"The Departments acknowledge that employers rely on their carrier and/or third-party administrator (TPA) to administer their plans to comply with MHPAEA requirements but also emphasize the plan sponsor's fiduciary obligation to ensure their plan complies with MHPAEA.... The proposed three-part analysis will require plans and issuers with the help of their health plan actuaries to do a deep dive into the relevant plan-level claims data to demonstrate parity. Plan sponsors will need to work closely with their carrier and/or TPA partners to obtain the various elements needed for the analysis."  MORE >>

"[T]he regulatory package signals a change in how the Departments will enforce MHPAEA: with a clear focus on the outcomes of coverage rules that may limit access to mental health and substance use disorder (MH/SUD) benefits. The regulatory package also provides helpful guidance for stakeholders charged with evaluating the design and application of NQTLs in group health plans and demonstrating how such design and application complies with the MHPAEA."  MORE >>

"The DOL expects plans to have already performed and documented NQTL analyses.... Sponsors of self-insured health plans have been attempting to comply with this requirement by obtaining standard NQTL analyses prepared by their medical and prescription drug third-party administrators and care coordinators (TPAs). It is clear from this guidance that most (if not all) of these standard documents do not satisfy the DOL's expectations for an NQTL analysis."  MORE >>

"The proposed rules incorporate new and revised definitions of key terms ... The final requirement includes collection of the number and percentage of relevant claims denials, as well as other data relevant to the NQTL as required by State law or private accreditation standards. The rules propose a modified, non-exhaustive list of NQTLs, drawing from NQTLs that have been the subject of comparative analyses reviewed by the Departments."  MORE >>

"[T]he Medicare Part D Creditable (or Non-Creditable) Coverage Notice ... must be provided annually prior to the Part D annual enrollment period beginning October 15th. The notice only has to be provided once in every 12 month period ending on October 14, so even if an employer provides it earlier in the year (for example, because they have a renewal date early in the year), they would not need to provide the same notice again later that year."  MORE >>

"Beginning January 1, 2024, PBMs operating in Florida must continue to be registered with the OIR ... and hold a valid certificate of authority as an Administrator (TPA) in Florida ... [A]ny PBM operating in Florida without a valid certificate of authority as a TPA will be subject to a fine of $10,000 per violation per day. Beginning January 1, 2025, PBMs will be subject to biennial exams to ensure they are in compliance with Florida law."  MORE >>

"The Child Extended Bereavement Leave Act (CEBLA), which  ... will take effect on January 1, 2024, will require covered Illinois employers with 50 or more employees to allow additional amounts of unpaid leave to employees who suffer the loss of a child due to homicide or suicide."  MORE >>

"[T]he Sixth Circuit held that an employee's notice of need for leave, regardless of whether the employee was ultimately entitled to the leave, was protected conduct under the [FMLA].... Accordingly, an employee has a claim for retaliation under the FMLA if an adverse action is taken against them because they requested leave, even if they are not entitled to that leave under the FMLA." [Milmen v. Fieger & Fieger, P.C., No. 21-2685 (6th Cir. Jan. 25, 2023)]  MORE >>

"This new case highlights the arguments Plaintiffs' may make in challenging claims handling, and how the Sixth Circuit rejected those arguments." [Avery v. Sedgwick Claims Management Services, Inc., No. 22-1960 (6th Cir. July 24, 2023; unpub.)]  MORE >>

"Leaning on the impact that the health and productivity of the workforce can have on an organization's success, employers are uniquely positioned to take the lead on influencing health improvements more broadly. The payoff could be sizeable and long-lasting. In fact, we could see life span in the United States increase by an average of 12 years and health span increase by an average of 19.4 years by 2040[.]"  MORE >>

"[This issue brief] outlines some of the decision-making process with respect to adding benefits and the challenges of incorporating more equity-improving elements into health insurance plan designs. The summary ... highlights the insights shared in the conversations. "  MORE >>