16 pages. "Conventional wisdom has been that treating more patients with commercial, or private, health insurance was seen as a good thing from a net revenue point of view ... [D]ata shows that commercial payors reimburse providers at a higher amount on a per-case basis compared with Medicare ... In fact, commercial payors take the longest to pay, require providers to jump through more administrative hoops to get paid, and delay payments to providers via claim denials at a higher frequency than government payors."

"In a highly technical opinion letter ... the [DOL] clarified how to calculate FMLA leave usage when an employee takes intermittent leave during a holiday week.... [It is] critical to understand that the term 'workweek,' as defined under the FMLA, is the employee's normal schedule (hours/days per week) prior to the start of FMLA leave. "

"[A] more vigorous assertion of ERISA fiduciary obligations, either by employee-backed litigation or more thoughtful federal regulation (not always an oxymoron) could provide an independent tool to bolster healthcare price transparency that matters and strengthen the combined force of pro-transparency pressure. At a minimum, it could motivate some employers to contract with intermediaries (including better-structured association health plans, independent coverage health reimbursement arrangements, stop-loss insurers, and pharmaceutical benefits managers) that are more accountable to the employee beneficiaries of self-insured plans."

"It is imperative that applications for long-term disability due to long-haul COVID-19 ... be scrutinized to determine if a claimant continues to be residually or totally disabled.... Engaging medical experts to review a claimant's medical records will be vital to ensuring that only legitimate claims are paid. It is expected that courts are likely to undertake a fact-based analysis, and as scientists begin better understand the effects of long-haul COVID-19, it is expected that there may be guidelines for diagnosis simi- lar to chronic fatigue."

Rev. June 2023. "What's New: The form and instructions have been updated to be completed on Pay.gov as of July 1, 2023.... The form and the instructions have undergone major revisions in the format and information required."

"[Notice 2023-43], which is in the form of questions and answers, covers: [1] Conditions for self-correction; [2] Eligible inadvertent failures that may not be self-corrected at this time; [3] Conditions that will not apply under the interim guidance ... Plan sponsors may rely on this guidance in determining whether self-correction is allowed until IRS updates [Rev. Proc. 2021-30]."

"[1] Employers' more generous leave policies do not relieve them of their FMLA leave obligations.... [2] Prior temporary employment may count toward FMLA eligibility.... [3] Employers may not rely on 'undue hardship' to deny FMLA leave.... [4] 'Maternity leave' is an ambiguous term."

"A new [DOL opinion letter] clarifies how ... to calculate [FMLA] leave ... when it's taken during a week that includes a holiday.... If a holiday falls during a week when an employee takes a full workweek of FMLA leave, then a full week is counted as FMLA leave. However, if a holiday falls during a week when an employee works some hours and takes some FMLA leave, the holiday is not counted as FMLA leave, unless the employee was normally scheduled and expected to work on that holiday."

"[One] provision the senators highlight as a priority for the [DOL] is allowing employers to offer pension-linked emergency savings accounts to non-highly compensated employees.... The senators also asked the DOL to focus on requiring defined benefit plans to include more information on plan assets, liabilities and funding status in their annual funding notices.... The lawmakers also directed the DOL and Treasury Department to amend regulations so that defined contribution plans can consolidate certain required notices."

"Total savings rate for the first quarter -- which reflects a combination of employer and employee 401(k) contributions -- improved to 14% (compared to 13.7% in Q4 2022 and 13.8% in Q3 2022... [T]he average 401(k) employer contribution, which includes profit sharing and matching contributions, reached a record 4.8% in Q1[.]"

"The message the Tenth Circuit's ruling sends to insurers ... clearly establishes that health benefit administrators are required to acknowledge and address the evidence submitted by claimants. A decision will not be upheld simply because it is supported by a doctor's opinion. Instead, insurers must engage with the opinions of the treating doctors and explain their basis for any disagreement." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023)]

"The decision affirms that, if the plan so provides, discretionary eligibility criteria for severance benefits is permissible under ERISA. However, plan sponsors should be aware that the exercise of discretion in certain ways can cause issues under other federal laws intended to protect against discrimination ... [and] in the context of a voluntary severance plan, the exercise of discretion with respect to eligibility could negate the voluntary nature of the plan." [Carlson v. Northrop Grumman Severance Plan & Northrop Grumman Corp., No. 22-1764 (7th Cir. May 8, 2023)]

"The aggregate funded ratio for U.S. corporate pension plans increased by an estimated 0.8 percentage points in May and ended the month at 99.8% ... The monthly change in funded ratio resulted from a 2.9% decrease in liability value partially offset by a 2.0% decrease in asset value. The aggregate funded ratio is estimated to have increased by 2.3% and 2.4% year-to-date and over the trailing twelve months, respectively."

"Encouraging executive officers to reduce errors requiring restatements, the new rule targets compensation awarded to executive officers as a result of erroneously reported financial information that is received in the three-year period preceding the date when an issuer is required to prepare an accounting restatement due to material noncompliance with any financial reporting requirement under securities laws."

"Florida's surprise billing law ... requires insurers to pay the 'usual and customary provider charges for similar services in the community where the services were provided' for out-of-network emergency care. The hospitals ... asserted that Cigna underpaid them for out-of-network emergency services, when their own data showed they normally receive five times Cigna's allowance.... The district court agreed with Cigna, but ... the Eleventh Circuit remanded the case with instructions that a jury must decide the 'community' rates." [North Shore Med. Ctr., Inc. v. Cigna Health & Life Ins. Co., No. 22-10514 (11th Cir., May 25, 2023)]

"Transitioning to an RBP plan can be quite disruptive to plan members and administrators because it represents a significant departure from traditional PPO plans. Some key considerations for those considering an RBP plan are outlined [in this article]."

"While the SEC may further postpone this deadline, listed issuers would be advised to prepare their boards now to approve compliant clawback policies by August 8, 2023, ... assuming that the SEC approves the listing standards by June 9, 2023[.]"

"[A]verage total medical spending increased in the quarter leading up to the cancer diagnosis, peaked in the quarter including and following diagnosis and then declined, though post-diagnosis spending remained higher than pre-diagnosis spending throughout the year."

"An examination of the health care claims of 8.6 million group plan enrollees in 2021 revealed that over 80 percent of top spenders had at least 1 of 5 chronic health conditions -- heart disease, respiratory conditions, musculoskeletal conditions, skin disorders, and nervous system conditions. This Fast Fact reviews the spending of people with one or more of these chronic conditions."

An unofficial monthly report of the Moody's Daily Long-term Corporate Bond Yield Averages and Moody's Daily Treasury Yield Averages (used as benchmarks by some corporate pension plans).

"Instead of what it described as an 'extra-textual' limitation on class certification, the D.C. Circuit held that the existing requirements of Rule 23 (and a district court's discretion to alter proposed class definitions) should be used to prevent certification of fail-safe classes.... [T]he D.C. Circuit was faced with an ERISA class action, in which the plaintiff sought to certify a proposed class of current or former employees of the defendant (or their beneficiaries) who had 'been denied vested rights' to retirement benefits." [In re White, No. 22-8001 (D.C. Cir. Apr. 4, 2023)]

"Although there is language in the preamble to the privacy rule that seems to assume that the privacy official will be an employee of the covered entity, there is no explicit requirement to that effect. And because some covered entities (e.g., most group health plans) will not have employees, the privacy official's duties will have to be performed by a third party (for a group health plan, usually an employee of the plan sponsor)."

"[C]overed employers must allow all employees (full-time, part-time, and seasonal) to earn and use up to 40 hours of paid leave each year, which employees can use for any purpose.... [E]very employer will need [to] determine the best way for their organization to satisfy the Act's requirements, draft any new policies that are needed, carefully review and revise any existing paid time off policies to ensure compliance with the Act, post the required notice, and set up a system to comply with the Act's record-keeping requirements. Employees may begin using paid leave under the Act on March 31, 2024, or after the first 90 days of their employment (whichever is later)."

"The court concluded that the retirees' arguments, along with their claims that they had made specific decisions in reliance on the employer's statements, were enough to allow the case to proceed and for the retirees to pursue the equitable remedies of reformation or surcharge." [Baker v. Save Mart Supermarkets, No. 22-4645 (N.D. Cal. Apr. 7, 2023)]

"Hidden Hurdle 1: Equality does not equal parity ... Hidden hurdle 2: When you don't (and can't) know how your plan is run ... Hidden hurdle 3: Didn't we exclude that?"