"The analysis requires an examination of each NQTL, its underpinnings, application to benefits, and outcomes. The analysis needs to be thoroughly documented with the documentation available to the [DOL, HHS and Treasury], applicable state authorities, and plan participants on request.... Health plan sponsors will need to work with their insurers or other plan vendors to gather the information, perform the evaluations, and document the analysis in compliance with the requirements."  MORE >>

The proposed regulations include a new three-part framework for evaluating "non-quantitative treatment limitations" (NQTLs) imposed on plan benefits.... This flowchart illustrates the new framework in the proposed rule.  MORE >>

53 pages. "However sliced, the network restrictions 'require providers to structure benefit plans in particular ways,'... and 'prohibit[] employers from structuring their employee benefit plans in a [certain] manner,' ... And either way, ERISA preempts these provisions because a pharmacy network's scope (which pharmacies are included) and differentiation (under what cost-sharing arrangements those pharmacies participate in the network), are key benefit designs for an ERISA plan." [Pharmaceutical Care Management Assoc. [PCMA] v. Oklahoma, No. 22-6074 10th Cir. Aug. 15, 2023)]  MORE >>

"The Third Circuit Court of Appeals found that Aetna's Rule 23(f) petition is untimely because the Reconsideration Order did not materially alter the Class Certification Order.... The court found that these changes were more akin to 'minor clarifications' than material alterations.... Because Aetna did not file its Rule 23(f) petition within fourteen days of [the original class certification order], the court denied it as untimely." [Wolff v. Aetna Life Ins. Co., No. 22-8056 (3d Cir. Aug. 9, 2023)]  MORE >>

"[S]everal courts have found that the analysis in Thole has equal import on cases brought by plan participants in ERISA-governed welfare benefit plans ... [T]he courts held that welfare benefit plans were structurally analogous to defined benefit pension plans in ways that may preclude participants ... from having Article III standing to bring claims against plan fiduciaries ... [because,] like defined benefit pension plans, the participants have no beneficial interest in any of the assets of the plan, but rather merely have a right to receive future benefits under the terms of the plan."  MORE >>

21 pages. "There is no reasonable way to cover all employees under a single paid family and medical leave plan ... [O]ne plan could not effectively provide at least as generous of a plan that would supersede all of the mandatory statutory paid leave state plans. However, [the] analysis really comes down to why an employer would want a single plan: to provide equal benefits to all employees, promote talent acquisition and retention and for ease of administration. These three main concerns are solvable with legal mechanisms and tools currently in place, which will continue to expand as the legal options continue to evolve."  MORE >>

"Limits for qualified transportation fringe benefits and health FSAs are expected to rise significantly for the second year in a row, due to the unusually large increase in C-CPI-U for the year (5.2% for the 11 months ending July 2023). Before the record 7.1% increase in the 2023 limits, the average annual increase was 2.1% for the period since indexing on transportation fringe benefits began in 1999."  MORE >>

"Victims of severe storms, straight-line winds, and tornadoes in parts of Mississippi that occurred from June 14, 2023 to June 19, 2023, now have until Oct. 16, 2023, to file various individual and business tax returns and make tax payments ... individuals and households affected ... that reside or have a business in Claiborne, Copiah, Covington, Jackson, Jasper, Jefferson, Jefferson Davis, Lawrence, Leake, Neshoba, Newton, Rankin, Scott, Simpson, Smith and Wayne Counties and the Mississippi Choctaw Indian Reservation qualify for tax relief."  MORE >>

"Rather than persisting with outdated processes, there's new opportunity for HR teams to reduce administrative burden, empower employees to make informed benefits decisions, and generate valuable insights into cost improvements to support larger organizational goals. This guide will dive into common challenges of managing employee benefits administration and how to overcome these obstacles with employee engagement strategies and tools for looking ahead."  MORE >>