"Due to the fact that the [HHS] did not publish updated National Health Expenditures tables for 2021, this year's fees are based on the projections set out in the 2020 tables.... [P]lans should pay close attention to next year's fee changes as the accuracy of 2020's projections may be affected by current inflationary trends."  MORE >>

"Explaining that most questions and complaints received to date by the No Surprises Help Desk relate to sending the initial payment or notice of denial (and the associated required disclosures) and providing information about the open negotiation period, the agencies outline the specific steps to follow to comply with these requirements."  MORE >>

"Although the regulations do not specifically address hold-the-spot fees of the type your participant has asked about, an IRS official has informally commented that a hold-the-spot fee may qualify as an indirect expense if it must be paid to obtain care when the leave is over."  MORE >>

"[In a June 7 FAQ,] CMS said that insurers that pay reduced or no commission to agents and brokers who assist consumers during special enrollment and pay higher amounts for getting people covered during open enrollment in the same benefit year 'violate the guaranteed availability provisions of the [ACA].' "  MORE >>

"[T]he court explained that the plain text of the FMLA makes clear that a violation does not require actual denial of FMLA benefits....[T]he court also shared other examples of what could be considered prohibited 'interference' with taking FMLA leave, including: the refusal to grant or accept proper requests for FMLA leave; overly burdensome FMLA approval processes and procedures; and, as in this case, informing an employee with FMLA leave available that missing additional time will have consequences." [Zicarelli v. Dart, No. 19-3435 (7th Cir. Jun. 1, 2022)]  MORE >>

"[T]he court found that 29 C.F.R. Section 2560.503-1 states plainly '[t]he plan administrator shall provide a claimant with … notification of a plan's benefit determination on review' within 45 days.... The review period is bound by strict time limits with protections for delays by the claimant and the claims administrator. Hartford's proposed reading of 503-1's requirements would allow multiple remands and delay resolution indefinitely." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

"In a dispute involving long-term disability benefits under a plan governed by [ERISA], the Court of Appeals for the Second Circuit concluded that a benefit determination on administrative review under the [DOL's] claims regulations must decide with finality whether a claimant is entitled to benefits. The court rejected the insurer's argument that the DOL's regulations afforded the insurer flexibility and additional time to remand the matter for further internal consideration." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

"Employers should update any reminder or incentive program to avoid prompting cancer screening more often than recommended.... More frequent repeats of cytology or HPV testing are medically indicated for some people with initial positive tests or at high risk for cervical cancer, so health plans should not implement caps on the frequency of these tests. Employers should encourage health plans to update any quality reporting or gaps in care programs to reflect current evidence-based guidance."  MORE >>

"[T]he 2101h open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on July 18-20, 2022.... The three-day meeting will take place at the [DOL offices in Washington DC]. The meeting will also be accessible via teleconference and some participants, as well as members of the public, may elect to attend virtually.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The Advisory Council will study the following topics: [1] Cybersecurity Issues Affecting Health Benefit Plans, and [2] Cybersecurity Insurance and Employee Benefit Plans."  MORE >>

"The vote failed 49-51, with all 50 Republicans and Senate Majority Leader Chuck Schumer, D-N.Y., voting no. Mr. Schumer voted no for procedural reasons and immediately filed a motion to reconsider the nomination."  MORE >>