"[T]his notice modifies prior guidance regarding benefits relating to testing for and treatment of COVID-19 that can be provided by a health plan that otherwise satisfies the requirements to be a high deductible health plan (HDHP) ... Specifically, this notice provides that the relief described in Notice 2020-15 ...  applies only with respect to plan years ending on or before December 31, 2024.

"This notice also clarifies ... that the preventive care safe harbor ... does not include screening (i.e., testing) for COVID-19, effective as of the date of publication of this notice [June 23, 2023]. This notice also provides that items and services recommended with an 'A' or 'B' rating by the United States Preventive Services Task Force (USPSTF) on or after March 23, 2010, are treated as preventive care for purposes of section 223(c)(2)(C), regardless of whether these items and services must be covered, without cost sharing, under Public Health Service Act section 2713."  MORE >>

"[T]here are specific calculation methods used to configure the number of covered lives and special rules may apply depending on the type of plan being reported.... HRAs and health FSAs that are not excepted from reporting only must count the covered participants and not the spouses and dependents. The Form 720 instructions do not outline all of these rules."  MORE >>

"The Act is extensive and is aimed at increasing competition in the health care market, heightening price transparency, and reducing prescription drug costs.... [1] Payer-provider contracting requirements ... [2] PBM practices and contracts ... [3] Drug discount card program ... [4] Registration for pharmaceutical marketing ... [5] Reducing prescription drug costs ... [6] Facility fees ... [7] Certificate of need laws."  MORE >>

"[T]he opt-out election remains available with respect to [three] group health plan mandates: [1] standards related to newborns and mothers, [2] reconstructive surgery following mastectomies, and [3] Michelle's Law (now obsolete for most plans due to the ACA's requirement to cover dependent children to age 26). Detailed election and notification requirements apply for plans wishing to rely on the opt-out."  MORE >>

"This case highlights the importance of clearly drafting -- and carefully following -- delegation of authority procedures. To decrease the likelihood of de novo review by a court, delegation of discretionary authority should be done in accordance with the plan's terms, and final decisions should be made only by parties who are permitted to do so under the plan." [Laake v. Benefits Committee, Western & Southern Fin. Group Co. Flexible Benefits Plan, Nos. 22-3182, 21-4178 (6th Cir. May 19, 2023)]  MORE >>

"[T]he Ninth Circuit held that Aetna, apart from its initial calculation of benefits, repeatedly and over the course of years provided Morris individualized consultations with, and phone support from, benefits specialists and customer service, including about the amount of her benefits, as well as letters for Morris to submit to financial institutions verifying her benefit amounts, knowing she and the institutions would rely on the letters. Conveying such information 'amounts to a fiduciary act,' according to the circuit court." [Morris v. Aetna Life Ins., No. 21-56169 (9th Cir. June 2, 2023; unpub.)]  MORE >>

"[M]ost high-cost participants have received treatment for one or more chronic conditions and many have steadily progressed along a line of increasing comorbidities, until their health status declined to the point where they required high-cost care. The more plan sponsors understand these characteristics and cost drivers, the better they can align interventions and apply viable management strategies to reduce or mitigate costs."  MORE >>

"[These] analyses demonstrate two important findings if the Braidwood ruling is upheld and cost sharing is imposed: [1] Enrollees using preventive services may face a substantial increase in their individual out-of-pocket spending, and [2] reintroduction of patient cost sharing will have a minimal impact on overall employer health care spending, because when spread across the entire pool of covered lives, the costs of covering select preventive services are very low."  MORE >>

"Small businesses and workers looking for greater flexibility in their health care benefits will see fewer administrative burdens and improved choices under legislation passed this week by the House of Representatives.... [T]hese solutions are based on feedback gathered in Committee hearings held in communities around the country during which small business owners shared their stories about the cost and time required to navigate America's health insurance system."  MORE >>