"The relief took effect in 2020 and applies for the duration of any plan year beginning before the end of the COVID-19 PHE. If the PHE ends on May 11, 2023, a calendar year telehealth-only plan could remain covered by the exemption until the end of 2023. But if the plan year is, for example, June 1-May 31, the relief applies only until the end of the current plan year on May 31, 2023; as of June 1, 2023, that plan would have to comply with the preventive services mandate and the prohibition on annual and lifetime limits."  MORE >>

"The IRS's latest reminder of the substantiation requirements for health FSAs and DCAPs does not break any new ground -- the rules have been in place for many years and the prohibition on substantiation shortcuts is well known. Nevertheless, it serves as a helpful review of the rules, while also underscoring the potential problems with some current arrangements and making it even more difficult for plans that are not in compliance to say they 'didn't get the memo.' "  MORE >>

"Contributions to the Program will now begin for both the employer and employees on October 1, 2024. Eligible employees may begin to use Program benefits on January 1, 2026.... Contributions to the Program will be split 50/50 between employers and employees.2 However, employers may choose to pay more than 50 percent (up to the entire portion required for employees)."  MORE >>

"Addressing the broad implications of its analysis, the court explained that attributing fiduciary status to TPAs in situations like this could ultimately harm participants by interfering with typical TPA business models. For example, to avoid functional fiduciary status, a TPA could be required to play the role of an unsecured lender to the plan by paying claims in advance and being reimbursed later." [Mass. Laborers' Health & Welfare Fund v. Blue Cross Blue Shield of Mass., No. 22-1317 (1st Cir. Apr. 25, 2023)]  MORE >>

"The Fifth Circuit explained the difference between a legal dispute, that is a dispute about a plan's meaning, and a factual dispute, which is a dispute about a plan's application.... The court rejected Blue Cross's arguments that it gave the legally correct interpretation. The court also agreed with the district court that substantial evidence does not support Blue Cross's decision." [Salim v. Louisiana Health Service & Indemnity Co., No. 22-30573 (5th Cir. May 3, 2023; unpub.)]  MORE >>

"The insurer did not give an explanation for the reversal of coverage for a midwife, leaving a couple with no recourse after exhausting all processes within the claims processing, including a formal appeal, which was denied.... Plaintiffs ... contended that UnitedHealthcare, Oxford Health Plans LLC and Oxford Health Insurance Inc. changed course regarding the midwife after the baby was born[.]" [Winter v. UnitedHealthcare, No. 23-0523 (D. Conn. complaint filed Apr. 25, 2023)]  MORE >>

"Employers must be hypervigilant, ensuring that any [evidence of insurability (EOI)] requirements are satisfied before payroll deducting for optional life coverage. Employers should review enrollment and payroll coordination processes in place with current technology or enrollment platform vendors to ensure alignment of records and identification of outstanding EOI requests on an ongoing basis. If the new DOL processes are ignored by an employer, the risks are huge."  MORE >>

"Although these are federal rules, state departments of insurance have the primary enforcement role with respect to state-regulated insurers. Insurance regulators can do more than just confirm that insurers are posting these data -- they can also help ensure that the data files, currently difficult to access and use, fulfill their potential to help constrain health care cost growth and improve affordability for state residents."  MORE >>

"The 2023-2024 Priority Guidance Plan will identify guidance projects that the Treasury Department and the IRS intend to actively work on as priorities during the period from July 1, 2023, through June 30, 2024."  MORE >>

"Victims of Severe Winter Storms, Straight-line Winds, Flooding, Landslides and Mudslides in California that began on Feb. 21, 2023, now have until Aug. 15, 2023, to file various individual and business tax returns and make tax payments ... [I]ndividuals and households ... that reside or have a business in Modoc County qualify for tax relief."  MORE >>