"[CMS] is releasing this draft bulletin for comment. This bulletin proposes the submission deadlines under 45 CFR 155 subpart K for health insurance issuers applying to offer qualified health plans (QHPs) on the Federally-facilitated Exchanges (FFEs)."  MORE >>

64 pages. "This rule finalizes the methodology and data sources necessary to determine Federal payment amounts to be made for program year 2023 to States that elect to establish a Basic Health Program under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Health Insurance Exchanges."  MORE >>

"To review all of the major CAA and [transparency in coverage (TiC)] requirements, you can access [a] checklist for plan sponsors here [a] our checklist for plan service providers here. This article summarizes the new CAA and TiC reporting requirements with deadlines that are soon approaching."  MORE >>

"Group health plan (GHP) sponsors continue to be subject to state reporting, but no state has added a new reporting obligation since 2021. As a reminder, ERISA arguably preempts some, but not all, state reporting requirements for GHP sponsors. This GRIST summarizes key state reporting mandates for GHP sponsors and reflects recent changes."  MORE >>

"this post highlights the tax consequences of employer-sponsored holiday perks such as gift cards, turkeys, hams and gift baskets. Under the current tax rules, employers may give infrequent low value gifts of property or services to employees on a tax-free basis.... To qualify as a tax-free de minimis fringe benefit, a gift from an employer must be of nominal value, infrequent, and not similar to cash."  MORE >>

"While it appears that the state [supplemental paid sick leave (SPSL)] will expire, there are still local COVID-19 supplemental paid sick leave ordinances in effect in the Cities of Oakland, Long Beach, Los Angeles, and the County of Los Angeles."  MORE >>

"Beginning in 2024, the program will provide eligible employees partial wage replacement for 12-16 weeks of leave, depending on the circumstances. Employees will be able to take paid leave for many of the same reasons permitted under the federal [FMLA]. The program also will extend paid leave so victims of domestic violence, sexual assault or stalking can handle related issues."  MORE >>

"Some companies choose to ease the burden of a higher-than-required deductibles by providing HRA coverage that helps reimburse expenses above the HDHP minimum, but before the higher plan deductible is reached. For HDHPs, these reimbursements must be made after the individual has satisfied the minimum HDHP deductible or else employees will not be able to contribute to an HSA."  MORE >>

"On average, enrollees in large employer health plans who have an emergency department visit spend $646 out-of-pocket on the visit. There is significant variation in emergency department spending, with 25% of visits costing over $907 out-of-pocket and another quarter costing less than $128 out-of-pocket[.]"  MORE >>

"While there is no comprehensive information on the overall adequacy of provider networks, states and CMS identified issuers that were not in compliance with network adequacy standards. Information also indicated other potential limitations in access to certain provider specialties like mental health and pediatrics. States and stakeholders also reported interrelated factors that may contribute to inadequate networks -- provider shortages, challenges in contracting with providers, and geography." [GAO-23-105642]  MORE >>

"Employers may be left with little protection as insurance carriers pass on increases in healthcare service and prescription drug prices to group health plans, driving up premiums. And if an employer is already struggling with healthcare inflation, added costs will come out of employee paychecks."  MORE >>