"The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, respectively. At present, the Administration's plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the Administration's previous commitments to give at least 60 days' notice prior to termination of the PHE."  MORE >>

"For use in preparing 2022 returns.... What's New: [1] Telehealth and other remote care services.... [2] Health FSA contribution and carryover for 2023.... [3] Insulin products.... [4] Health FSA contribution and carryover for 2022.... [5] Home testing for COVID-19 and personal protective equipment for preventing spread of COVID-19... [6] Surprise billing for emergency services or air ambulance services."  MORE >>

"As the Public Health Emergency ends, plan sponsors should review coverage of COVID-19 and related costs to determine how the plan will cover such costs going forward. Plan sponsors should also consider whether any continued coverage may cause parity problems under [MHPAEA].... When the national emergency period ends on May 11, 2023, the 60-day clock will begin counting down toward the end of the Outbreak Period. At the end of the Outbreak Period, the extended [COBRA] deadlines will revert to their pre-emergency timeframes."  MORE >>

"Under a new proposed rule, fewer employers would be able to decline to provide employees health care coverage for birth control. [HHS], [DOL] and Department of the Treasury issued the proposed rule on Jan. 30 to remove the moral exemption under [ACA] regulations. The religious exemption would remain in place."  MORE >>

"The 2023 Regulations provide new options and flexibility for employers to meet the MAPFML requirement to provide health insurance coverage during leave. However, some questions remain[.]"  MORE >>

"The Ninth Circuit has reversed a district court's ruling that a health insurer violated [ERISA] by using claims processing guidelines that were more restrictive than generally accepted standards of care ... to adjudicate mental health and substance use disorder (MH/SUD) claims ... [concluding] that the district court erred by treating claims reprocessing as a stand-alone remedy under ERISA. The Ninth Circuit's decision withdraws and replaces another Ninth Circuit decision in this litigation from March 2022." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]  MORE >>

"[T]he Ninth Circuit stated that ERISA's benefit claim provision (29 U.S.C. Section 1132(a)(1)(B)) only provides a right to 'recover benefits or to enforce or clarify rights under the plan.' Thus, reprocessing, which entails 'a remand to the administrator for reevaluation' is not a proper remedy under this provision, and is only 'a means to the ultimate remedy,' i.e., the payment of benefits. As a result, the court ruled that the district court violated the Rules Enabling Act by creating a substantive right not authorized in ERISA[.]" [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]  MORE >>

"Lisa Erban applied for life insurance benefits as the beneficiary after her husband died ... She claims the defendants breached their fiduciary duty when they denied her benefits because they failed to inform her that she could continue her husband's life insurance benefits by continuing to pay premiums and that they did not completely inform her about the deadline to convert her husband's plan. The federal judge denied the defendant's motion to dismiss, finding Erban stated a plausible claim that the defendants breached their fiduciary duty in light of her husband's illness." [Erban v. Tufts Medical Center Physicians Org., Inc., No. 22-11193 (D. Mass Jan. 23, 2023)]  MORE >>

"[In] the coming year, plans .plans should be mindful of preserving the defensive privileges surrounding pricing methodology.... [I]nsurers and plans should anticipate that the outcome of many cases in 2023 will be decided on how much evidence providers gain through discovery and how clear (or unclear) plan language on pricing is.... [S]ome courts are allowing providers' claims [involving COVID-19 reimbursement] to proceed by reasoning that if a provider has standing to sue under ERISA by virtue of a plan beneficiary's assignment of benefits, then a plan may have breached an ERISA plan's terms in its failure to reimburse certain COVID-19 testing claims."  MORE >>

"A revised actuarial report published on October 20, 2022, now shows WA Cares is expected to be able to pay benefits through the first 75 years of operation. However, should modeling assumptions change, the report provides the WA Cares tax could require an increase from .58 percent to 1.23 percent of wages to cover benefit expenditures."  MORE >>