"[F]or plan years beginning in 2024, the affordability percentage for employer mandate purposes is indexed to 8.39%. This is a significant decrease from 2023 and the lowest affordability threshold since the [ACA] was implemented."  MORE >>

"On August 22, 2023, ... the Ninth Circuit panel granted the Plaintiffs' motion for panel rehearing and vacated and replaced the January 26, 2023 opinion. The substantive change in the recent decision has to do with whether the district court erred when it excused unnamed class members from demonstrating compliance with the ERISA plans' administrative exhaustion requirement." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]   MORE >>

"The TMA and co-plaintiffs argued that the methodology contradicted the No Surprises Act and resulted in artificially low QPAs, which then skewed arbitration decisions in favor of insurers. After [the August 24] ruling vacated the provisions at issue, [HHS, DOL] and Treasury will have to publish new guidance.... [T]he departments have frozen all activity in the arbitration portal for the second time this month. The departments say providers and insurers should continue using negotiations to try to reach agreement on out-of-network payments." [Texas Medical Association v. HHS, No. 22-560 (E.D. Tex. Aug. 24, 2023)]  MORE >>

"[The] plan document granted the Benefits Committee, as opposed to the Benefit Department, the authority to administer the plan and determine benefits. While the plan permitted the Benefits Department to 'assist' the Committee, the Court found that ... [this] plan provision did not constitute an explicit delegation of the Benefits Committee's discretionary authority to the Benefits Department.... Because the Department lacked discretionary authority when deciding the benefits claim, the lower court and the 6th Circuit reviewed the Benefits Department's decision using the 'de novo' standard." [Laake v. Benefits Committee, Western & Southern Financial Group Co., No. 21-4178 (6th Cir. May 19, 2023)]  MORE >>

"Previously focused on healthcare providers, the settlement with UnitedHealthcare emphasizes the need for health plans to provide members with timely access to their health information.... In the press release describing the settlement, OCR Director Melanie Fontes Rainer emphasized that health plans are not exempt from the access requirement."  MORE >>

Updated Aug. 25, 2023. Descriptive list of current and proposed state and federal guidance, regulations, and legislation.  MORE >>

"This detailed set of Frequently Asked Questions, fully updated for 2023, addresses the workplace-related issues facing employers in the wake of hurricane-related disasters. In addition to legal obligations you need to consider, this Insight also addresses the practical questions that most often arise both while preparing and in the aftermath of storms."  MORE >>

"Looking ahead over the next two years, employers are focused on shaping a more competitive benefit portfolio that meets their employees' diverse needs across a range of areas: Financial wellbeing/short-term finances comes in first. Approximately four in 10 employers globally (39%) and in North America (41%) ... indicate this is the benefit area where they most want to improve their market position ... Additionally, roughly three in 10 respondents globally (31%) and across most regions indicated they were looking to improve their position in retirement plan/long-term finances."  MORE >>