"President Biden has extended the COVID-19 National Emergency, which was declared on March 13, 2020, and was scheduled to end March 1, 2022. This latest extension of the National Emergency is expected to last for at least one year. Extending the National Emergency also extends temporary delays of certain deadlines applicable to group health plans."  MORE >>

"To date, 14 states, Washington, D.C., and over 20 localities have PSL laws in effect, while four jurisdictions -- Nevada; Maine; Bernalillo County, New Mexico; and West Hollywood, California -- have earned paid time off (EPTO) laws in effect that are structured similarly to the PSL laws but allow employees to use leave for any reason."  MORE >>

"Under the prior guidance, it was deemed unreasonable for an employer to ask an employee for ... documentation substantiating their need for PSL unless the employee was out of work for more than three consecutive days ... The OLSE has now extended the presumption of unreasonableness to when an employee is out for up to and including five consecutive days for COVID-19 related reasons and is not under a doctor's care."  MORE >>

"For 2022, many TPAs are subjecting NSA claims to their 'shared savings' and similar programs, which could result in unexpectedly large fees.... [P]lan sponsors, brokers, and consultants should start asking whether applying savings programs to NSA claims is the right approach. It might be better to carve NSA claims out of savings programs or to pay a flat fee for NSA claims that is not related to the dollar amount of the claims. "  MORE >>

"Self-funded plans, including level-funded plans, need to check their administrative services agreements to see exactly how much responsibility they might bear for decision-making.... Who will make decisions and represent the plan when it comes to arbitration? ... The new rules also limit a plan's ability to deny emergency claims.... Emergency care is defined broadly for the purposes of these rules.... [M]ost health care claims payers and processors are not prepared to run with this standard yet."  MORE >>

"The ACA requires health plans to cover four broad categories of preventive services without any cost-sharing (i.e., at no cost to the participant). The Health Resources and Services Administration (HRSA) recently updated its guidelines to include several new women preventive services that health plans must cover beginning in 2023."  MORE >>

"The Fifth Circuit ... [explained] that Reliance had made only an eligibility determination, not a disability determination -- two determinations that are 'in fact distinct.' ... [O]nce the district court determined that Newsom was in fact eligible for benefits and determined the date on which Newsom's eligibility began, the district court similarly should have stopped its decision-making process and remanded the case to Reliance to make the separate disability determination." [Newsom v. Reliance Standard Life Insurance Co., No. 20-10994 (5th Cir. Feb. 18, 2022)]  MORE >>

"[This report] uses actual enrollment data to provide a one-of-a-kind look at behavior-based trends in: [1] Employer Benefit Offerings; [2] Health Plan Premiums and Out-of-Pocket Costs; [3] Employee Elections ... Key Insights: ... Employers continue to diversify health benefit packages.... Employers limit cost-shifting of health care cost increases for employees.... Employees are prioritizing financial security via voluntary benefits."  MORE >>

29 pages. "Outcomes-based arrangements (OBAs) -- which base reimbursement on whether a therapy worked or not -- are one tool to help manage costs. This is particularly applicable in gene therapies for rare diseases ... As more states investigate sustainable financing options for gene therapies, this paper reviews example OBAs and key lessons learned from states with existing contracts."  MORE >>

"Some of these benefits will include sick days, vacation days, and paid parental leave. These changes in company policy come on the heels of months of complaints from employees about poor conditions. They also come in response to nationwide labor shortages."  MORE >>