26 pages; Apr. 13, 2022. "This document provides instructions for the HHS risk adjustment models for the 2021 benefit year, with revisions from the updated 2021 benefit year software instructions posted on the CCIIO website on January 7, 2022." [Also available: Technical Details (XLSX) and 2021 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

"If an employee in a family was offered affordable self-only coverage, the employee would still not be eligible for premium tax credits. The family would thus have to purchase two policies -- one for the employee through the employer and one through the marketplace for the remaining family members. The family also may have to meet two deductibles, be subject to two out-of-pocket limits, and might find itself in two different provider networks. Families with more than one employee offered self-only coverage may need to purchase several policies, one for each employee and a marketplace plan for the remaining family members."  MORE >>

"Paid leave will be available to eligible employees for family leave, medical leave, and family military leave reasons beginning on January 1, 2025.... Beginning October 1, 2023, employees, employers, and self-employed individuals must begin making contributions to the Fund.... Covered employers include any person or governmental authority that employs at least one individual in the state of Maryland."  MORE >>

"The law covers the vast majority of employers in the state ... and will ensure that covered private sector employees ... who have worked at least 680 hours over the 12-month period immediately preceding the date on which the leave is to begin have up to 12 weeks annually of paid time off for certain purposes. Benefits will replace 90% of weekly wages for an employer's lowest-income employees (with a smaller percentage for higher-paid workers), up to a maximum of $1,000 per week."  MORE >>

"The district court believed that the definition of 'active work' should be read in conjunction with the definition of 'determination date.' According to the district court, because Ten Pas was considered 'actively at work' through Labor Day weekend, he could not have become disabled until September 2.... The Seventh Circuit found error with the district court's analysis.... Only two things are relevant, the date the disability began, and the last day worked just prior to that date. The district court impermissibly injected the 'active work' definition into the equation." [Ten Pas v. Lincoln National Life Ins. Co., No. 20-1259 (7th Cir. Apr. 11, 2022)]  MORE >>

"The 6th U.S. Circuit Court of Appeals said a lower court erred in dismissing Ruth Mae Chelf's claims for breach of fiduciary duty based on the 'ministerial function' exception to ERISA ... That defense was unavailable to Walmart because ... '[Walmart] was a fiduciary as it indisputably exercised control over the Plan's assets when it handled Mr. Chelf's premiums, exercised control over the disposition of the Plan's assets, and had discretionary authority over the administration of the Plan,' [judge Jane B. Stranch] wrote[.]" [Chelf v. Prudential Ins. Co., No. 20-6097 (6th Cir. Apr. 12, 2022)]  MORE >>

"EBRI's analysis finds stark differences in HSA behavior based on accountholder race, ethnicity, gender, and income.... Disparities in HSA account balances along racial, ethnic, gender, and income lines are not adequately explained by the length of HSA ownership. Instead, the disparities EBRI observes appear to be largely driven by contributions."  MORE >>

"House Bill 2322, named the Health Care Freedom of Choice Act, would authorize the Oklahoma Insurance Department to hold hearings and levy fines on insurance companies that refuse to pay claims from 'practitioners, hospitals, home care agencies, or ambulatory surgical centers despite them meeting requirements for compensation as laid out in the measure,' according to the bill summary."  MORE >>

"Analyzing and mining data can help plans find interesting or questionable patterns that may be a sign of fraud or waste.... External auditors should take certain steps to detect material errors and irregularities in the plan financial statements.... Multiemployer plan policies detail plan compliance with government regulations, mandate consistency in plan operations, help plans avoid legal liability and give assurance to others that that the plan is well run."  MORE >>