"[E]mployer contributions (including non-cashable flex credits) generally cannot exceed $500 per plan year for the health FSA to maintain excepted benefit status.... Therefore, in most cases the maximum health FSA amount available for plan years beginning on or after January 1, 2023 will be limited to $3,050 (max employee salary contribution) + $500 (max employer contribution, if offered) = $3,550 (combined).... Other notable 2023 employee benefit amounts."  MORE >>

"Employees can put an extra $200 into their health care flexible spending accounts (health FSAs) next year ... as the annual contribution limit rises to $3,050, up from $2,850 in 2022. The increase is double the $100 rise from 2021 to 2022 and reflects recent inflation. If the employer's plan permits the carryover of unused health FSA amounts, the maximum carryover amount rises to $610, up from $570."  MORE >>

"Though we are waiting for the final rule and for the Departments to establish a method for submitting the reports, plans and issuers should start ensuring that their systems and vendors are able to gather and collect the data identified by the Proposed Rule. Practically speaking, the heavy lifting associated with the reporting requirements is likely to fall on issuers and TPAs. Plans and issuers should review their service agreements to determine how air ambulance reporting requirements will be covered and to ensure that everything is on track for when the reporting requirements take effect."  MORE >>

"Employers that sponsor a health plan can require their health insurance companies(for fully-insured products), and TPAs (for self- funded health plans), and PBMs, to make the data submission to HHS on behalf of the Employer Plan Sponsors. The request can be manifested in a written agreement. The regulations also allow the prescription pricing data to be submitted separately by a 'reporting entity', which is an entity other than or in addition to the Plan Sponsor."  MORE >>

"The affordability standard for an employee's PTC eligibility remains based on the cost of self-only coverage, so this regulatory change will not increase the number of employees who will newly become eligible for PTC-subsidized coverage on the Exchange.... The 2022 Regulations do not affect the employer mandate penalty, because they do not change the affordability rules for employees themselves, and the employer mandate is only triggered when an employee, not a family member, receives a PTC. Therefore, when a family member purchases health insurance on the Exchange, the employer is not penalized for failure to offer affordable coverage."  MORE >>

"[1] The voice of the customer should be their top focus ... [2] Customer service and benefits technology should be a seamless experience ... [3] When your employees engage with the service team, it must feel personal."  MORE >>

"More than one-third (36%) of silver plans in the individual market in 2022 apply the deductible to mental health services, compared with only 23 percent that apply the deductible to primary care visits. Even when the benefit designs are equivalent, the average copay for mental health services is higher than for primary care ($34 versus $29 in individual market silver plans). A broad range of insurers in 30 states currently offer silver plans where mental health services are more expensive for consumers than primary care visits."  MORE >>

"On September 1, 2022, Maine announced that the weighted average health insurance premium for small businesses will fall by 0.8 percent from 2022 to 2023. This is the first such reduction in average small group health insurance premiums in Maine since at least 2001.... The difference is largely the result of concerted state action coupled with July 2022 federal approval of Maine's Section 1332 State Innovation Waiver amendment."  MORE >>

"It is undisputed that [the insured] died of mixed drug toxicity following self-administered intravenous injection of morphine, hydromorphone, meperidine, and fentanyl. She did not have a prescription for these drugs and even though the dosage of each of the medications was within the reported therapeutic range, the combination of the drugs was lethal. Plaintiff argued that benefits were payable because 'ingestion' can only be reasonably interpreted to mean 'digestion' ... [T]he Eighth Circuit determined that LINA's interpretation of 'ingestion' was reasonable and that its interpretation of the facts is supported by substantial evidence." [Richmond v. Life Ins. Co. of N. Am., No. 21-3929 (8th Cir. Oct. 18, 2022)]  MORE >>