023

OCTOBER 22-24 LIMRA ANNUAL CONFERENCE National Harbor, MD www.limra.com MARCH 25-27 WOMEN’S LEADERSHIP SUMMIT 2024 Las Vegas, NV www.ellevatefoundation.org

OCTOBER 8-10 SIIA NATIONAL CONFERENCE Phoenix, AZ www.siiaconferences.org

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