"Although the STLDI and fixed indemnity proposals follow from a 2022 executive order and come as no surprise, they would have far-reaching implications for some benefit designs. Also worth noting is a comment request on level-funded plan arrangements. These self-insured arrangements -- with set monthly plan sponsor payments to a service provider to cover estimated claims and administrative costs -- are reportedly increasing, and the agencies seek to better understand their designs and whether additional guidance is needed to clarify the plan sponsor's obligations."  MORE >>

"[The FAQ] clarifies the price comparison information required to be made available to individuals beginning on January 1, 2024.... FAQs 60 also clarifies the extent to which a provider is considered to have a contractual relationship with an insurer and must be considered in-network for the required limits under the Patient Protection and [ACA's] maximum out-of-pocket limits."  MORE >>

"While these FAQs provide a few clarifications, many open questions remain about the surprise billing rules and their overlap with preexisting ACA requirements. In particular, the requirement to provide an advanced explanation of benefits bears many similarities to the individual cost-sharing disclosure requirements in the existing TiC regulations."  MORE >>

"IRS Notice 2023-37 [provides] that COVID testing and treatment are not preventive care. This means they can only be provided under a high deductible health plan ('HDHP') on a first dollar basis by plans which plan years end no later than December 31, 2024. HDHPs that continue to cover these services on a first dollar basis will cause their participants to be ineligible to contribute to health savings accounts (HSAs)."  MORE >>

"[T]he new law provides the following two new circumstances in which a service worker can use paid sick leave: [1] For a 'mental health wellness day,' ... [2] Where a service worker is the parent or guardian of a child who is a victim of family violence or sexual assault, for (a) medical care or psychological or other counseling for physical or psychological injury or disability, (b) obtaining services from a victim services organization, (c) relocating due to such family violence or sexual assault, or (d) participating in any civil or criminal proceedings related to or resulting from such family violence or sexual assault."  MORE >>

"The plan permits employees to take leave to care for any individual with whom they have 'a significant personal bond that is or is like a family relationship regardless of biological or legal relationship.' Employees can take paid leave immediately after starting employment."  MORE >>

"While it is not unusual for an administrative agency to modify or change a regulatory position over time, usually in response to changing circumstances, an outright reversal is less common. The IRS made the complete about-face after receiving 3,888 comments on the proposed regulations, most of which supported the change. This article examines the rationale advanced by the IRS in support of its changed position in the matter of the 'family glitch.' It also considers how the IRS's position might fare if challenged in the wake of West Virginia v. EPA"  MORE >>

"[T]his new era of information transparency has spurred a small but growing stream of lawsuits. Surprisingly though, the plaintiffs in these suits are plan sponsors (or their committees) in their role as plan administrator, as opposed to plan participants, and the defendants are health plan third-party administrators rather than the plans themselves. In light of these recent lawsuits, this post focuses on fiduciary considerations for health plans in this new era of fee and price transparency."  MORE >>

"The package includes four bills: [1] Transparency in Billing Act [HR 4509] ... [2] Transparency in Coverage Act [HR 4507] ... which provides consumers with price transparency for medical services and prescription drugs [and] brings much needed light to Pharmacy Benefit Managers' (PBMs) business practices ... [3] Health DATA Act [HR 4527] ... Ensures health plan fiduciaries are not contractually restricted from receiving cost or quality of care information about their plan. [4] Hidden Fee Disclosure Act [HR 4508] ... Strengthens requirements that PBMs and Third-Party Administrators (TPAs) disclose compensation to plan fiduciaries."  MORE >>

"Analyzing healthcare plan data shows the direction of spending and care, but it takes clinical informatics to understand why those trends are occurring -- and to find the most cost-effective ways to deliver care for plan sponsors."  MORE >>

"Today's retirees typically spend about a third less on medical care than retirees did back in 2004 ... Workers who are over 55 but not yet eligible for Medicare are spending somewhat less too. Two policies have reversed the trend of years of rising costs: the introduction of Medicare's Part D prescription drug coverage and the [ACA] ... But behind the 20-year decline in healthcare spending, adjusted for inflation, is another fact of life: healthcare costs increase as people age, and some people are luckier than others."  MORE >>

"Nearly 2,000 employers, patient advocates, pharmacies, providers and businesses sent a letter to Congress [on July 12,] strongly urging passage of pharmacy benefit manager (PBM) reform legislation that would address the anticompetitive practices of some PBMs while bringing greater transparency to the pharmaceutical supply chain."  MORE >>

"As companies grapple with attracting and retaining key talent, investment in employee benefits remains a key priority for most U.S. employers; however, many still face cost challenges as benefit expenses continue to rise ... Almost two-thirds (65%) of employers feel that their current benefit plan is effective or highly effective in attracting and retaining key talent, and half (49%) are focused on their benefit plans meeting needs across all employees. As they look to meet these needs, employers plan to improve their benefits position in financial wellbeing (43%) and mental health support (37%)."  MORE >>