"The removal of gag clauses from medical and pharmacy contracts is [the plan sponsor's] responsibility and should include a thorough review of BAA's and NDA's [the plan has] in place with medical and pharmacy carriers. Although the CAA-2021 amends ERISA laws, public sector employers must also attest that all gag clauses are removed from contracts to give unfettered access to data to make more informed healthcare decisions."  MORE >>

"As originally enacted, the TiC Final Rules require group health plans and health insurance issuers to disclose on a public website in-network negotiated rates and historical net prices for covered prescription drugs.... [FAQ Part 61] provides that enforcement of the rule will now be exercised on a case-by-case basis ... The Departments have [also] clarified that enforcement of the requirement to disclose certain rates as dollar amounts is a fact-specific determination exercised on a case-by-case basis, rather than a blanket safe harbor."  MORE >>

"The new proposed fees of $150 (from $50) will take effect on January 1, 2024, after a notice and comment period.... This rule comes as a relief to both payors and providers who have been waiting to hear when the Federal IDR Process will restart after the portal has been partially paused due to recent litigation."  MORE >>

"Many employers incorrectly assume they do not have to offer COBRA at retirement if they offer a retiree medical plan or a retiree health reimbursement arrangement (HRA), but the calculus is not that simple. Whether there is a requirement to offer COBRA and if so, to whom and when, depends on a number of factors[.]"  MORE >>

"Typically, states have a different definition of who is considered a resident and who needs to be reported for purposes of their state individual mandates. Additionally, states can have their own unique reporting deadlines, acceptable data formats and methods for submitting data.... As of September 2023, the states with their own mandates include Massachusetts, California, New Jersey, Rhode Island, Vermont and Washington, D.C."  MORE >>

"The amended regulations, which take effect October 15, better align with the ordinance's 2020 amendments and provide additional clarifications of employer obligations."  MORE >>

"The benefit contribution rate for employers has been increased to .88% of eligible wages.... The maximum weekly benefit amount will be $1,144.90 per week."  MORE >>

"The investigation found that United denied numerous claims based on a participant's failure to provide evidence of insurability, after accepting premiums for years without determining if insurability requirements were satisfied.... In light of this, and a prior similar enforcement action against another insurer in 2022, all sponsors, fiduciaries, administrators, and insurers of ERISA-covered group life, disability, or other insurance programs requiring insurability should verify the timeliness of insurability determinations made by their programs currently, and within the applicable statute of limitation period for claims"  MORE >>

"[A]ll 10 drug companies whose drugs were selected for price negotiation with Medicare for the first cycle of the program have decided to participate in those negotiations.... These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023 ... Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs."  MORE >>

10 pages. " Depending on the commitment an employer is willing and able to make, and the needs of its employees, while balancing all benefit considerations, there are two primary approaches employers can use to address student loan debt, as well as a few expanded approaches an organization should consider."  MORE >>

"In today's dynamic work environment, one of the most complex challenges faced by employers is managing a multigenerational workforce.... One way to bridge this gap is through the strategic design of employee benefits packages that cater to an age diverse population.... Before you construct a new benefits strategy, it's essential to understand the key preferences of each generation."  MORE >>