"[1] What is a gag clause? ... [2] What is prohibited? ... [3] What reporting is required? ... [4] Can a self-funded plan contract with its third-party administrator for reporting?"  MORE >>

"The Proposed Rules would ... [1] Require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on access to mental health and substance use disorder benefits and medical/surgical benefits, and would set forth a special rule regarding network composition. [2] Amend existing examples and add new examples on the application of the rules for NQTLs ... [3] Set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Tri-Agencies."  MORE >>

"The proposed regulations are the latest indication of increasing agency attention toward plan and insurer compliance with the parity rules -- particularly with respect to the comparative analysis requirement. Here are highlights of the proposals."  MORE >>

"DOL, HHS, and Treasury have jointly issued [ACA FAQs Part 60] addressing interactions between the No Surprises Act, which provides protections against surprise medical bills, and certain requirements under the [ACA].... Two FAQs address the interaction of surprise billing cost-sharing requirements and the ACA annual out-of-pocket maximum limitation. The third addresses transparency disclosures. The bottom line of all the FAQs is the need for consistency."  MORE >>

"CMS announced a temporary special enrollment period on HealthCare.gov, through which individuals who lose Medicaid or CHIP coverage and come to HealthCare.gov anytime between March 31, 2023 and July 31, 2024 will be able to enroll. With respect to employers and other plan sponsors, CMS requests that they also adopt [this] rule ... CMS estimates that approximately 3.8 million individuals who lose Medicaid eligibility will be eligible for employment-based coverage."  MORE >>

"Although your plan may not impose a surcharge for these children, revising or repricing the plan's coverage tiers without making the structure age-based may allow your company to accomplish the same financial goals. For example, a plan design in which the cost of coverage increases for tiers with more covered individuals would not violate the ACA's age 26 mandate, so long as the increase applies without regard to the age of any child."  MORE >>

"Two recent cases have suggested that plan participants will have a difficult time establishing standing in suits alleging that service providers to group health plans charged excessive fees or otherwise improperly received excessive compensation." [Winsor v. Sequoia Benefits & Ins. Servs., LLC, No. 21-16992 (9th Cir. Mar. 8, 2023); Knudsen v. MetLife Grp., Inc., No. 23-0426 (D.N.J. July 18, 2023)]  MORE >>

"Courts have repeatedly held that damages for COBRA violations are generally limited to unreimbursed medical expenses less applicable premiums and deductibles. Neither COBRA nor ERISA provides for extra-contractual or consequential damages such as recovery for emotional distress." [LiCausi v. Allentown Sch. Dist., No. 21-0957 (E.D. Pa. Jul. 11, 2023)]  MORE >>

"The 2023 Advisory Council will study the scope and impact of employee benefit plans' limitations on disability benefits for mental health and substance use conditions. For example, many long-term disability (LTD) plans limit the duration of benefits for disabilities resulting from mental health conditions, while benefits for disabilities due to other medical conditions may continue until retirement age. The Council will study the extent, prevalence, rationale and impact of these limitations on disability benefits, including whether certain health conditions have been misclassified as being subject to such limitations, and will make recommendations based on its findings."  MORE >>

"The typical annual cost for GLP-1 medications for weight loss therapy is ~$16,000 per patient.... According to a 2018 report by The Milken Institute, obesity-related complications resulted in $1.39 trillion worth of direct medical treatments and indirect productivity losses annually ... [H]ealth plan sponsors are now faced with the dilemma: should we cover these new, high-cost weight loss medications that are garnering significant attention?"  MORE >>

"Historically, self-insurance -- where employers take on the risk and handle claims directly -- was largely viewed as a feasible strategy for companies employing 500 or more individuals. However, as these plans have evolved and become more adaptable, they now present a tangible opportunity for organizations with even as few as 25 employees. This approach allows employers of all sizes to not only mitigate healthcare expenses but also enhance the benefits they provide."  MORE >>

"This post provides an update on how the IDR process is working over its first year of operation. It also includes a brief summary at the end on the release by the federal agencies of a report on the impact of the NSA and some continued implementation advice in response to three frequently asked questions."  MORE >>

"[T]he 217th open meeting of the [ERISA Advisory Council] will be held via teleconference on August 29, 2023.... The purpose of the open meeting is for the ERISA Advisory Council to hear testimony from invited witnesses on the following topics: [1] Long-Term Disability Benefits and Mental Health Disparity, and [2] Recordkeeping in the Electronic Age. Descriptions of these topics are available on the ERISA Advisory Council's web page ... The ERISA Advisory Council will also discuss and finalize views on section 2509.95-1 of title 29, Code of Federal Regulations (relating to the fiduciary standards under the [ERISA] when selecting an annuity provider for a defined benefit pension plan)"  MORE >>

"[T]he 2023 Advisory Council will examine the implications of employee benefit plans' shift to electronic/digital recordkeeping for compliance with ERISA's record retention requirements and related matters. The Council will examine the tools and technologies used by plan administrators and third-party service providers to manage and retain plan records electronically, and will identify recent trends in electronic recordkeeping systems, potentially including the use of artificial intelligence.... The Council also intends to investigate the transfer of records when plan-level transactions occur, such as recordkeeper transitions, spin-offs, plan terminations, orphaned plans, and pension risk transfers.... The Council intends to determine if guidance would be beneficial with respect to records retention, the authenticity and reliability of the electronic records, the data security of electronic records, or other issues[.]"  MORE >>