"The FAQ clarifies when a health care provider is in-network for the purposes of reaching the maximum-out-of-pocket limit and how facility fees are to be disclosed.... The FAQ clarified that a provider with a contractual relationship with a health plan will be considered in-network for the purposes of applying the [maximum out-of-pocket] limit[.]"  MORE >>

"While there may be a little breathing room regarding enforcement of the [California Privacy Rights Act of 2020 (CPRA)] under this court order as the California regulators review how to proceed, the overall outcome is that employers and benefit plans that are not subject to the HIPAA or Gramm-Leach-Bliley exceptions still should be working toward compliance, where applicable, since the current [California Privacy Protection Agency] regulations are still enforceable, and the CPRA regulations will be enforceable in March 2024."  MORE >>

"Effective October 1, 2023, Connecticut employees whose health care coverage has been terminated by an employer because of a strike, lockout, or other labor dispute will be eligible for special enrollment in state health insurance programs."  MORE >>

"Benefits will be financed by a mandatory 'premium' based on employee wages of up to 1%, to be split evenly between employee and employer, with each bearing a maximum burden of 0.5% of weekly wages as a premium. Maine employers with fewer than 15 employees will not be subject to the payment of the employer's portion of the premium, though they will still be obliged to collect and remit the employee portion. While coverage is delayed until the May 1, 2026, start date, Maine employers and employees will begin paying the 1% premium beginning on January 1, 2025."  MORE >>

"RBP programs frequently yield savings ranging from 20% to 40% for employers and employees in the first year. These impressive results, however, are not for the faint-hearted or those comfortable with their traditional HMO or PPO and reluctant to invest the necessary effort. Any half-hearted approach to RBP will lead to pitfalls."  MORE >>

"While the primary focus of the CAA was on surprise medical billing, it also included significant provisions related to PBMs. The new requirements aim to address concerns regarding drug pricing practices and rebate arrangements, ultimately benefiting both employers and employees."  MORE >>

"[The authors] show that the distributional incidence depends on the correlations between income, expected costs, and insurance demand. [They] discuss the general implications for the design of subsidies and mandates when policymakers value both equity and efficiency. Then, in an empirical case study of a large employer, [they] show that the incidence of selection falls on higher-income employees, who are more likely to choose generous health insurance plans."  MORE >>

"[CMS finalized] a rule that pharmaceutical products qualify for negotiation based on their active ingredient or moiety -- the part of the product that creates its treatment effect. Several manufacturers and trade groups have since filed suit, arguing, among other things, that the IRA's protections are unconstitutional and that the agency abused them to finalize an overly 'broad interpretation' of what constitutes a drug.... But overlaying the IRA with the complexities of how drugs change over the course of their time on the market suggests that CMS has little flexibility if the policy is to achieve the savings estimated by the CBO."  MORE >>

"[W]ithin-firm variation accounts for a dramatically lower percentage of total variation in benefits than in wages.... [T]he presence of high-wage workers in unrelated divisions of a firm as well as workers hired in high-benefit local labor markets positively predicts their colleagues' benefits, controlling for occupation, wages, state, and industry.... [F]irms with more generous benefits attract and retain more high-wage workers, but also reduce their reliance on low-wage workers more than low-benefit peers. [These] results suggest that benefits disproportionately matter for worker-firm matching and, hence, compensation inequality."  MORE >>