"The Proposed Rule also suggests that TPAs subject to Section 1557 may be held liable for Section 1557 violations when the allegedly discriminatory act or feature originated with the TPA. For example, if a group health plan adopts a template plan document provided by the TPA, the TPA could be found liable. This appears to be the case even in the event the plan sponsor formally adopts the document or benefit design as the plan settlor."  MORE >>

"[T]he employee-employer exemption included in the [California Consumer Privacy Act (CCPA)] expires on January 1, 2023 ... Civil penalties may be assessed for a failure to comply ... including failure to amend contracts deemed subject to the law."  MORE >>

"This bill requires covered employers to provide eligible employees with 5 days of unpaid bereavement leave for the death of an employee's family member. AB 1949 goes into effect on January 1, 2023 and applies to private employers with five or more employees and to all public employers."  MORE >>

"California extended the time for eligible employees to use COVID-19 supplemental paid sick leave by three months, or until the end of 2022. In a further change, Assembly Bill 152 also allows California employers to require further COVID-19 testing as a condition of using this paid sick leave."  MORE >>

"With thousands and thousands of codes that can be assigned to everything from the diagnosis of a patient's condition to the facility where they receive care, there is plenty of room for error in medical billing. And it may never get caught -- partly because billing has become so complicated and partly because patients, health plans and claims administrators may not have all the data they need to catch the errors."  MORE >>

"[M]any states have implemented laws that restrict abortion services through various civil and criminal penalties.... Some of [the] issues are obvious, such as how, if at all, will group health plans provide coverage for abortion services. Other issues are more obscure, such as whether reimbursements for abortion-related travel and lodging expenses are excludable for federal income tax purposes. Employers that choose to provide such reimbursements through their group health plans may encounter several legal obstacles."  MORE >>

"Overall spending on mental health care services as a percentage of total spending increased from 6.8 percent in 2013 to 8.2 percent in 2020.... Among enrollees with a mental health diagnosis, average annual spending on mental health care services ... between 2013 and 2020 ... increased 20 percent, or an average of 3 percent per year.... Spending on outpatient mental health services increased 37 percent, while spending on prescription drugs for mental health disorders fell 15 percent."  MORE >>

"This article discusses the latest data on marketplace enrollment and the uninsured rate; updates on litigation over the preventive services mandate; a request for information on implementation of the advanced explanation of benefits (AEOB) requirement; and state updates from Wisconsin and Vermont."  MORE >>

"CMS has announced the 2023 Medicare Part A and B premium, deductible and coinsurance amounts. As in prior years, there are increases in the Part D amounts. However, the Part B premium and deductible will decrease."  MORE >>

"[1] See if your employer provides dental benefits ... [2] Determine which type of dental plan is right for your needs ... [3] Understand network access and out-of-pocket costs ... [4] Get dental insurance before you need care ... [5] Make sure your provider takes the dental insurance ... [6] Understand dental insurance limitations."  MORE >>

"The Mental Health Matters Act [HR 7780], passed in the US House of Representatives on September 29, [1] significantly expands the [DOL's] authority to enforce or file civil litigation with respect to mental health parity violations and [2] eliminates discretionary clauses, potentially dismantling the administrative process of [ERISA]."  MORE >>

"In an enforcement action involving an administrative subpoena seeking documents from a service provider for employer-sponsored health and retirement plans, the Seventh Circuit held that the [DOL's] investigatory authority under [ERISA] is not limited to ERISA plan fiduciaries. The Seventh Circuit also concluded that the subpoena was not too indefinite or unduly burdensome." [Walsh v. Alight Solutions LLC, No. 21-3290 (7th Cir. Aug. 12, 2022)]  MORE >>