"[T]he 2024 maximum annual limitation on cost sharing is $9,450 for self-only coverage and $18,900 for other than self-only coverage. This represents an approximately 3.8 percent increase above the 2023 parameters ... [T]he 2024 required contribution percentage under section 5000A of the Code [will be] 7.97 percent, ... a decrease of approximately 0.20 percentage points from 2022[.]"  MORE >>

370 pages. "[T]his proposed rule includes proposed payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as proposed 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also proposes requirements related to updating standardized plan options and reducing plan choice overload; re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers."  MORE >>

"[A 6-page checklist] covers the latest new guidance and offers refreshed advice for self-funded employers.... [S]elf-funded employers are ultimately responsible for making sure their plan is compliant with all new requirements. It is important to protect your interests in any new contract language with your vendors. Employers and other plan sponsors could have fiduciary liability if they do not ensure their plans comply with these rules."  MORE >>

"The Inflation Reduction Act of 2022 was enacted in August 2022, and mandates major changes in healthcare over the next few years. Immediate impacts will be felt in 2023. While the bill is specifically focused on Medicare, there is potential for these changes to impact all types of healthcare coverage, including the commercial health insurance market. This paper primarily focuses on considerations for health plans and their Medicare-eligible population, while also highlighting the potential effects on the overall market."  MORE >>

"AB 1949 is codified as an amendment to the California Family Rights Act (CFRA), but bereavement leave under the new law must be considered separate and distinct from the CFRA's family and medical leave entitlement. In other words, the five days of bereavement leave must be provided in addition to the 12 weeks of family and medical leave permitted under the CFRA. The new law will take effect on January 1, 2023."  MORE >>

"The Funds and Roadsafe dispute whether contributions should include all hours worked by covered employees or just hours performed by employees engaged in construction and highway work. The district court granted summary judgment to RoadSafe, finding that the CBA unambiguously requires contributions only for construction and highway work. The Eighth Circuit affirmed." [Greater St. Louis Constr. Laborers Welfare Fund v. RoadSafe Traffic Sys., Inc., No. 22-1050 (8th Cir. Dec. 9, 2022)]  MORE >>

"First Circuit held that an insurer has a fiduciary duty under ERISA to verify individual employee eligibility for group benefit plan coverage at or near the time of enrollment. Insurers can shift the duty of eligibility verification to employers through the plan's language. Due to a circuit split, Employers in the 1st, 4th and 8th Circuits should check their benefit plans' terms to determine who is responsible for enrollment duties and eligibility verification, including determining when to accept premiums from employees." [Shields v. United of Omaha Life Ins. Co., No. 21-1290 (1st Cir. Oct. 4, 2022)]  MORE >>

"This case is the latest in an increasing number scrutinizing health plans' coverage for gender-affirming treatment under the ACA. That said, NCSHP has appealed the court's decision to the US Court of Appeals for the Fourth Circuit. No federal appellate court has addressed whether policy exclusions for gender-affirming treatment violate the ACA." [Kadel v. Folwell, No. 19-0272 (M.D. N.C. Dec. 5, 2022)]  MORE >>

"Who is an ineligible dependent? ... Why would an ineligible dependent be listed on the plan? ... How can a plan prevent ineligible dependents from being listed on the plan?  ... What is a dependent eligibility audit?  ... Should an audit be communicated in advance, and if yes, how? ... What happens if ineligible dependents are discovered?"  MORE >>

"EBSA closed 1,072 civil investigations with 741 of those cases (69%) resulting in monetary results for plans or other corrective action.... EBSA's enforcement program helped 16,024 terminated vested participants in defined benefit plans collect benefits of $1.548 billion owed to them.... EBSA opened 188 criminal investigations and closed 208 criminal investigations. 118 of the 188 criminal cases opened during FY2021 involved health benefit plans."  MORE >>