"The amount due is based on the end of your plan year. For calendar year plans, the amount due by July 31 is $2.79 per covered life.... Note that the fee is due on all covered lives on the plan. Covered lives include spouses, dependents, retirees, and COBRA beneficiaries."  MORE >>

"HHS has provided a variety of resources relating to the surprise medical billing protections of the No Surprises Act ... including a chart summarizing when a state or other independent dispute resolution (IDR) process applies rather than the federal process."  MORE >>

"Illinois recently amended its Child Bereavement Leave Act to expand the reasons for leave, including miscarriage and stillbirth, and adds additional covered family members. The law will now be called the 'Family Bereavement Leave Act' and goes into effect on January 1, 2023."  MORE >>

"Prior to the recent amendment, the Child Bereavement Leave Act (CBLA) made it compulsory for Illinois employers with at least 50 employees to provide their employees with 10 workdays of unpaid leave annually to grieve the death of a child. With the recent amendment ... the 10 days of unpaid leave now applies to any 'covered family member.' A 'covered family member' is broadly defined[.]"  MORE >>

"Most insurance carriers and stop-loss providers will permit employers to offer coverage as of the employee's date of hire or the first of the month coincident with or next following the employee's date of hire. Employers can therefore often accommodate such requests by modifying the plan's eligibility terms for all employees.... [T]he plan precedent derived from permitting a waiting period exception will always be a thorny concern that is difficult to manage."  MORE >>

"The federal price transparency requirements for hospitals entered a new phase this month, with CMS not only issuing the first fines for noncompliance but also publicizing those penalties. Two hospitals were levied combined penalties of just under $1.1 million ... According to [a recent study], fewer than 6% of hospitals were fully compliant between July and October 2021."  MORE >>

"Blues experienced a modest decline in costs, the first since 2015.... Broadly speaking the cost decline entailed a redeployment of resources: Sales and Marketing increased as Corporate Services decreased.... The decline in growth in Corporate Services was especially notable, a 16.3 percentage point difference from the prior year. The change in Medical and Provider Management also resulted in a striking 8.9 percentage point difference."  MORE >>

"The Court's ruling seems likely to encourage insurers and group health plans to reduce coverage for outpatient dialysis, thereby shifting the cost of dialysis to Medicare. The two dissenting justices observed that the Court's opinion 'tells plans they can do just that, so long as they target dialysis, rather than the patients who rely on it, for disfavored coverage.' Although the dissenting justices declared that 'Congress would not -- and did not -- craft a statute permitting such a maneuver,' plans appear to be safe in taking this approach, at least for the time being." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]  MORE >>

"The newly proposed affordability test is contrary to the statute. There is only one lawful affordability test for those with an offer of ESI, and it applies to workers and their dependents: If a worker must pay more than 9.5 percent of household income for self-only coverage, then she and her dependents qualify for PTCs."  MORE >>

"The plain language of the statutory text unambiguously includes the family glitch as part of the process to determine eligibility for premium subsidies. The legislative history confirms this plain reading ... The family glitch lowered the ACA's cost, reduced the incentive for employers to drop coverage, and protected the individual market risk pool. The family glitch may be disfavored today, but Congress enacted it by design and fixing it administratively would illegally sidestep Congress."  MORE >>

"California employers have recently experienced a material uptick in lawsuits from employees seeking reimbursement for expenses incurred while working from home.... Many California businesses continue to have employees work from home or are now using a hybrid structure. These employers should be aware of their reimbursement requirements under California law and review their policies and telecommuting agreements to ensure employees are being properly reimbursed."  MORE >>