182 pages. "This document sets forth proposed rules that would amend the definition of short-term, limited-duration insurance, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. This document also sets forth proposed amendments to the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets. This document further sets forth proposed amendments to clarify the tax treatment of certain benefit payments in fixed amounts received under employer-provided accident and health plans. Finally, this document solicits comments regarding coverage only for a specified disease or illness that qualifies as excepted benefits, and comments regarding level-funded plan arrangements."  MORE >>

"[1] Is cost sharing for services furnished by a nonparticipating provider, facility, or provider of air ambulance services (as defined for purposes of the No Surprises Act) considered cost sharing for benefits provided outside of a plan's network for purposes of the MOOP limit? Yes.... [2] The Departments are aware that some plans and issuers have contractual relationships with providers, facilities, or providers of air ambulance services that the plans and issuers do not consider to be part of their network. May a plan or issuer treat a provider, facility, or provider of air ambulance services with which it has a contractual relationship as out-of- network for purposes of the MOOP limit under PHS Act section 2707 and ACA section 1302(c), while also treating them as participating for purposes of the No Surprises Act? No.... [3] Are facility fees included in the definition of items and services for purposes of the TiC Final Rules and the GFE requirements of the No Surprises Act? Yes."  MORE >>

"This NPRM proposes to modify the definition of short-term, limited-duration insurance (STLDI) and modify the conditions for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit. The NPRM also solicits comments regarding specified disease excepted benefits coverage and comments regarding level-funded plan arrangements. The NPRM further includes a proposal from the Department of the Treasury (Treasury) and the [IRS] that would clarify the tax treatment of certain benefit payments in fixed amounts received under employer-provided accident and health plans."  MORE >>

"Employer plan sponsors of HSA-qualifying HDHPs that currently cover COVID-19 testing and/or treatment prior to the satisfaction of the minimum annual HDHP deductible should amend the terms of the plan to no longer do so for plan years ending after December 31, 2024."  MORE >>

"Nearing halftime of 2023, state lawmakers have racked up points on prescription drug reforms, with pharmacy benefit managers (PBMs) and plan sponsors largely playing defense. Several bills have scored, more have an open look as the shot clock winds down, and a court appeal in Denver is awaiting officials' review. Here are first-half highlights and a preview of the third and fourth quarters."  MORE >>

"[This article provides] a table of currently pending PBM-reform legislation, featuring brief descriptions, links to the texts, and additional information about each bill. [The authors] have highlighted significant bills, such as those introduced by Committee Chairs, bills that have attracted considerable attention from outside the Beltway, and bills that are most likely to make progress on the Hill."  MORE >>

"While allowing these medications to be covered may lead to more short-term pharmacy spending, in the long-term it could alleviate overall costs by treating diseases associated with obesity.... Utilization management (UM) helps to ensure that these drugs are only used for patients who have diabetes. Prior authorization could also be implemented[.]"  MORE >>

"For employers, integrating advanced primary care into a benefits package starts with engaging health plan partners and other primary care partners on key goals around health outcomes and realigned payment models that incentivize early prevention, outreach and accountability for health improvement."  MORE >>

"The hope is that apps and platforms will make it easier to buy and understand insurance, and easier to get the best healthcare fast. That means high-quality care at a low price at a time that's convenient for patients.... Though employees will have the ability to make easy changes to benefit plans -- especially voluntary benefits -- the role of HR may change, depending on the employer's size."  MORE >>

"[This] report focuses largely on establishing a baseline and a framework for further evaluation. The report details key trends in factors that will be important to evaluate NSA effects including: [1] the implementation and impacts of state surprise billing laws already in effect; [2] trends in market consolidation and concentration; [3] the impact of market consolidation and concentration on prices, quality, and spending; and [4] trends in [out-of-network] billing."  MORE >>