"Plan administrators should review prior communications sent to qualified beneficiaries regarding the tolling of COBRA election and premium payment periods and provide updated communications to the extent necessary. Given that deadlines are calculated on an individual basis, a general notice describing the end of the COVID-19 pandemic and the impact on COBRA deadlines may be preferable in some situations ... Administrative processes should also be reviewed and adjusted ... to avoid unintentionally extending COBRA deadlines beyond the end of the COVID-19 emergency."  MORE >>

"If your arrangement is a voluntary employee-pay-all telehealth benefit offered by a third party, with employer involvement limited as set forth in the safe harbor, it would not be an ERISA plan. If it does not meet all the requirements of the safe harbor, it will be an ERISA plan and must comply with the generally applicable rules ... As a group health plan, a telehealth plan raises legal issues aside from ERISA's applicability, including considerations under COBRA, HIPAA, and coverage mandates[.]"  MORE >>

"Florida's Prescription Drug Reform Act, ... aims to enhance drug pricing transparency, define relationships and contract requirements between PBMs and pharmacy benefit plans and/or network pharmacies, and enact protections for pharmaceutical consumers. The Florida Department of Financial Services is expected to develop rules to implement the new laws."  MORE >>

"[P]lan sponsors should remember that the Fifth Circuit administrative stay is not a decision on the merits of the underlying case. ... [T]he Fifth Circuit pressed pause on the district court order so that the pre-Braidwood preventive services mandate would remain intact for now while the case proceeds." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023); No. 23-10326 (5th Cir. motion for stay granted May 15, 2023]  MORE >>

"The Tenth Circuit's decision means that health plan administrators cannot rely on compliance with ERISA's claims procedure regulations to establish that the plan engaged in a 'meaningful dialogue' with claimants in addressing an administrative appeal from a determination that particular services were not medically necessary." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023)]  MORE >>

"The court determined that while the severance agreement provided the employee with initial notice that she had rights under COBRA, it did not indicate whether the employee received the additional information or if the employer timely processed the employee's request for continued coverage. Thus, the court denied the employer's motion to dismiss, allowing the COBRA claim to proceed to trial." [Davis v. World Ins. Assocs., LLC, 2023 WL 2665727 (D.N.J. Mar. 28, 2023)]  MORE >>

"An increase in prescriptions and the overall expense of these drugs has prompted insurance plans and self-insured groups to consider whether providing coverage for these medications is sustainable. Besides cost, sponsors need to consider the long-term efficacy and potential side effects of these medications."  MORE >>

"The [FTC] is expanding its probe into pharmacy benefit managers by issuing compulsory orders to two group purchasing organizations [GPOs] that negotiate rebates on behalf of PBMs.... Caremark, Express Scripts and Optum account for 80% of the PBM market, and all three are integrated with large national health plans: Aetna, Cigna and UnitedHealthcare, respectively. These massive companies also own GPOs, providers, data analytics and more."  MORE >>

"Witnesses shared their firsthand experience of using price transparency to benefit patients seeking care or small businesses sponsoring insurance for their employees.... [O]ne in four hospitals are estimated to be in compliance with [the] price transparency rules and only four hospitals out of 6,000 nationwide have ever been fined for noncompliance."  MORE >>

"Among the changes outlined in a [CMS] fact sheet is implementation of a firm 90-day window for coming into full compliance from the time CMS issues a request for a corrective action plan (CAP).... Hospitals also can expect penalties to become routine for failing either to submit a CAP within 45 days or to come into compliance within 90 days of the CAP request."  MORE >>

"Nationwide, about 8 percent of working wives whose husbands develop a medical problem quit their jobs ... But in the researchers' comparison of California, New Jersey and New York with states that do not offer family paid leave, the wives who live in states with paid leave programs are substantially less likely to leave a job to care for home or family after the spouse goes to the emergency room or winds up in the hospital."  MORE >>

"The friendly-PC model involves a professional service corporation (PSC) conducting a medical practice in affiliation with a management services organization (MSO).... Although the friendly-PC model may be a solution to the corporate practice of medicine doctrine, it can create unintended consequences for employee benefit plans sponsored by the PSC and MSO."  MORE >>