26 pages. "This 2023 Draft Letter provides updates on operational and technical guidance for the 2023 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2023 Draft Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs).... The 2023 Draft Letter focuses on guidance that has been updated for the 2023 plan year[.]"  MORE >>

"[This article takes a] quick look at what guidance is expected in 2022, two requirements that are delayed pending guidance and two areas where we might see guidance in 2022 from the federal agencies overseeing employee benefits."  MORE >>

"Plan sponsors who are going through an RFP process should consider seeking the disclosure information early on in the process and before starting negotiations with a particular vendor. This could allow the plan sponsor to compare direct and indirect compensation information from a number of vendors, making it easier to determine and document for ERISA compliance purposes whether the compensation that any one vendor earns is reasonable."  MORE >>

"DOL will not be issuing regulatory guidance on the disclosures at this time, but [FAB 2021-03] answers some questions relating to how the DOL intends to apply and interpret the fee disclosures requirements. In the meantime, service providers will be deemed to be in compliance with the disclosure rules so long as they follow a reasonable, good faith interpretation of the requirements."  MORE >>

"CMS is focusing on policy proposals ... that would be applicable to pharmacy price concessions only, and not applicable to non-pharmacy price concessions, such as manufacturer rebates. The data shows that pharmacy price concessions, net of all pharmacy incentive payments, grew more than 107,400 percent between 2010 and 2020.... CMS estimates the new definition of negotiated price is expected to reduce beneficiary costs by $21.3 billion over 10 years, or approximately 2 percent."  MORE >>

"The most significant point made by the court ... was its determination that after approving Dr. Roehr's claim and paying benefits for nearly 10 years without interruption, Sun Life needed to offer more of an explanation than a change of mind in order to justifiably terminate benefit payments. The Eighth Circuit is not the first court to express such a conclusion." [Roehr v. Sun Life Assurance Co. of Canada, No. 21-1559 (8th Cir. Dec. 27, 2021)]  MORE >>

"Lower wage workers were less likely than higher wage workers to have access to paid family leave. In March 2021, 6 percent of private industry workers with an average wage in the lowest 10 percent had access to paid family leave, compared with 43 percent of workers with an average wage in the highest 10 percent."  MORE >>

116 pages. "OIG continues to recommend the following legislative actions: [1] Repeal ERISA's limited-scope audit exemption.... [2] Expand the authority of [EBSA] to correct substandard benefit plan audits and ensure that auditors with poor records do not perform additional plan audits.... [3] Require direct reporting of ERISA violations to DOL ... [4] Strengthen criminal penalties.... The OIG remains concerned over [EBSA's] ability to protect the benefit plans of about 158 million workers, retirees, and their families under [ERISA]. In particular, the OIG is concerned about the statutory limitations on EBSA's oversight authority and inadequate resources to conduct compliance and enforcement."  MORE >>

"Typically, the conversation about benefits is a once per year event, and usually only over the brief course of Open Enrollment. Employees use their benefits 365 days a year, so developing a communication and education strategy that is ongoing will maximize their benefits and allow both them and the employer to get the most bang for their buck."  MORE >>