"[FAQs Part 55] clarify processes related to initial payments, disclosures, and the open negotiation period.... Federal officials devote several FAQs to explaining how the NSA applies to plans that do not have a provider network, such as a plan that uses reference-based pricing.... The FAQs confirm that the sponsor of a group health plan without its own website can satisfy [the public disclosure] requirement if their service provider posts the information on its website (on behalf of the group health plan).... [T]he plan can still be held liable if the service provider fails to post the information."  MORE >>

"[T]he language in the final rule reduces the emphasis on the QPA.... IDR entities ... won't be instructed to generally choose the submitted offer that's closest to the QPA ... When deciding which party's offer should be accepted as the final payment amount in the baseball-style arbitration cases, IDR entities have more leeway under the final rule to assess [specific] information if submitted by either party[.]"  MORE >>

"Effective for plan years beginning on or after December 31, 2022, HDHPs will be permitted to cover insulin for a broader range of uses than before, prior to satisfaction of the deductible, without adversely affecting a participant's eligibility to contribute to a health savings account (HSA)."  MORE >>

"Employers, particularly those with self-funded plans, should be mindful of these guidelines when working with their TPAs and when making plan design choices. For employers who sponsor HRAs and health FSAs, if the employer's plan covers all Code Section 213(d) expenses, employers should not need to make any changes to the plan. If the employer wishes to exclude OTC emergency contraception that is not prescribed by a medical doctor, then the employer should specify this as an exclusion in the plan materials."  MORE >>

"State legislatures and regulatory agencies hit full swing during the second quarter of 2022. Many focused on paid leave provisions -- new, revised, clarified and/or validated ... Insulin costs and pharmacy benefit manager (PBM) limitations remained at the forefront ... Numerous states added coverage mandates to existing insurance laws, including provisions addressing health savings account (HSA) eligibility."  MORE >>

"Beginning January 1, 2023 ... eligible employees are entitled to a maximum of 10 workdays of unpaid leave following the death of a covered family member or a covered pregnancy, or adoption-related event. However, if an employee experiences the death of more than one covered family member in a 12-month period, the employee is entitled to take up to six weeks of bereavement leave during the 12-month period."  MORE >>

"[1] Do my employees have an Amazon-esque experience when electing benefits? ... [2] Are we being challenged with the most progressive ideas and strategies to help control costs while improving our benefit offerings?.... [3] Do we receive proactive or reactive customer service?.... [4] Does my broker understand my business, and do they work with similar organizations?.... [5] Does my broker offer retirement consulting, and can they assist in any other HR initiatives?.... [6] What am I paying my broker?"  MORE >>

"[T]he share of employers offering paid maternity leave beyond what is required by law dropped to 35% this year, down from 53% in 2020 ... Companies also downsized paternity-leave programs. The share of employers giving paid paternity time off fell to 27% in 2022, from 44% in 2020 ... The declines might stem from companies changing their leave policies back to what they were in 2019 after extending more parental benefits to workers during the pandemic[.]"  MORE >>

"In a recently released bulletin, the Arkansas Insurance Commissioner made clear to PBMs that they are prohibited from charging pharmacies any fees related to network participation, including pharmacy credentialing or re-credentialing fees. The bulletin was released in response to complaints from pharmacies about these illegal fees."  MORE >>