Health Benefits

July 2026 Employers with Medicare-eligible employees face strict federal rules governing how employer-sponsored health plans must coordinate with Medicare. These rules, known as the Medicare Secondary Payer (MSP) regulations, determine who pays first, regulate what employers may say or do, and impose significant penalties for non-compliance. Failure to follow these requirements can expose...

Employer Pressure to Decline Group Coverage in Favor of Medicare: Why It’s Prohibited (Even for Groups <20 Employee) Even when an employer has fewer than 20 employees, making Medicare primary under the MSP rules, there are still strict federal protections preventing an employer from influencing an employee’s decision to enroll in Medicare instead of the employer’s group health plan. Below...

When employers receive Medical Loss Ratio (MLR) rebates from their insurance carriers, it’s not just a financial credit. It’s a compliance obligation. These funds must be evaluated and distributed in accordance with ERISA and ACA rules, ensuring that any portion attributable to employees is handled properly, documented clearly, and delivered within required timelines. These steps...

This month’s article highlights ACA Reporting Requirements for Forms 1094 and 1095, Employers and Paternity Leave, and state requirements for Short-Term Disability Insurance. ACA Reporting Requirements for Forms 1094 and 1095 ACA reporting involves the submission of Forms 1095 and 1094 by employers to the IRS each year. These forms are crucial for ensuring compliance with the Affordable Care...