"These are the filing instructions for the report to the Secretary required by section 2718 of the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees. The data included in the MLR Annual Reporting Form (MLR Form) are the exact data that will be used to calculate an issuer's MLR and rebates, if any, under section 2718 of the PHSA[.] " [Also available: MLR 2021 Annual Reporting Form (XLSX) and MLR 2021 Calculator and Formula Tool (XLSM)]  MORE >>

"Can an employer reimburse abortion travel expenses in excess of the limits under Code section 213(d)? ... Can abortion travel expenses be reimbursed through an HRA or Health FSA? ... What kind of documentation is required to reimburse abortion travel benefits under an FSA or HRA/EBHRA? ... Can abortion travel expenses be reimbursed through an HSA? ... Can abortion travel benefits be provided through an EAP? ... What if a state attempts to ban abortions obtained outside of the state? What if a state attempts to ban reimbursement for abortions?"  MORE >>

"An employer's particular approach will need to consider the organization's culture, employee expectations, and the ability of their carriers and vendors to administer these benefits.... [E]mployers [should consider] ... [1] whether the additional benefits for abortion raise any concern with mental health parity requirements that apply to group health plans ... [2] the appropriate taxation of travel and lodging reimbursements under IRS rules; and [3] the potential risks of civil and/or criminal liability based on the states in which their employees live.' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

"[If] a state has a law making it a crime for anyone to pay for or reimburse the costs of an abortion, it would be very difficult to argue that ERISA preempts said law as applied to self-funded ERISA plans ... On the other hand, laws like [Oklahoma's] -- which provide for a civil cause of action against anyone who pays for or reimburses the costs of an abortion -- are likely preempted by ERISA as it relates to ERISA self-funded group health plans.... There are numerous issues and considerations beyond the state law issues[.]' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

"While the court ... acknowledged that administrators are entitled to flexibility in administering benefits, the Second Circuit concluded the need for flexibility cannot outweigh the purpose of the regulation to limit the number of appeals a claimant must pursue. Hence, the court determined that Hartford was obligated to decide McQuillin's entitlement to benefits within 45 days of his appeal submission, and the failure to do so rendered the duty to appeal exhausted after 45 days elapsed without a benefit determination." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

"In a dispute over reimbursements for COVID-19 testing, a district court concluded that the coverage mandates under the [FFCRA] and the [CARES Act] did not create a private right of action. The court therefore dismissed claims by a health provider alleging that a health plan's insurer violated the CARES Act by underpaying it for COVID-19 testing for five individuals." [Saloojas, Inc. v. Aetna Health of Calif., Inc., No. 22-1703 (N.D. Cal. June 23, 2022)]  MORE >>

"[In] most cases, a court will find that, even where the presumption against suicide in claims for benefits under accidental death or accidental death and disability policies is the correct standard, there was sufficient evidence in the record to rebut the presumption."  MORE >>

"A live, in-person Open Enrollment session may work for your organization, especially if you have been planning to bring everyone together.... Live virtual meetings can be productive if managed well, though technical difficulties and a lack of attention to virtual meeting etiquette can often get in the way.... [Some employers] have replaced live gatherings, whether virtual or in-person, with a communication campaign that is varied and effective."  MORE >>

"The federal government's HR agency confirmed that federal employees may use sick leave to travel to obtain reproductive health services, although the measure falls short of employee groups' request for paid administrative leave after abortion ruling."  MORE >>

"This article provides an overview of common integration-related issues that arise with respect to 401(k) and health and welfare plans in strategic mergers and acquisitions (M&A) transactions, and [discusses]: [1] The areas on which buyers their advisors should focus during diligence in order to best integrate a target's health and welfare plans; [2] Similar issues that arise with respect to 401(k) plans; and [3] Some of the unique concerns surrounding health and welfare and 401(k) plans sponsored by professional employer organizations (PEOs)."  MORE >>