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Medical Loss Ratio (MLR) Rebates: A Timely Reminder | WI Employee Benefits Team

The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR … Continued

Compliance Recap August 2024 | Wisconsin Benefits Advisors

FEDERAL COURT BLOCKS FTC NON-COMPETE BAN NATIONWIDE: IMPORTANT INSIGHTS FOR EMPLOYERS On August 20, 2024, the U.S. District Court for the Northern District of Texas delivered a crucial ruling, effectively halting the Federal Trade Commission’s (FTC) Rule prohibiting most non-compete agreements. The Rule, which was set to go into effect on September 4, 2024, was … Continued

Compliance Recap July 2024 | WI Employee Benefits Agency

FORM 5500 FILING FOR HEALTH AND WELFARE PLANS The Form 5500 series is a component of the Employee Retirement Income Security Act’s (ERISA) reporting and disclosure framework. The Form is used to report information on the qualification of the plan, its financial condition, investments, and its operations. It also guarantees that participants, beneficiaries, and regulators have access … Continued

Compliance Recap June 2024 | WI Benefits Agents

ACA PREVENTIVE CARE MANDATE REMAINS IN PLACE WITH AN EXCEPTION In a recent decision, the U.S. 5th Circuit Court of Appeals upheld a key provision of the Affordable Care Act (ACA) that mandates private insurance cover preventive services without cost to patients. However, the court also ruled that the plaintiffs are exempt from complying with this mandate, … Continued

Form 5500: What You Need To Know | WI Employee Benefits Team

Attention Employers: Don’t Miss Your Form 5500 Deadline! Here’s a simplified breakdown of what you need to know about filing your employee benefit plan report: Who Needs to File? Employers subject to ERISA (Employee Retirement Income Security Act) with employee benefit plans, unless exempt. What to File? Form 5500 (annual report) for each employee benefit … Continued

Compliance Recap May 2024 | Wisconsin Benefits Team

PREPARE NOW TO PAY THE PCORI FEE The Patient-Centered Outcomes Research Institute (PCORI) fee funds research that evaluates and compares health outcomes, clinical effectiveness, and the risks and benefits of medical treatments and services. Effective through 2029, the IRS treats this fee like an excise tax, applied to all covered lives, including employees, retirees, spouses, … Continued

Benefits Check-up: 6 Compliance Issues Affecting Your Clients’ Health | WI Benefits Agents

A health plan is more than a product or service; it’s a relationship. All productive and healthy relationships—especially in the benefits space—rely on trust. When an employer extends trust in a broker or insurance carrier to purchase something as critical as healthcare—for people as critical as their workers and families—we’re obligated to raise all factors … Continued

Compliance Recap April 2024 | WI Employee Benefits Group

FEDERAL TRADE COMMISSION BANS NON-COMPETE CLAUSES On April 23, 2024, the Federal Trade Commission (FTC) finalized a rule banning most employers and employees from entering into non-compete clauses, effective 120 days post-publication in the Federal Register. This move aims to eliminate these clauses across all levels of workers, with a narrow exception for senior executives’ pre-existing agreements. … Continued

Compliance Recap March 2024 | WI Employee Benefits Group

AFFORDABLE CARE ACT INFORMATION REPORTING Beginning in 2024, most employers obligated to report under the Affordable Care Act (ACA) must file returns electronically by March 31, 2024. Employers filing fewer than 10 returns a year are allowed to use paper filing. Since March 31 falls on a weekend, the deadline this year is April 1, … Continued

Compliance Recap February 2024 | Wisconsin Benefits Consultants

In early February, a federal class action lawsuit was filed against Johnson & Johnson (JNJ) and its plan fiduciaries, alleging overpayment for prescription drugs within its prescription drug plan. The complaint alleges that under the Employee Retirement Income Security Act of 1974 (ERISA), JNJ’s plan fiduciaries are obligated to diligently compare service providers, seek cost-effective options, and … Continued

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