40 pages, April 2022. "This document provides guidance to disputing parties who are seeking to resolve a claim for payment for [out of network] health care items or services through the Federal IDR Process.... This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process."  MORE >>

44 pages; April 2022. "The purpose of this document is to provide guidance to certified IDR entities on various aspects of the Federal IDR Process. This document includes information on how the parties to a payment dispute may initiate the Federal IDR Process and describes the requirements of the Federal IDR Process, including the requirements that certified IDR entities must follow in making a payment determination. This document also includes information related to other aspects of the Federal IDR Process that certified IDR entities must follow, including guidance on confidentiality standards, record-keeping requirements, and the process for revocation of IDR certification, as well as how parties may request an extension of certain time periods for extenuating circumstances."  MORE >>

"The continuation of the National Emergency and the associated continuation of the disregarded period for the certain employee benefit plan deadlines will remain a challenge for plan sponsors to ensure affected participants and beneficiaries are afforded the benefit of the extended deadlines.... Plan sponsors should coordinate with their insurers and third-party administrators to ensure that their plans are being administered consistent with these extended deadlines."  MORE >>

"San Francisco requires covered employers to make minimum healthcare expenditures on behalf of their San Francisco employees ... After waiving the reporting requirement the past two years due to the pandemic, the report for 2021 is due by May 2.... Covered employers should also ensure that they are making the minimum healthcare expenditures ... during 2022."  MORE >>

"The [Illinois] COVID-19 paid leave law has raised both legal and practical questions for school administrators. [Fifteen] pressing questions about the implications of the law and implementation are addressed [in this article]."  MORE >>

"Two recent laws make changes to Washington's long-term care (LTC) insurance mandate.... [One] delays the original start date for employee contributions from Jan. 1, 2022, until July 1, 2023. The measure also delays the benefit start date by 18 months to July 1, 2026, shortens the vesting time frame and provides a reduced benefit for residents born before 1968. A second law ... offers additional premium contribution exemptions."  MORE >>

"The court [found] that ERISA governs plans arising from employment relationships, and that one cannot have an employment relationship with oneself. In other words, ERISA's definitions of employer and employee contemplate separate parties. Here, the plaintiff had not alleged that his business had any employees, and the [health insurance] policy provided coverage only to plaintiff as an individual." [Till v. National General Accident & Health Insurance Co., No. 21-1256 (N.D. Ill. Mar. 8, 2022)]  MORE >>

"The district court ... found that Wal-Mart was not acting in a fiduciary capacity when it was performing administrative functions of collecting and applying premiums. The Sixth Circuit found that ... Wal-Mart was a fiduciary that indisputably exercised control over the Plan's assets when it handled Mr. Chelf's premiums, exercised control over the disposition of plan assets, and had discretionary authority over the administration of the plan." [Chelf v. Prudential Ins. Co., No. 20-6097 (6th Cir. Apr. 12, 2022)]  MORE >>

"The budget asks Congress to amend ERISA [to] let health plan participants and beneficiaries better record losses due to MHPAEA violations ... Increasing plan participants' ability to recover losses would be huge for both patients and the plaintiff's bar. Even more interesting is the request to allow the DOL to go after the vendors responsible for designing and applying quantitative and non-quantitative treatment limitations (QTLs and NQTLs) for self-funded group plans....Giving the DOL a broader enforcement authority would be a MHPAEA game-changer."  MORE >>

Video of April 12 hearing, with testimony by [1] Dana Kennedy, AARP Arizona; [2] Dr. Suganya Karuppana, Valle del Sol Community Health; [3] Dora Vasquez, Arizona Alliance for Retired Americans; [4] Jenny Peña, MD Anderson Cancer Center; and [5] Judy Wilson, MS patient.  MORE >>

"When it comes to the FMLA, don't be the [employer] who: [1] Fails to identify an employee's need for leave.... [2] Reacts inappropriately to an employee's request for FMLA leave.... ][3] Badgers employees during their FMLA leave.... [4] Blabs about an employee's medical condition to others ... [5] Don't automatically terminate employment after FMLA leave ends! ... [6] When you terminate your employee (for unexcused absences), think long and hard before you contest their unemployment compensation."  MORE >>

"A plan network was available to 98 percent of state and local government union workers and 99 percent of nonunion workers participating in medical care plans.... A service requirement existed for 40 percent of educational services workers participating in medical care plans.... In 2021, a coinsurance was required for 58 percent of state and local government workers participating in medical care plans.... Ninety-eight percent of union workers and 99 percent of nonunion workers had an individual out-of-pocket maximum. The median amount was $2,000 for union and $3,000 for nonunion workers."  MORE >>

24 pages. "State and local government pension systems, many of which offer retiree health care as a cornerstone benefit, continue to wrestle with [managing costs]. Rapidly rising healthcare costs could compromise the pension benefits of current and future retirees and destabilize the very retirement security that pensions strive to provide.... One existing solution, retiree medical trusts (RMTs), has already proved attractive to many public sector employers and unions ... Like pensions, RMTs harness the power of collective investing to provide income in retirement -- in this case, for the specific purpose of defraying medical expenses"  MORE >>