[Guidance Overview]

Not All Surprises Are Good: Phase I of the Surprise Billing Rules

"[B]efore 2022 begins employers may want to ... [1] Work with third-party administrators (TPAs) to update plan documents to incorporate new surprise billing rules, implement requirements under new surprise billing rules, and implement an [independent dispute resolution] process. [2] Confirm TPAs will update EOBs to include No Surprises Act surprise billing disclosures. [3] Confirm TPAs can calculate [the qualifying payment amount (QPA)].... [4] Prepare to make publicly available and post on the plan's website a notice regarding balance billing protections."  MORE >>

Snell & Wilmer

[Guidance Overview]

To Mandate or Not? FAQs on Mandatory Vaccine Programs for Employers

"The two primary exceptions to the general permissibility of employer-mandated vaccination policies are for employees with disabilities and for those with a sincerely held religious belief, practice, or custom.... While there is no federal law requiring paid leave for voluntary vaccines or for recovering from vaccine side effects, state and local laws may require it."  MORE >>

Reed Smith

[Guidance Overview]

Health Insurance Continuation Coverage Under COBRA (PDF)

"This report provides a simplified explanation of who qualifies for COBRA continuation coverage, the nature of COBRA continuation coverage, and corresponding employer and employee responsibilities. It also incorporates descriptions of the temporary relief that was provided [by EBSA and IRS] ... [which] extends various COBRA time frames ... during the COVID-19 pandemic. This report also includes a high-level description of the temporary COBRA premium assistance included in [ARPA]. " [R40142, updated Aug. 13, 2021]  MORE >>

Congressional Research Service [CRS]

[Guidance Overview]

State Drug Price Transparency Gains Momentum, Increasing Challenges for Manufacturers

"Developments include the passage of new laws, implementing regulations, and guidance documents.... State price reporting requirements reflect a patchwork of burdensome requirements that are evolving quickly, significantly complicating compliance efforts."  MORE >>

Sidley Austin LLP

Court Awards ERISA Penalties for Plan's Failure to Disclose Administrative Services Agreement and Claims Criteria

"[T]he court held that the plan, employer, and claims administrator violated MHPAEA by using the InterQual Criteria to determine whether the dependent's residential treatment center benefits were medically necessary.... The court held that, because the InterQual Criteria and the ASA are instruments under which the plan is operated under ERISA, the claimants were eligible for ERISA statutory penalties for the plan's failure to provide these two documents within 30 days of the claimants' request." [M. S. v. Premera Blue Cross, No. 19-0199 (D. Utah Aug. 10, 2021)]  MORE >>

Thomson Reuters Practical Law

New York Cuts Rate Increases Requested by Health Insurers

"Health insurance rates in New York are set to increase by an average of 3.7% for individuals, and 7.6% for small group plans.... [T]he Department of Financial Services lowered requests sought by 13 insurance companies ... [who] had requested to increase rates by 11.2% for individuals and 14% for small groups[.]"  MORE >>

FingerLakes1.com

[Opinion]

Private Equity Is Buying Up Health Care: Patients (and Doctors) Beware

"The galloping private equity takeover of medical assets should ring alarm bells. These corporate raiders' only interest is in short term profits. Dentists they own have been pressured to drill healthy teeth in children, dermatologists have been pushed to amp up lucrative procedures, and private equity-owned ED staffing firms are largely responsible for 'surprise bills' for ED care."  MORE >>

Physicians for a National Health Program [PNHP]

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Jackson Introduces New Retirement Investment Annuity

Jackson National Life Insurance Company

Willis Towers Watson selects Carl Hess as President and Future CEO

Willis Towers Watson

NFP Acquires Fallon Benefits Group, Inc., an Atlanta-Based Employee Benefits Brokerage and Consulting Firm

NFP Corp.

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Connecticut Paid Leave: What You Need to Know

August 27, 2021 WEBCAST

Littler

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Employer Self-Funded Health Insurance Is Taking Us in the Wrong Direction

Alain C. Enthoven, in Health Affairs Blog

Ninth Circuit: ERISA Plan's Procedural Error in Reviewing Claim for Disability Benefits Does Not Warrant Remand to the Plan

Roberts Disability Law

Third Circuit Joins Seventh Circuit in Holding Paid Leave May Be Required During Military Service

Morgan Lewis