"Health Insurance Marketplaces have three options to redetermine on an annual basis eligibility for enrollment in a qualified health plan (QHP) through a Marketplace and for insurance affordability programs.... [O]ne of these options is a set of alternative procedures specified by the Secretary for the applicable benefit year. This guidance describes these alternative procedures for benefit years 2024 and later, replacing earlier guidance."  MORE >>

"The proposed rule, if adopted, would enhance the protection currently offered by regulation by requiring plans and issuers adopting NQTLs to collect, analyze, consider, and publish data relating to NQTLs and the ways that NQTLs affect plan benefits."  MORE >>

"Florida, Minnesota, Tennessee, and Texas adopted new paid family and medical leave (PFML) laws. Other states modified existing laws ... Paid sick and safe leave (PSSL) drew attention ... Costs of prescription drugs (particularly insulin) are an ongoing concern, with Florida, Maryland, North Dakota, and Texas enacting laws that appear to apply to fully insured and self-funded health plans. A few states ... expanded the availability of telehealth services. Several states ... addressed coverage of fertility and/or abortion services in insured plans."  MORE >>

"Oregon's paid family and medical leave and wage replacement program is now accepting employee applications and will soon be paying benefits to eligible employees. Starting August 14, Oregon employees can apply for paid time off benefits provided by Paid Leave Oregon (PLO). PLO benefits will start on September 3."  MORE >>

"Patterson initially recognized the validity of UHC's claim based upon the summary of the underlying health plan, but later learned -- after he had paid a portion of the recovery to UHC -- that the health benefit plan did not recognize a right to reimbursement by UHC. The Sixth Circuit ultimately determined that Patterson had the right to sue UHC for claims under ERISA, due to the improper claim that UHC had made for reimbursement in the first place." [Patterson v. United HealthCare Ins. Co., No. 22-3167 (6th Cir. Aug. 1, 2023)]  MORE >>

"Plan sponsors shared their thoughts on the primary reasons contributing to a rise in medical plan costs for 2024. The top four responses are: 22% -- Utilization due to chronic health conditions (up from last year); 19% -- Catastrophic claims (same percentage as last year); 16% -- Specialty/costly prescription drugs/cell and gene therapy (new in the top four this year); 14% -- Medical provider costs (up from last year)."  MORE >>

"The minimum discount stipulated by the IRA exceeds 2020 rebates for only 4 of the 10 drugs expected to be negotiated in 2026 ... Based on 2020 gross spending, the minimum required discount on these 4 drugs combined would generate savings of $1.8 billion ... Why are only 4 of 10 drugs likely to have lower prices under IRA? The reason is that rebates are already very high for 6 of the 10 remaining drugs of interest."  MORE >>

"Customer service and self-service tools were named as the top enablers of customer satisfaction. Adhering to a customer's communication preference goes a long way in impacting customer satisfaction. Consumers expect their health plans to leverage social determinants of health data to deliver more personalized services. Consumers trust their health plans, but they place the blame on payers for the high cost of health care."  MORE >>

"Industry experts believe KP's aim is to build a big enough presence across the country to effectively compete with players like Amazon, Aetna CVS Health, Walmart Health, and UnitedHealth Group in providing health care for large corporate customers.... But it's not clear how KP will be able to bring its model, in which facilities and doctors receive a monthly per-member fee for all care, to markets where it doesn't own an integrated system of physicians, hospitals, and health plans, as it does in California."  MORE >>

"[T]he 218th open meeting of the [ERISA Advisory Council] will be held September 19-21, 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[.]"  MORE >>

12 pages. "83% of [the] panelists agreed or strongly agreed that at least 10% of employers involved in the gig economy will offer contract workers voluntary payroll-deduction retirement savings mechanisms, such as IRAs, solo 401(k)s, and HSAs by the end of 2026.... 60% agreed or strongly agreed that by year-end 2026, at least 10% of employers in the gig economy will offer voluntary insurance benefits to their contract workers. However, opinions ... began to diverge on topics like voluntary healthcare, voluntary savings programs for contract workers, and future legislation allowing contractors to participate in 401(k) plans."  MORE >>