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Agent compensation disclosureAmong its many new requirements for employee benefit plans, the Consolidated Appropriations Act, 2021 (CAA) created new compensation disclosure requirements. The new rules require brokers and consultants anticipated to earn $1,000 or more in direct or indirect compensation to disclose that compensation to the plan sponsor prior to entering into an agreement to provide that service.
The requirement is effective for contracts entered into, extended, or renewed on or after December 27, 2021. The Department of Labor issued Field Assistance Bulletin No. 2021-03 as there are many unanswered questions on how to comply.
USHL is providing the DOL bulletin and an Agent Compensation Disclosure on our websites to assist in disclosing compensation. Here are the links to the form and Field Assistance Bulletin No. 2021-03.
Compensation Disclosure - ACA
Field Assistance Bulletin No. 2021-03
The GA/Agent should maintain a signed copy of the disclosure document for all contracts should an audit occur. USHL reserves the right to request verification of compliance.
Direct any questions to the Employee Benefits Security Administration’s Office of Regulations and Interpretations at 202-693-8500.
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Appeal and claim forms
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Evidence of Coverage
2023
Ascension Personalized Care EOC - Indiana 2023
Ascension Personalized Care EOC - Kansas 2023
Ascension Personalized Care EOC - Michigan 2023
Ascension Personalized Care EOC - Tennessee 2023
Ascension Personalized Care EOC - Texas 2023
2022
Ascension Personalized Care EOC - Indiana 2022
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Managing private informationAPC Authorization for Agent Access*
Request for Appointment of Personal Representative
Request for Confidential Communications and Restrictions
Request to Terminate Personal Representative - COMING SOON
Request to Terminate Confidential Communications and Restrictions
Authorization to Disclose Protected Health Information
Request for Accounting of Disclosures - COMING SOON
Request for Amendment of Private Information - COMING SOON
*Full medical access form available upon request -
National ancillary list
Ascension Personalized Care offers a network of national ancillary providers to ensure convenient access to high quality, cost-effective services, including but not limited to medical supplies, durable medical equipment (DME) and other services. In addition to these national vendors, locally based participating doctors may be available. Please check the Ascension Personalized Care provider directory to find a local doctor.
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Non-opioid directive (Michigan)
Michigan has enacted a new law that allows people to refuse opioid medications by placing a non-opioid advance directive in their medical file. The goal of the new law – which went into effect 03/24/2022, is to prevent more people from becoming addicted to opioid pain medication.
Patients may revoke a non-opioid pain management form executed by themselves at any time and in any manner. A guardian or patient advocate may also revoke the form for a minor at any time and in any manner.
To add a non-opioid advance directive to your medical file, please fill out the form below and give it to your doctor.
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Out-of-network claim forms
Additional resources
