"This article provides [1] a recap of the deadlines, [2] rules of thumb for determining the deadlines, and [3] tables more specifically addressing some of the most common deadlines that arise. Plan administrators should review plan operations now and prepare to administer these shifting deadlines correctly to avert potential penalties and minimize avoidable claims exposure."  MORE >>

"The FAQs confirm that the Departments view the court's ruling as applying only to A and B recommendations by the [USPTF]. The Departments encourage continued coverage of preventive care services that have been invalidated and plan to issue further guidance. High-deductible health plans may continue to treat preventive care services invalidated by the court's ruling as preventive care that is not subject to the required deductible." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

"Programs to treat a drug-related substance use disorder, programs to treat an alcohol use disorder, and smoking cessation programs qualify as medical care because the programs are considered treatment for a disease. However, therapy, nutritional counseling, and weight-loss programs will only be considered medical care if used to treat a specific disease (e.g. obesity). Programs for general health or wellbeing will not qualify as medical care."  MORE >>

"This piece summarizes provisions related to the individual and small group market risk adjustment programs. The final payment notice largely continues existing risk adjustment policies, but HHS did finalize some policy changes, which largely (though not entirely) mirror those in the proposed rule."  MORE >>

"CMS has released the following 2024 parameters for the defined standard Medicare Part D prescription drug benefit: [1] Deductible: $545 (up from $505 in 2023); [2] Initial coverage limit: $5,030 (up from $4,660 in 2023); [3] Out-of-pocket threshold: $8,000 (up from $7,400 in 2023); [4] Total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are not eligible for the coverage gap discount program: $11,477.39 (up from $10,516.25 in 2023); and [5] Estimated total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are eligible for the coverage gap discount program: $12,447.11 (up from $11,206.28 in 2023)." [Also available: CMS Fact Sheet]  MORE >>

"When the law goes into effect on July 1, 2023, Virginia will join nearly 20 other states that require employers to provide medical donor leave.... Virginia employers with at least 50 employees must provide unpaid leave to organ donors, including bone barrow donors. Employees are eligible for this leave if they were employed by their current employer for at least 12 months prior and worked at least 1,250 hours in the preceding 12 months."  MORE >>

"he ruling does not affect preventive care recommended by HRSA and ACIP. Additionally, many states mandate preventive care for fully insured group plans. The injunction took effect on March 30, 2023. Marketwide impacts could be felt when insurance contracts renew annually for the 2024 plan year." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

"The [DOL] announced a settlement with the Prudential Insurance Company of America ... that will require the financial giant to revise its practices after a federal investigation found the ... company collected life insurance premiums from participants for extended periods, but then denied numerous claims after the participants died, citing the participants' failure to provide evidence of insurability when they applied for insurance."  MORE >>

"DOL officials say Prudential denied about 200 group life claims based on lack of evidence of insurability from 2017 through 2020. The company has agreed to limit evidence-of-insurability challenges to claims involving insureds who died within three months of starting to pay premiums. Officials say they would like to see all group life issuers limit challenges based on questions about evidence of insurability."  MORE >>

"The [HIPAA] Privacy Rule was designed to protect individuals' medical records and other personal health information. However, the latest practices by health insurance carriers raise serious concerns about how they circumvent these rules to maximize premiums.... Using third-party databases, risk adjustment models like the DCG, and other analytical tools by insurance carriers to inflate their underwriting decisions exploits a nefarious loophole that violates the spirit of HIPAA.... Contrast this unsavory practice to how those same carriers hide behind HIPAA privacy to shield a client's claim data while asking for the latest 12% increase."  MORE >>

"[E]mployers that do not want to risk having to do things like send COBRA notices for their employee assistance programs will want to take the COVID-related provisions out of those plans.... With the PHE came suspension (practically speaking) of required blackout notices; relaxed rules for distributions and loans from employee retirement accounts; permissible COVID-related distributions; and remote notarizations.... [It] is essential that employers check up on their plans to see if any COVID-related provisions that were placed into various benefit plans, including through the actions of insurers or other vendors, may now need to be removed."  MORE >>