39 pages; updated Mar. 2023. "This guidance document is effective for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years ... beginning on or after January 1, 2022 ... This document provides guidance to disputing parties who are seeking to resolve a claim for payment for [out of network] health care items or services through the Federal IDR Process.... This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process."  MORE >>

43 pages; updated Mar. 2023. "This guidance document is effective for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years ... beginning on or after January 1, 2022 ... This document includes information on how the parties to a payment dispute may initiate the Federal IDR Process and describes the requirements of the Federal IDR Process, including the requirements that certified IDR entities must follow in making a payment determination. This document also includes ... guidance on confidentiality standards, record-keeping requirements, and the process for revocation of IDR certification, as well as how parties may request an extension of certain time periods for extenuating circumstances."  MORE >>

"With the higher penalty amounts, employers who do not offer minimum essential coverage (MEC) or who offer unaffordable coverage or coverage that does not provide minimum value to their full-time employees could face additional financial exposure compared to previous years.... Employers should invest in tools or seek assistance from professionals to streamline their reporting process and avoid costly mistakes."  MORE >>

"The Court noted that at least one court has declined to consider the value of the ERISA claim presently being litigated ... [and] concluded that even if it were to consider the potential benefits that Plaintiff would be entitled to if she were to prevail in the litigation, that factor alone did not overcome the clarity of the Agreement or the fact that Plaintiff consulted her disability attorney before signing it." [Schuyler v. Sun Life Assurance Co. of Canada, No. 20-10905 (S.D.N.Y. Mar. 7, 2023)]  MORE >>

"Most employees do not treat HSAs as long-term savings and instead use their HSAs to pay for current health care expenses with before-tax dollars.... Employees with greater financial literacy and liquidity are more likely to treat their HSAs as savings, but even most of this group does not. Employees tend to discount employer HSA deposits relative to cash and do not view HSA dollars as fungible with lower health insurance premiums."  MORE >>

"Researchers ... used artificial intelligence to analyze health plan provider directories for over 40% of U.S. physicians, and found inconsistencies for 81% of doctors across five major insurers ... Most of the inconsistencies were among addresses among physicians listed as practicing in multiple locations."  MORE >>

46 pages. "This report provides an overview of key aspects of the health insurance exchanges, including types and administration of exchanges, eligibility and enrollment, plan costs and financial assistance, insurer participation, and exchange financing. It also includes information about policy changes enacted under [ARPA] and ... the Inflation Reduction Act, as well as recent administrative policy changes, including those made in response to the [COVID-19] pandemic and related economic recession." [R44065 updated Mar. 17, 2023]  MORE >>

12 pages. "[This report] is based on issuers submitting at least 90% of three quarters of claims data and 90% of enrollment data for the 2022 benefit year." [Also available: Appendix A: Interim 2022 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX); and Appendix B: Interim 2022 Benefit Year Risk Adjustment Geographic Cost Factor (XLSX)]  MORE >>

"Victims of severe winter storms, flooding, landslides and mudslides in California beginning March 9, 2023, now have until Oct. 16, 2023, to file various individual and business tax returns and make tax payments ... [I]ndividuals and households ... that reside or have a business in Alpine, Amador, Butte, Calaveras, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Los Angeles, Madera, Mariposa, Mendocino, Merced, Mono, Monterey, Napa, Nevada, Orange, Placer, Plumas, Sacramento, San Benito, San Bernardino, San Francisco, San Joaquin, San Mateo, San Luis Obispo, Santa Barbara, Santa Clara, Santa Cruz, Sierra, Sonoma, Stanislaus, Trinity, Tulare, Tuolumne and Yuba counties qualify for tax relief."  MORE >>