"Just when you thought the confusing COVID-19 ERISA deadline extensions were behind you ... [the] Administration is calling on employers and plan sponsors to amend their group health plans to extend the 60-day special enrollment period required by HIPAA for individuals losing Medicaid and CHIP and ideally match the temporary special enrollment period on HealthCare.gov that runs from March 31, 2023 [through] July 31, 2024."  MORE >>

"The amendments ... provide considerable new detail regarding the evaluation of nonquantitative treatment limitations (NQTLs), by providing a framework to evaluate NQTLs that is similar to the way quantitative treatment limitations are evaluated. The new regulations address the requirement under the Consolidated Appropriations Act, 2021 for plans to perform and document an analysis on NQTLs imposed by the plan on mental health and substance use disorder benefits, as compared to medical and surgical benefits."  MORE >>

"While these regulations are merely proposed at this time, once finalized they may significantly impact coverage offerings available to employers, particularly those who do not offer comprehensive medical coverage. Moreover, they signal that the Agencies have level-funded plans on their radar and may soon seek to define and regulate them differently than traditional self-funded plans."  MORE >>

"[T]he Illinois Victims' Economic Security and Safety Act (VESSA) ... applies to all Illinois employers and requires them to provide unpaid leave to employees who are victims of domestic, sexual, or gender violence or crimes of violence.... Under the amendments, employees also may take leave: [1] to attend the funeral or alternative to funeral or wake of a family or household member who is killed in a crime of violence; [2] to make arrangements necessitated by the death of a family or household member who is killed in a crime of violence; or [3] to grieve the death of a family or household member who is killed in a crime of violence."  MORE >>

"The suit challenges the denial of insurance coverage for inpatient mental health treatment provided to the plaintiff's daughter ... According to the complaint, in denying the claim the defendants used nonquantitative treatment limitations (NQTLs) on behavioral health benefits that don't generally apply to medical and surgical benefits, and that in denying the claim, the defendants 'imposed an accreditation requirement that does not apply to outdoor behavioral health treatment.' " [Chris C. v. Aetna Health and Life Ins. Co., No. 23-3786 (N.D. Calif. complaint filed Jul. 28, 2023)]  MORE >>

"The varying state methods for addressing surprise bills complicate the evaluation of the NSA's impacts.... The impact of state surprise billing laws on in-network and [out of network (OON)] prices is not clear.... The overall prevalence of OON professional claims decreased from 6% to 4.7% from 2012 to 2020. The share of OON payments also declined from 9.2% in 2012 to 6.8% in 2020.... OON claims were most common among people aged 18-24 and least common among people aged 55-64."  MORE >>

"For self-insured plans, bearing the financial burden of paying high cost for prescription drugs, specialty medications and associated stop-loss premium rates can be a challenge. In response, self-funded plans are increasingly using alternative funding strategies through Pharmacy Benefit Managers (PBMs) so as to maintain medication benefits while achieving a meaningful cost savings to participants."  MORE >>

"Amazon has rolled out a slew of new benefits for its employees, including an emergency savings fund, a mental health app and financial counseling, as wellness challenges mount for workers. The new benefits come as employers navigate a precarious time: Companies are seeing massive dips in employee well-being, while at the same time trying to compete for talent in a tight labor market and stay ahead of economic pressures."  MORE >>

"[The] average total Part D beneficiary premium is projected to decrease by 1.8% in 2024, from $56.49 in 2023 to $55.50 in 2024. The average total Part D premium is the sum of the average basic premium and the average supplemental premium for plans with enhanced coverage[.]"  MORE >>