"Plan sponsors that want to confirm their prescription drug coverage is creditable or want to remain qualified for the employer retiree drug subsidy will have to determine if their 2024 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage, which may require a closer look this year due to improvements in the Medicare Part D program brought about by the Inflation Reduction Act of 2022."  MORE >>

"[I]ndividuals covered by an HDHP may continue to contribute to an HSA following the end of the PHE. COVID-19 vaccinations also continue to be considered preventive care under Section 223 of the Code for purposes of determining whether a health plan is an HDHP."  MORE >>

"The court was unpersuaded by the arguments of the Fund and its amici (including the [DOL]) that finding Blue Cross to be a nonfiduciary would lead to anticompetitive practices that concededly could harm plans and their participants ... Thus, based on ERISA's far from pellucid statutory definition of fiduciary, the First Circuit allowed Blue Cross to evade fiduciary responsibility to the tune of $1.4 million in plan losses caused by its ... medical claims pricing and payment practices." [Mass. Laborers' Health & Welfare Fund v. Blue Cross Blue Shield of Mass., No. 22-1317 (1st Cir. Apr. 25, 2023)]  MORE >>

"Many employers and insurers are opting to wait out the appeals process before considering whether to make changes to their health plans' coverage of recommended preventive services, ... [T]he appellate court will be called upon to address a host of complex legal issues and, when deciding those issues, will have the views of not only the parties in the case but also from an array of interested third parties who will file briefs attempting to influence the outcome of the appeal." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

"Print Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system.... [T]he arbitration criteria are meant to place providers and insurers on roughly equal footing in dispute resolution, thus giving insurers motivation to include more providers in their networks. Over time, that should help reduce the flood of disputes in the IDR portal."  MORE >>

"It is common for EAP providers to fail to recognize an EAP as an ERISA benefit plan.... Often, the service agreement with the EAP does not address claims, fiduciary status, and COBRA responsibilities."  MORE >>

"Third-Party Administrators (TPAs) are important components of self-funded employer health plans.... [1] What is a third-party administrator? ... [2] What are the benefits of a third-party administrator?.... [3] How do you select a third-party administrator?.... [4] Will transitioning to a health plan with a TPA be disruptive?"  MORE >>

"[1] Don't forgo clinical services.... [2] Take steps to manage anxiety.... [3] Improve sleep.... [4] Explore complementary approaches.... [5] Try pressure therapy."  MORE >>

"[The bill] includes: [1] Increasing the Office of Insurance Regulation's authority over PBMs ... [2] Largely preventing a practice known as 'spread pricing' ... [3] Placing restrictions on PBMs that have affiliated pharmacy businesses.... [4] Preventing PBMs from requiring patients to receive prescriptions by mail."  MORE >>

"[R]evised family attribution rules under [SECURE 2.0], effective for plan years after December 31, 2023, will permit businesses owned separately by spouses to provide benefits to their respective employees without necessarily having to count the employees of the other spouse.... [F]amily-owned entities ... should understand how the Act may alter the employee populations counted for qualified retirement plans and also for identifying Applicable Large Employer status under the health insurance mandate of the [ACA]."  MORE >>