"[T]he IRA provides a safe harbor that allows high deductible health plans (HDHPs) to cover insulin before the participant meets the HDHP's deductible without adversely affecting the participant's health savings account (HSA) eligibility. In addition, the IRA ... establishes a system for Medicare to negotiate drug prices with manufacturers ... [which has] the potential to raise group health plans' costs in the future because employer group health plans are not eligible for the negotiated drug price rates or the rebates."  MORE >>

"While much of the mechanics of the surprise billing protections will be handled by carriers and TPAs, employers should be familiar with the relevant parts of these FAQs. They may also want to consider moving any links to their machine readable files back onto the TPA's website, if possible."  MORE >>

"The proposed changes are intended to clarify the requirements related to maintaining health insurance benefits for employees on family or medical leave. While the proposed changes provide welcome guidance about how an employer can provide required health coverage to employees on leave, questions remain about when employer-provided health coverage may be terminated."  MORE >>

"San Francisco voters recently passed Proposition G, which requires employers with 100 or more employees worldwide to provide up to 80 hours of paid public health emergency leave to their San Francisco employees during a public health emergency. This ordinance will become operative on October 1, 2022."  MORE >>

"The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015. Double-digit specialty Rx cost trend, mostly driven by price increases and new-to-market specialty drugs, continues to be a major driver of Rx cost trends. Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.4 percent."  MORE >>

"With a [point of service (POS)] plan, you can receive care from an in-network or out-of-network provider, but you pay less for going in-network. It's similar to the PPO model in that respect. Most POS plans require you to work with a primary care provider to coordinate your treatment and get a referral if you want to see a specialist. This is similar to the way an HMO works."  MORE >>

"Allowed amounts paid by insurers for their health insurance exchange (HIX) plans are typically lower than their commercial group rates and higher than their Medicare Advantage rates for the same service at the same hospital.... Policy makers considering policies to improve affordability in the HIX market should not assume that plans pay providers the same prices as they do for their commercial plans."  MORE >>

"[T]he court explained that when an administrator tacks on a new reason for denying benefits in a final decision, additional evidence is necessary to afford a participant a 'full and fair review' as required by ERISA. By denying Kay's motion to augment, the district court insulated the insurer's decision from a full and fair review." [Kay v. Hartford Life and Accident Ins. Co., No. 21-55463 (9th Cir. Sept. 21, 2022; unpub.)]  MORE >>

"The court found that [U.S. Preventive Services Task Force (USPTF)] members were principal officers who must be nominated by the President and confirmed by the Senate. The court noted that USPTF was not part of HHS or another agency and its members are not directed or supervised by someone appointed by the President and confirmed by the Senate. Therefore, because the USPTF members were not properly appointed, the court held that their appointments violated the Appointments Clause." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

"Life insurance was available to 57 percent of private industry workers in March 2022 ... Forty-three percent of private industry workers had access to short-term disability insurance.... Thirty-five percent of private industry workers had access to long-term disability insurance.... Wellness programs were available to 43 percent of private workers."  MORE >>

"[L]arge employers should change how they purchase health care.... [1] Realign financial incentives ... [2] Own, analyze, and use quality and financial data ... [3] Implement innovative benefit designs ... New transparency data can help employers make better health care decisions."  MORE >>

"[T]he 212th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held via a teleconference on Tuesday, October 18, 2022.... The purpose of the open meeting is for the members of the ERISA Advisory Council to discuss potential recommendations for the Secretary of Labor on the issues of: [1] Cybersecurity Issues Affecting Health Benefit Plans, and [2] Cybersecurity Insurance and Employee Benefit Plans. Descriptions of these topics are available on the ERISA Advisory Council's web page[.]"  MORE >>

"[R]eplacing the total rewards statement with a digital, highly-personalized total rewards experience [provides] a tool that accurately reflects the multiple components of the total rewards employers deliver to employees.... The ideal personalized total rewards view encompasses pay, stock, health and wellbeing, retirement, and work/life benefits.... Embedding personalized messages that drive employee behaviors is the real value behind the communication."  MORE >>