"To meet the [Transparency in Coverage] requirements that will be enforced starting on July 1, 2022, plans and issuers must create two files -- one to disclose in-network provider rates for covered items and services and another to disclose out-of-network allowed amounts and billed charges for covered items and services."  MORE >>

"[T]he departments have provided an enforcement safe harbor for satisfying the reporting requirements for plans and issuers that use alternative reimbursement arrangements that do not permit the plans and issuers to derive with accuracy specific dollar amounts contracted for covered items and services in advance of the provision of that item or service, or that otherwise cannot disclose specific dollar amounts."  MORE >>

"While this enforcement safe harbor provides narrow relief, every bit helps as the July 1 compliance date for machine-readable files approaches. The agencies indicate that they will monitor implementation of the machine-readable files requirements and may revisit this safe harbor in the future, including when underlying fee schedules become more widely available as providers transmit expected charges to plans and insurers"  MORE >>

"[FAQs Part 53] provide an enforcement safe harbor for satisfying the Section 2715A reporting rules for plans and insurers that use alternative reimbursement arrangements that: [1] Do not permit the plans and insurers to accurately derive specific dollar amounts contracted for covered items and services before the items or services are provided. [2] Otherwise cannot disclose specific dollar amounts using the Departments' methods provided in technical implementation guidance through GitHub."  MORE >>

"Ms. Chelf argued that Wal-Mart did not inform Mr. Chelf of his right to convert his optional life insurance, did not communicate with him regarding the payment of premiums or the alleged termination of his insurance, and failed to apply his unpaid time off to cover the cost of the premiums while he was on disability.... [T]he Sixth Circuit found that Wal-Mart was 'acting in a fiduciary capacity' and not a 'purely ministerial' capacity by mishandling Mr. Chelf's premium payments, and thus Ms. Chelf's allegations 'suffice to state a claim for breach of fiduciary duty[.]' " [Chelf v. Prudential Ins. Co., No. 20-6097 (6th Cir. Apr. 12, 2022)]  MORE >>

"The challenged agency action ... was Notice 2007-83, entitled 'Abusive Trust Arrangements Utilizing Cash Value Life Insurance Policies.' ... The plaintiffs ... were penalized for failure to file Form 8886 to report this listed transaction on their tax return.... [T]he issue on which the Sixth Circuit decided the case was the failure of the IRS, in issuing Notice 2007-83, to comply with the notice and comment period requirements of the Administrative Procedure Act." [Mann Construction Inc. v. U.S., No. 21-1500 (6th Cir. Mar. 3, 2022)]  MORE >>

"The most common strategy for preserving employees' HSA eligibility is to offer a post-deductible HRA option for HDHP participants. Under this approach, the HRA will not cover any expenses incurred prior to the employee satisfying the statutory minimum HDHP deductible."  MORE >>

"Congress, regulators, and market disrupters are interested in pursuing solutions to address PBM practices that have led to consolidation, lack of transparency, and spread pricing, as well as the impact rebates ... may play in driving up overall drug prices. [This article outlines] some of the policy and market-based reforms that could disrupt the PBM industry in the years ahead."  MORE >>

"PBMs must be licensed by January 1, 2023. PBMs which fail to become licensed in New York by January 1, 2023, may be subject to cease and desist orders and/or monetary penalties ... The new law also requires PBMs to file by July 1, 2022 (and thereafter annually by July 1st) ... a report which provides certain financial information requested by the DFS and the terms and conditions of any contact between the PBM and 'any other party relating to PBM services provided to a health plan or provider."  MORE >>

"Since most of the activity and basic plan operations are outsourced to service providers ... it can be easy to overlook the importance of assessing cybersecurity risks and the potential for cybersecurity breaches impacting employee benefit plans. However, this significant amount of outsourcing elevates cybersecurity risk ... [P]lan sponsors must ensure that plan data is being protected by all parties involved as part of their fiduciary responsibility.."  MORE >>