"[T]he ACA out-of-pocket maximum limits for 2023 will be $9,100 for self-only coverage and $18,200 for family coverage ... This is up about 4.6% from the 2022 limits of $8,700 and $17,400, respectively.... While these changes are not effective until 2023, the much earlier announcement gives employers ample time to prepare for 2023 enrollments."  MORE >>

"HHS is proposing [1] a more comprehensive standard for nondiscrimination in benefit designs for individual market and small group health insurance coverage ... [2] amendments to the medical loss ratio (MLR) regulations ... [3] new and more stringent requirements for the review of QHP networks ... [and] [4] to tighten its regulations governing insurance agents, brokers, and web-brokers assisting consumers in enrolling in QHPs."  MORE >>

"As of January 2022, California, Connecticut, Hawaii, Massachusetts, New Jersey, New York, Puerto Rico, Rhode Island, Washington, and Washington, DC, mandate paid leave for an employee's own health condition. Oregon and Colorado will begin similar programs in 2023.... Despite some common elements, differences in these mandates make compliance and administration particularly challenging for multistate employers."  MORE >>

"Plan sponsors should consider confirming that PBMs and TPAs will directly cover OTC COVID-19 tests in accordance with the Direct Coverage Safe Harbor, and if not, what actions they will take to comply with the new requirements to cover OTC COVID-19 tests. Practically, PBMs and TPAs may need additional time to establish a direct coverage program. In the meantime, plans will be required to pay the full costs of tests, even if greater than $12."  MORE >>

"In this report, [CBO] examines trends in nationwide spending on prescription drugs over the 1980-2018 period. The report also provides a more detailed analysis of trends in spending, use, and prices in the Medicare Part D and Medicaid programs over the 2009-2018 period."  MORE >>

"The Supreme Court decision does not prohibit employers from mandating vaccination.... Some states and localities require at least some employers to have vaccine mandates, and some employers are requiring boosters. On the other hand, ... 14 states have laws or regulations that limit or prohibit employers from implementing vaccine mandates."  MORE >>

"As long as the injunctions remain in place, it appears reasonably clear that the federal government cannot enforce the federal contractor mandates ... [E]mployers that have entered into agreements regarding COVID-19 workplace safety measures may still need to consider whether their particular agreements remain enforceable."  MORE >>

"[M]ost benefit programs are 'benchmarked' to be close to (above or below) average. Almost no companies seek to be best-in-class, and rarely do any seek to be world class.... [M]any more employers can sponsor high-performing benefit programs -- programs with excellent and affordable coverage, exceptional service, and at a low cost. The process begins with good data but shouldn't end with the status quo."  MORE >>

"No matter how the buyer seeks to limit its potential liability, ... the days of ignoring employee benefits and other employment-related issues in the diligence process are history. These issues matter in terms of legal liability, deal valuation (and evaluation) and post-acquisition integration of operations/policies/assets."  MORE >>

"Nearly a third of people don't want to give up the freedom of remote work that was prompted by the pandemic, saying they would quit before returning to traditional office life ... Workers are also eager to retire, with 48% indicating they would hang up their hats sooner than expected if they weren't dependent on employers for health care insurance ... Nearly as many, 44%, said they plan to take Social Security payments as early as possible, even if that meant having less income."  MORE >>