"This revenue procedure provides the applicable percentage table in Section 36B(b)(3)(A) ... for taxable years beginning in calendar year 2024. This table is used to calculate an individual's premium tax credit under Section 36B. This revenue procedure also provides the indexing adjustment for the required contribution percentage in Section 36B(c)(2)(C)(i)(II) for plan years beginning in calendar year 2024. This percentage is used to determine whether an individual is eligible for affordable employer-sponsored minimum essential coverage under Section 36B."  MORE >>

28 pages. "The risk adjustment methodology that HHS will use when operating a risk adjustment program on behalf of a State for the 2023 benefit year will calculate a plan average risk score for each covered plan based upon the relative risk of the plan's enrollees, and apply a state payment transfer formula to determine risk adjustment payments and charges for plans within a State market risk pool. The methodology addresses three considerations: [1] adverse selection in the individual and small group (including merged) markets; [2] plan metal level differences and permissible rating variation; and [3] the need for risk adjustment transfers that net to zero." [Also available: [Technical Details (XLSX) and 2023 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

"Specific regulations for COBRA continuation coverage in M&A transactions address which party must assume COBRA liability in an asset sale. While parties are free to agree on the allocation of the responsibility and liability for COBRA coverage in the asset purchase agreement, [those regulations] will control if the parties' agreement fails or if this issue is not addressed in the purchase agreement."  MORE >>

"[HHS has] published the Maximum Annual Limitation on Cost Sharing for 2024 limits for 2024. In addition, the IRS published (in Rev. Proc. 2023-23) the 2024 inflation adjusted amounts for Health Savings Accounts (HSAs) and the maximum amount that may be made newly available for an Excepted Benefit Health Reimbursement Arrangement (EBHRA). The chart below compares this year's limits and parameters to the 2024 limits."  MORE >>

37 pages. "[T]he district court did not err in certifying three classes to pursue the fiduciary duty claim. However, by certifying the denial of benefits classes without limiting the classes to those with claims that UBH denied under a specific Guidelines provision(s) challenged in this litigation that applied to the claimant's own request for benefits, the certification order improperly enlarged or modified Plaintiffs' substantive rights ... Accordingly, we reverse the district court's certification of the denial of benefits classes.... [T]he district court erred to the extent it determined that the Plans require the Guidelines to be coextensive with GASC. Therefore, the judgment on Plaintiffs' denial of benefits claim is reversed ... And we remand for the district court to answer the threshold question of whether Plaintiffs' fiduciary duty claim is subject to the exhaustion requirement." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]  MORE >>

"The court found it problematic that Reliance Standard did not give its reviewers a copy of Jordan's doctor's letter disagreeing with their opinions.... The court found Jordan's doctor's evidence to clearly establish her entitlement to benefits. Rather than a remand to Reliance Standard for 'a third bite at the apple,' the court issued a remand with instructions to enter judgment in favor of Jordan." [Jordan v. Reliance Standard Life Ins. Co., No. 22-5234 (6th Cir. Aug. 18, 2023)]  MORE >>

"Having described the state of ERISA preemption, the court then dealt with what it saw as a threshold issue. Was the Oklahoma law even within ERISA's purview given that, in its aim and effect, it only directly governs PBMs, not plans? The court had no trouble answering in the affirmative ... Turning to the geographic access provision, the discount prohibition and the any willing provider provision, the court concluded that all three were preempted because they govern a central matter of plan administration by requiring that prescription drug benefits be structured in a particular way." [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]  MORE >>

"46% of respondents said they already cover the diabetes and anti-obesity drugs, known as GLP-1s, for weight loss. Some 3% percent said they were adding it for the 2024 plan year and 13% said they were considering it for the following year. By comparison, 92% said they already cover it for diabetes."  MORE >>

"A significant majority of multinational employers provide tailored employee benefits and related services to [internationally mobile employees] as a key element of a competitive benefit package. While some employers still rely on home and/or host country plans, offering truly global programs has numerous advantages."  MORE >>

"Two of the biggest sources of traditional PBM profit are dispensing margin on specialty drugs and retention of manufacturer rebates. Both are calculated as a factor of list prices -- and as those list prices increase, so does your PBM's profitability.... [A] closer look at supply chain economics reveals that pharma's net profit on brand drugs may actually be shrinking, and generic drugs have been steadily deflating for 10 years or more. If prices at the counter continue to rise while manufacturers' profits fall, where are those dollars all going? They are quietly absorbed by the world's most sophisticated middleman, the traditional PBM."  MORE >>