"The relief comes in the form of a permanent extension of certain [ACA] reporting deadlines, a temporary reprieve from new prescription drug reporting requirements, and a two-year continuation of the ability to offer telehealth and remote care services under HSA-compatible high deductible health plans."  MORE >>

"The affected retail pharmacy transactions include health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of benefits. Additionally, under the proposed rule, the Medicaid pharmacy subrogation transaction standard would become applicable to all health plans."  MORE >>

"Unless exempt, employers that offer a parking benefit must provide a Clean-air Transportation Fringe Benefit, develop a transportation demand management plan, pay a fee, or discontinue the parking benefit. All covered employers must submit a compliance report to the DDOT every two years or be subject to fines and penalties."  MORE >>

"The Family and Medical Leave Act (FMLA) allows employers to establish call-in requirements for employees to use FMLA leave. But an employee's reference to flare-ups, if connected to FMLA certification, may suffice to satisfy call-in requirements." [Render v. FCA US LLC, No. 21-2851 (6th Cir. Nov. 16, 2022)]  MORE >>

"The court found that, despite having Article III standing, Mr. Curtis's challenges to physical therapy denials were too dissimilar to denials received by other potential class members for the five other therapies -- speech, pulmonary rehabilitation, cognitive rehabilitation, occupational, and voice -- for Mr. Curtis to have class standing to litigate claims related to these services on behalf of the class." [Curtis v. Aetna Life Ins. Co., No. 19-01579 (D. Conn. Jan. 4, 2023)]  MORE >>

"Given that much of the current focus of financial wellness programs is aimed at helping employees fulfill their current and future needs, which includes preparing for a secure retirement, it can be short-sighted not to treat post-employment benefits as the concluding step in an employee's financial wellness journey."  MORE >>

"On June 7, 2022, the [FTC] announced its decision to launch an inquiry into the business practices of pharmacy benefit managers (PBMs).... This is not ... the first time that the FTC crossed paths with the PBMs. Earlier encounters offer a useful window into the evolving PBM market and the associated policy challenges. This Viewpoint offers a reminder of why PBMs emerged in the first place, why they have amassed such alarming influence, and how they positioned themselves as powerful actors within the prescription drug distribution system."  MORE >>

"Share to Facebook Share to Twitter Share to Email App Share to Print Share to More North Carolina State Health Plan officials are researching the differences between the provider networks for Aetna and Blue Cross and Blue Shield of North Carolina as they prepare for a shift in management of the health insurance plan. State Treasurer Dale Folwell.... said he expects administration costs to go down as the plan moves to a new third-party administrator for the first time in 40 years."  MORE >>

"United Healthcare ... had sought a refund of more than $2 million after claiming that an audit showed that it had overpaid Low-T Physicians Service ... Following a review and negotiations, the Low-T groups offered to settle for $24,665.... At trial, United Healthcare's general counsel and investigator said they were not aware of the settlement offer until after the check was deposited.... Evidence showed that the ... associate general counsel for United Healthcare who had been communicating with Low-T ... should have received the letter six days before the check was cashed. After a deposition, he found the letter in his files." [United Healthcare of Texas, Inc. v. Low-T Physicians Services, PLLC, No. 02-22-00170 (Ct. App. Tex. Jan. 5, 2023)]  MORE >>

"Employers continue to absorb healthcare premiums and other costs.... Virtual primary care will continue to take off as the next generation of telehealth.... Companies may need to manage through significant change as they right-size their organization in line with current market conditions.... Employers continue to reduce expenses in defined contribution plans.... The pace of defined benefit plan terminations increases.... Pension plan sponsors begin to implement income distribution options in their defined contribution plans."  MORE >>