195 pages. "All enrollments made on or after July 28, 2022, should be processed in accordance with the operational requirements set forth in this document.... This manual provides operational policy and guidance on key topics related to eligibility and enrollment within the FFE and FF-SHOPs, as well as within the SBE-FPs, which use the Federal platform to perform their eligibility and enrollment functions."  MORE >>

"The 2023 open enrollment season is quickly approaching and more so than any year to date employers are going to need to use extreme caution to ensure its health plan is affordable.... In 2023 the affordability threshold will be 9.12 percent which is the lowest the number has ever been since the ACA's inception. The number is down significantly from the 2022 amount of 9.61 percent."  MORE >>

"The proposed rules apply a broader 'covered entity' definition than the definition included in the currently effective 2020 final rules.... [M]any group health plans will be indirectly affected as the rules include any entity that provides or administers health-related services including health benefits (including telehealth benefits) offered by health insurance carriers in relation to fully insured group health plans as well as the carrier's TPA services provided to self-insured plans."  MORE >>

"[This chart] provides a high-level summary to assist in determining whether the Federal IDR process or a state law or All-Payer Model Agreement applies for determining the out-of-network rate. "  MORE >>

"[F}or now, ... the current Paid Medical Act remain[s] in effect; however, effective February 19, 2023, the Earned Sick Time Act will replace the Paid Medical Leave Act ... unless the Court's decision is overturned altogether on appeal. It is also possible that parts of the ruling will become moot if new legislation is passed."  MORE >>

"Maryland law now requires employers with 15 or more employees to permit the use of existing accrued paid leave for bereavement purposes.... Few other states require employers to provide bereavement leave."  MORE >>

"Under the original amendment in the Massachusetts state budget, employers and employees could supplement the PFMLA benefit payments with 'any accrued sick or vacation pay or other paid leave provided under an employer policy.' ... Vetoing the provision, the governor stated concerns about the cost and implementation of the amendment and asked for a study on the costs.... [T]he Massachusetts legislature voted to override the governor's amendment veto and returned it to the governor for signature.... At this time, the governor has not acted."  MORE >>

"If your company ... [is] now allowing employees to work remotely, chances are there might be a few that are now residing in locations that require state mandate reporting. It's important to continue to monitor your organization's demographic data and update any records that are incorrect in a timely manner."  MORE >>

"With the continuing uptick in litigation surrounding deficient COBRA notices, now is a good time to review your notices as a precaution. While the [DOL's] Model Notices are a good place to begin, using the model notice alone does not insulate a plan from litigation."  MORE >>

"The qualifying payment amount (QPA) presumption at issue in this case is similar to the one regarding emergency services (and certain other services) that the district court vacated last February in litigation brought by general health providers. The same judge who issued the February 2022 ruling also decided the current case involving air ambulance services." [LifeNet v. HHS, No. 22-162 (E.D. Tex. Jul. 26, 2022)]  MORE >>

"Victims of severe storms, flooding, landslides and mudslides beginning July 26, 2022, now have until November 15, 2022, to file various individual and business tax returns ... Individuals and households ... that reside or have a business in Breathitt, Clay, Floyd, Johnson, Knott, Leslie, Letcher, Magoffin, Martin, Owsley, Perry, Pike, and Wolfe counties qualify for tax relief."  MORE >>

"[H]uman resources executives must look for ways to engage more deeply with their technology peers and embrace that overlooked resource. Doing so will help enlighten EBP plan managers about the difference between a cybersecurity risk management process and the technology that protects internet-connected systems such as hardware, software, and data from cyber threats."  MORE >>

"Even with Medicare coverage and ignoring long term care, retirees face sizable out-of-pocket costs for premiums, copays, and uncovered services.... After subtracting these costs, the typical retiree has only 75 percent of Social Security and 88 percent of total income left."  MORE >>