Employee Benefits – Current State of Affairs

As is not atypical of a new congress and a new executive branch, there is a period of suspending, reviewing, modifying and otherwise adjusting rules, regulations and priorities of the prior administration. Fast and furious might be an understatement for the pace with which the current administration is stirring up employee benefit issues. Following is a brief overview of some of the topics that are roiling:

Mental Health Parity Regulations

• Final regulations challenged by TheERISA Industry Committee.
• While this litigation plays out, plans must continue to ensure compliance with the rules.
• See past Benefit Beat article here

HIPAA Privacy Reproductive Health Final Rules

• Final rule has been challenged in court.
• Plans still need to comply with certain provisions of the final rule.
• See past Benefit Beat article here

Section 1557 of the Affordable Care Act/Gender Identity

• Prohibits discrimination on the basis of race, color, national origin, sex, age or disability.
• Litigation is ongoing.
• Executive Order 14187 issued on January 28, 2025.
  • Creating question as to the definition of gender identity.
• See past Benefit Beat article here.
• Executive Order 14168 was issued on January 20, 2025, related to gender identity.
• The Executive Order:
  • Recognizes only two sexes, male and female.
  • Aims to end federal enforcement of laws based on gender identity.
  • Directs federal agencies to enforce sex-based anti-discrimination laws without regard to gender identity.

ACA Preventive Mandate

• Supreme Court reviewing.
• All plans, except litigants must continue to cover preventive services for now.
• New preventive services required for plan years beginning on or after December 20, 2025:
  • Screening and counseling for intimate partner and domestic violence;
  • Breast cancer screening for women at average risk; and
  • Breast and cervical cancer screening.

The Fate of Fixed Indemnity Policies

• Executive Order 14148 issued on January 20, 2025, rescinded the notice requirement for fixed indemnity policies.
• Trump administration is looking into additional changes and updates to fixed indemnity type policies
• For additional information, see prior Benefit Beat articles here

In addition, on February 25, 2025, Executive Order 14221 was signed affirming interest in putting a laser-pointer on ensuring price transparency. As a reminder, health plans are required to make available three separate machine-readable files (1) in-network negotiated rates, (2) out of network allowed amounts, and (3) prescription drug reporting. This information must be publicly available in a searchable online format and must be updated monthly. It is a good time to make sure this information is properly posted and updated. If your plan is insured, the insurer should be posting the information. If your plan is self-funded, your TPA can post the information on its website if your plan does not have a public facing website. Confirm with your service provider that this obligation is being accomplished. This price transparency laser-pointer is also directed at hospitals who also have price transparency requirements.

The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. This information is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.