"Coverage is considered affordable if the employee's required contribution for self-only coverage on the employer's lowest-cost, minimum value plan does not exceed 9.12% of the employee's household income in 2023 ... An ALE may rely on one or more safe harbors in determining if coverage is affordable: W-2, rate of pay, and federal poverty level."  MORE >>

"For 2022 plan years, Bulletin 06-21 sets the maximum MCC deductibles at $2,750 for individual coverage and $5,500 for family coverage. A plan can have a separate prescription drug deductible if individual/ family amounts do not exceed $340/$680 in 2022. The overall maximum deductible still applies."  MORE >>

"Employees who are eligible for paid leave are those who've earned at least $2,500 in wages over a one-year period. Both employers and employees will contribute to the program. Employees will designate 0.45% of their wages and employers will provide a matching amount. This rate is set through 2025 in accordance with Proposition 118. After 2025, the rate will be set each year, however, the combined rate is statutorily capped at 1.2%."  MORE >>

"Excluding claimants at renewal, known as lasering, is not permitted for 61% of respondents -- with 43% of those having a renewal rate cap.... Plan mirroring is more common, now at 49%.... 98% of surveyed plans cover pharmacy, an ongoing increase from around 90% several years back. Increased high-dollar pharmacy exposure is driving the change, and stop-loss without pharmacy coverage is now ill- conceived."  MORE >>

"Commercial health plans average 1,851 in-network behavioral health care providers per 100,000 enrollees, representing a 48% increase over the past 3 years.... All respondents (100%) provide in-network coverage for telebehavioral health services ... More than 3 in 4 health plans (78%) have increased payments to in-network behavioral health providers ... 83% of plans report they assist enrollees with finding available behavioral health appointments."  MORE >>

"With the expansion of enhanced PTC subsidies until 2025, it becomes more likely that the higher subsidies will eventually be made permanent ... One consequence could be to make ACA marketplace plans a more appealing health care option for employers, who could opt to ... meet the ACA's coverage requirements by funding individual coverage health reimbursement arrangements (ICHRAs), which allow employees to purchase their own coverage on ACA exchanges."  MORE >>

"Although the federal IDR process has established an alternative method for resolving some [out-of-network (OON)] payment disputes, many are still subject to litigation in federal courts. Determining which OON payment disputes fall under the federal IDR process is a source of some confusion. Even for OON patients, there are circumstances in which disputes remain subject to litigation because no 'surprise bill' occurs."  MORE >>