"[T]he regulations have been amended to provide that an eligible employer-sponsored plan is affordable for related individuals (disqualifying them from a PTC) only if the required employee contribution for family coverage does not exceed 9.5% (indexed) of household income.... Related IRS guidance allows participants in non-calendar-year cafeteria plans to revoke their elections for family coverage to allow one or more family members to enroll in a QHP."  MORE >>

"Although [this article identifies] many action items ... employers will focus their 2023 compliance efforts in three areas: [1] how the Supreme Court's Dobbs v. Jackson Women's Health Organization decision impacts their health plans' coverage of abortion services; [2] how the end of the COVID-19 emergency declarations, when announced, will impact their health plans' coverage of COVID-19 and related services; and [3] how to comply with the requirements under the Consolidated Appropriations Act, 2021, including, but not limited to, the prohibitions against surprise billing under the No Surprises Act, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) comparative analysis, broker and consultant compensation disclosures under Section 408(b)(2) of [ERISA], and the medical and drug cost reports that are initially due December 27, 2022, and every June 1 thereafter."  MORE >>

"Effective review and oversight of MHPAEA enforcement in the states are time- and resource-intensive processes which pose significant challenges to regulators ... Providers and patients are often unaware of insurers' obligations to provide equal access to mental health services under the federal parity law, removing a tool that states rely on to flag potential violations.... Funding from federal grants has been critical in state enforcement efforts[.]"  MORE >>

"While Colorado voters approved Proposition 118 nearly two years ago, which set the path for implementation of the FAMLI program, employers and employees will not feel its effects until January 1, 2023. However, due to the impact FAMLI will have on the employment leave landscape, employers may want to begin educating themselves and their employees now on its requirements, as compliance will require cooperation across multiple departments."  MORE >>

"For employees, open season brings an opportunity to select a new healthcare plan that meets their needs. Unless they have the right information to evaluate their choices, however, they could end up with a plan that offers more headaches than health care.... [E]mployers can ensure the plans they offer do not create expensive and unnecessary roadblocks to healthcare services. Plans should be evaluated not just by their organizational costs but also by how they encourage preventive services and adherence to treatment for chronic and serious conditions."  MORE >>

"While some attempts by states to establish l rate-setting systems for hospitals have been successful in constraining price growth, many economists are wary of such market intervention. They share concerns that such systems may fall prey to two pitfalls: regulatory failure and regulatory capture.... [W]hile these dangers are real, they are also manageable -- and shouldn't stand in the way of thoughtfully crafted models for reining in health care prices."  MORE >>