{"id":25613,"date":"2024-02-20T16:34:00","date_gmt":"2024-02-20T16:34:00","guid":{"rendered":"https:\/\/progyny.com\/?p=25613"},"modified":"2024-04-24T19:11:50","modified_gmt":"2024-04-24T19:11:50","slug":"4-compliance-considerations-for-benefits-leaders","status":"publish","type":"post","link":"https:\/\/progyny.com\/blog\/4-compliance-considerations-for-benefits-leaders\/","title":{"rendered":"4 Compliance Considerations for Benefits Leaders in 2024"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Medical pathways in fertility and family building are complex, and the regulatory landscape is no different. At the federal level, treatment of infertility is not considered an essential health benefit. Currently, 21 states and D.C. have mandates for some or all fertility procedures, and 23 states have bills making their way through legislatures to add additional access. Even so, there\u2019s no one-size-fits-all approach to compliance in this space.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The foundational considerations for compliance in fertility and family building benefits include a combination of general healthcare regulation issues, HIPAA, ERISA, and specific mandates, PPACA and MHPAEA. This blog breaks down these regulatory issues to help you understand how they fit into your overall compliance and communication strategies.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">1) HIPAA: Health Insurance Portability and Accountability Act<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">The basics<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">HIPAA impacts the day-to-day mechanisms of how information is shared and how organizations function within their medical plans. It has significant provisions regarding the privacy and security of patient information. When it comes to family planning benefits, plans and providers must handle patient information with the same rigorous standards of privacy and security as they would with any other medical information.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pertinent provisions for family building benefits<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Family planning details just like other health information, are considered <a href=\"https:\/\/www.hhs.gov\/answers\/hipaa\/what-is-phi\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">Protected Health Information (PHI)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hhs.gov\/hipaa\/for-professionals\/privacy\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">Privacy Rule<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hhs.gov\/hipaa\/for-professionals\/security\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">Security Rule<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hhs.gov\/hipaa\/for-professionals\/privacy\/guidance\/access\/index.html#:~:text=Thus%2C%20individuals%20have%20a%20right,and%20disease%20management%20program%20files%3B\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Rights<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hhs.gov\/hipaa\/for-individuals\/notice-privacy-practices\/index.html#:~:text=Your%20health%20care%20provider%20and,mail%20from%20your%20health%20plan.\" target=\"_blank\" rel=\"noreferrer noopener\">Notice of Privacy Practices<\/a><strong>:<\/strong> Any unauthorized use or disclosure of PHI can result in significant penalties.&nbsp;<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Takeaways<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">HIPAA requirements around sharing minimum necessary information do not change simply because information, such as a pregnancy, may be exciting news. While the idea of letting an employee\u2019s manager know they\u2019re going through IVF so that they can be supportive and accommodating is well-intentioned, the transmission of protected health information by an employer should be for the administration of a plan and nothing else. It is vital to protect the health information of participants and make sure managers are doing the same.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A safe and effective option for organizations is purpose-built training that empowers managers to communicate and contextualize the range of benefits and resources available to employees.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">2) ERISA: Employee Retirement Income Security Act<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">The basics<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Nearly all employer-sponsored group health plans that cover or reimburse medical expenses are subject to disclosure, reporting, and other requirements under ERISA. While cumbersome, these requirements are designed to provide protection to employee participants and beneficiaries.&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pertinent provisions for family building benefits:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.dol.gov\/general\/topic\/retirement\/fiduciaryresp#:~:text=Fiduciaries%20must%20act%20prudently%20and,must%20avoid%20conflicts%20of%20interest.\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Fiduciary duties<\/strong><\/a>: The requirement to act in the best interest of plan participants&nbsp;&nbsp;<\/li>\n\n\n\n<li><a href=\"https:\/\/webapps.dol.gov\/elaws\/ebsa\/health\/employer\/1D.asp\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Nondiscrimination<\/strong><\/a>: Prohibits discrimination against plan participants based on factors such as race, gender, age, or disability. For instance, with fertility and family benefits, this means ensuring that the benefits are being provided equally to men and women and will include coverage for things such as vasectomies and female contraceptives.&nbsp;&nbsp;<\/li>\n\n\n\n<li><a href=\"https:\/\/www.dol.gov\/sites\/dolgov\/files\/ebsa\/about-ebsa\/our-activities\/resource-center\/publications\/reporting-and-disclosure-guide-for-employee-benefit-plans.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Notices to plan participants<\/strong><\/a>: For instance, the need to notify plan participants of the <a href=\"https:\/\/www.dol.gov\/agencies\/ebsa\/laws-and-regulations\/laws\/whcra\" target=\"_blank\" rel=\"noreferrer noopener\">Women&#8217;s Health and Cancer Rights Act<\/a> (WHCRA) and the <a href=\"https:\/\/www.dol.gov\/agencies\/ebsa\/laws-and-regulations\/laws\/nmhpa\" target=\"_blank\" rel=\"noreferrer noopener\">Newborns and Mothers Health Protection Act<\/a> (NMHPA). There are template documents you can download directly from agency websites to help fulfill this requirement.&nbsp;<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Takeaways<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Communication and documentation are key to ensuring plan participants can easily access information about their plan and that all documents are accurately aligned. A great place to start is with your plan documents and Summary Plan Description, which outline the formal terms and conditions of the health insurance plan and help participants understand their coverage.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want to learn more about the best practices around compliance communications? <a href=\"https:\/\/progyny.com\/blog\/compliance-and-communication-best-practices-for-fertility-and-family-building-benefits\/\" target=\"_blank\" rel=\"noreferrer noopener\">Click here<\/a>.<\/em>&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">3) PPACA: Patient Protection and Affordable Care Act<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">The basics<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The ACA brought about numerous changes and requirements, including the establishment of a list of essential health benefits (EHBs) that qualified health plans are required to cover. Family planning and contraceptive care are part of these essential health benefits, so these services are necessary to include in your health plan in order to be compliant.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pertinent provisions for family building benefits:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/786fa55a84e7e3833961933124d70dd2\/preventive-services-ib-2022.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Coverage without cost-sharing<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.healthcare.gov\/coverage\/birth-control-benefits\/\" target=\"_blank\" rel=\"noreferrer noopener\">FDA-approved contraceptives<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.healthcare.gov\/coverage\/mental-health-substance-abuse-coverage\/#:~:text=Mental%20and%20behavioral%20health%20services,and%20behavioral%20health%20inpatient%20services\" target=\"_blank\" rel=\"noreferrer noopener\">Coverage of counseling services<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.hrsa.gov\/womens-guidelines#:~:text=Under%20the%20ACA%2C%20most%20private,services%20%E2%80%93with%20no%20cost%20sharing.\" target=\"_blank\" rel=\"noreferrer noopener\">Gynecological services<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Takeaways<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Minor shifts in regulations at the state or federal level may appear small, but often create waves of change at the organization level. Utilize the relationship between your counsel and your fertility and family building vendor to navigate trends and changes.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">4) MHPAEA: Mental Health Parity and Addiction Equity Act<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">The basics<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MHPAEA is primarily concerned with ensuring that insurance plans offer mental health and substance use disorder benefits that are on par with their medical\/surgical benefits. It&#8217;s designed to prevent insurance plans from applying more restrictive benefit limitations on mental health and substance use disorder benefits than on medical or surgical benefits.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MHPAEA does not have specific provisions related directly to family planning but is relevant if the plan also covers mental health services related to reproductive health, pregnancy, post-partum depression, mental fog related to menopause or other related conditions.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pertinent provisions for family building benefits<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.dol.gov\/sites\/dolgov\/files\/ebsa\/about-ebsa\/our-activities\/resource-center\/faqs\/mhpaea-2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Parity in Financial Requirements<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.dol.gov\/agencies\/ebsa\/laws-and-regulations\/laws\/mental-health-parity\/mhpaea-enforcement-2022\" target=\"_blank\" rel=\"noreferrer noopener\">Parity in Treatment Limitations<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cms.gov\/cciio\/resources\/regulations-and-guidance\/downloads\/mhapeachecklistwarningsigns.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Parity in Non-Quantitative Treatment Limitations (NQTLs)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cms.gov\/marketplace\/private-health-insurance\/mental-health-parity-addiction-equity\" target=\"_blank\" rel=\"noreferrer noopener\">Scope of Service Application<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.dol.gov\/agencies\/ebsa\/laws-and-regulations\/rules-and-regulations\/public-comments\/mhpaea-model-disclosure-request-form\" target=\"_blank\" rel=\"noreferrer noopener\">Disclosure<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Takeaways<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Mental health goes hand in hand with fertility and family building, and vendors in the space need to prioritize equitable access and financial parity.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NOTE: As of July 2023, there are newly <a href=\"https:\/\/www.2020mom.org\/blog\/2023\/7\/28\/the-department-of-labor-issues-new-proposed-mental-health-parity-rules\" target=\"_blank\" rel=\"noreferrer noopener\">proposed rules to strengthen MHPAEA<\/a>. The Department of Labor conducted a study of a 2019 birth cohort in Texas, following mothers and babies to understand the impact, cost, and loss of productivity associated with maternal mental health conditions. The DOL identified that the loss of productivity and maternal health conditions cost the state of Texas $2.2 billion. Therefore, the Department developed new rules to provide more guidance and regulation around supporting and providing benefits for maternal mental health conditions.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This proposal hasn\u2019t yet been finalized, but it is an important call for equitable benefits and support in the previously heavily stigmatized space around maternal mental health.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want to learn more about compliance considerations and how they may impact your benefits strategy? Watch our webinar: The Compliance Puzzle \u2013 Legal Realities and Implications That Influence Family Building Benefits.<\/em><\/p>\n\n\n<section id=\"block_65d621923aa0d\" class=\"fav-block fav-button white-font style-primary wide\"><div class=\"container align-left\">\n    <a href=\"https:\/\/go.progyny.com\/compliance-blog-download-webinar\" title=\"\" class=\"button primary wide\" target=\"_blank\">Watch the Webinar<\/a>\n<\/div>\n<\/section>\n\n<section id=\"block_65d623433aa0e\" class=\"fav-spacer fav-block spacer shape-none shape-position-0 desktop-60 mobile-40\">\n<\/section>\n\n\n<div class=\"meeting-blog-block\"><h4>Ready to learn more about how Progyny helps employers and health plans create equitable benefit packages to support individuals throughout their health journeys?<\/h4><button class=\"meeting-block-btn\"><a href=\"https:\/\/progyny.com\/getprogyny\/\" target=\"_blank\" aria-label=\"Book a meeting - opens in new tab\" rel=\"noopener\">Book a meeting<\/a><\/button> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Medical pathways in fertility and family building are complex, and the regulatory landscape is no different. At the federal level, [&hellip;]<\/p>\n","protected":false},"author":45,"featured_media":25614,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[440,250],"tags":[483,540,317,213,554],"class_list":["post-25613","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-fertility-in-the-workplace","tag-b2b","tag-compliance","tag-family-building-benefits","tag-fertility-benefits","tag-legal"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>4 Compliance Considerations for Benefits Leaders in 2024 | Progyny<\/title>\n<meta name=\"description\" content=\"Medical pathways in fertility and family building are complex, and the regulatory landscape is no different.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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