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HHS Announces Final 2023 Cost-Sharing Maximums under the Affordable Care Act

Last year, HHS issued its final “Notice of Benefit and Payment Parameters for 2022” providing that, beginning with the 2023 benefit year, HHS will publish the maximum annual limit on cost-sharing in guidance issued by January of the year preceding the applicable benefit year, using the most recent National Health Expenditure Accounts income and premium data that is available at the time of publication. HHS recently issued a CMS notice (the “CMS Notice”) providing these annual limits for 2023. The 2023 maximum annual limit on cost sharing is $9,100 for self-only coverage (increased from $8,700 for 2022) and $18,200 for other than self-only coverage (increased from $17,400 for 2022). The CMS Notice is available here. 

Employee Benefits Regulations Potentially Impacted by the Biden Administration?ÇÖs Regulatory Freeze

On January 20, 2021, the Biden Administration issued a memorandum (the ?Ç£Memo?Ç¥) announcing a regulatory freeze on regulations that have not taken effect as of the date of the Memo. Specifically, the Memo recommends postponing the effective date of any regulation that has been issued, but has not taken effect, for 60 days from the date of the Memo. The Memo further directs that regulations not yet published in the Federal Register be immediately withdrawn for review. Listed below are some of the proposed and final regulations related to employee benefits that may be subject to withdrawal or postponement under the Memo: Prohibited Transaction Exemption 2020-02 ?Çô Improving Investment Advice for Workers & Retirees. Final Rule. Application of the Employer Shared Responsibility Provisions and Certain Nondiscrimination Rules to Health Reimbursement Arrangements and Other Account-Based Group Health Plans Integrated with Individual Health Insurance Coverage or Medicare. Final Rule. Pension Benefit Statements-Lifetime… Continue Reading

Federal Departments Announce No Enforcement Action Regarding Drug Manufacturer Coupons Counting Toward Out-of-Pocket Maximums

HHS?ÇÖs 2020 Notice of Benefit and Payment Parameters (?Ç£NBPP?Ç¥) provides that a group health plan does not have to count drug manufacturer coupons for brand-name drugs towards an annual out-of-pocket maximum if there is a medically appropriate generic equivalent. Many questions were raised by this rule, including (i) how it interacted with health savings account guidance and (ii) what types of arrangements and/or plans to which it applied. The DOL, HHS, and the Treasury Department (collectively, the ?Ç£Departments?Ç¥) announced in an FAQ (available here) that the Departments will not initiate any enforcement action if a group health plan does not count the value of drug manufacturer coupons toward an out-of-pocket maximum. This no enforcement policy lasts until HHS?ÇÖs 2021 NBPP becomes effective, and the 2021 NBPP should clarify how this rule affects employer-sponsored group health plans.

December 2022