"The arrangement described in [Chief Counsel Memorandum 202323006] is similar to other so-called 'double dipping' arrangements that the IRS has previously rejected. While varying in their design features and terminology, the latest iterations of these programs share certain features: reduction of employee salary or wages coupled with a restoration of the salary or wages and a claim of outsized payroll tax savings."  MORE >>

14 pages. "This updated slide deck describes agency guidance on which COVID-19 coverage mandates expired once the public health emergency ended on May 11, and how to calculate key plan and participant deadlines before and after the outbreak period ends on July 10. The slides also describe employer actions that the agencies encourage but do not require, such as steps to lessen the impact of Medicaid redeterminations on employees and their families."  MORE >>

"[C]alendar year HDHPs must subject COVID-19 testing and treatment to the deductible beginning with the 2025 plan year. This gives HDHPs more than a year to transition to applying the deductible to these services. However, non-calendar year HDHPs will have less time since the relief will only apply until the end of the 2023 plan year. This is because a 2024 non-calendar year plan year will end after December 31, 2024."  MORE >>

"The IRS's recent guidance on COVID-19 testing and treatment marks another (time-limited) eligible expense that plan sponsors will need to track as they monitor the scope of permissible expenses that can be covered under an HDHP before a participant satisfies the IRS minimum deductible."  MORE >>

"[DOL Opinion Letter FMLA2023-1-A confirms] that employees can use intermittent FMLA leave when they can't work required overtime hours due to an FMLA-qualifying reason. This leave can be taken on an hour-by-hour basis."  MORE >>

"[T]he IRS Office of Chief Counsel issued a memorandum on the FSA claims substantiation process and described situations when substantiation is sufficient and when it is not.... Employers that are renewing contracts for FSA administration with a TPA, implementing FSAs with TPA services or changing TPAs should review the TPA's claims substantiation procedures and contract language for legal compliance with all applicable laws and tax-favored status under section 125."  MORE >>

"The company's vice president explained that he pulled the trigger on the terminations based on suspected fraud, and the employees provided nothing to show that was not the real reason for the decision.... [T]he court noted that CSX did not notify the employees of their FMLA rights when they submitted their claim forms. But it also decided that they were not harmed by the omission; in fact, there was nothing to show they would have done anything differently had the notice been provided." [Adkins v. CSX Transportation, Inc., No. 21-2051 (4th Cir. June 16, 2023)]  MORE >>

"Historically, physician administered specialty pharmaceuticals are covered by a patient's medical benefit and oral medications are covered by the pharmacy benefit. Increasingly, however, specialty pharmaceuticals are being covered by pharmaceutical benefit. Does this make a difference? Does medical vs. pharmacy coverage of drugs impact patient access?"  MORE >>

"When ProPublica set out to find information on insurers' denial rates, we hit a confounding series of roadblocks.... The minuscule amount of details available about denials robs consumers of a vital tool for comparing health plans.... The limited government data available suggests that, overall, insurers deny between 10% and 20% of the claims they receive. Aggregate numbers, however, shed no light on how denial rates may vary from plan to plan or across types of medical services."  MORE >>

"Although medical claim inflation hovers around four percent, insurance companies regularly demand annual rate increases ranging from eight to 12% with no justification whatsoever. They will not provide smaller employers with actual claim information because doing so allegedly would violate HIPAA. As it turns out, insurance companies are not concerned about HIPAA because it does not apply to them when negotiating plan prices with employers."  MORE >>