"[1] IRS enforcement of ACA penalties has become much stricter.... [2] Electronic reporting will soon be required.... [3] Affordability threshold in 2024 is decreasing to 8.39 percent!.... [4] The 4980H penalties continue to increase."  MORE >>

"[W]hether an employer needs to submit a GCPCA on behalf of some or all of the provider agreements associated with their health plan will depend on each of their vendor's willingness to do it for them. At a minimum, employers will need to take inventory of which health benefits are subject to the requirement, verify with their vendors that provider contracts are compliant, and determine who is submitting attestations."  MORE >>

"In addition to setting the non-refundable administrative fee, the proposed rule also describes the methodology to calculate that fee, as well as setting the potentially refundable IDRE fee ranges for future disputes, and outlining considerations used to develop those ranges.... [T]he Departments also recently announced that IDREs may resume processing single and bundled (but not batched) disputes that were submitted to the portal on or before August 3, 2023."  MORE >>

"The monthly measurement method is one of two alternative approaches permitted under the ACA for Applicable Large Employers (ALEs) to determine employees' ACA full-time status. Unlike the more complex look-back measurement method, the monthly measurement method adopts a relatively simple approach that treats employees as full-time for any given calendar month if they complete at least 130 hours of service."  MORE >>

"At the appellate level, PCMA argued, and the Tenth Circuit agreed, that Oklahoma's law violated ERISA by limiting the options employers could use to structure its benefits. By limiting or directing the ways in which employers could structure benefit plans, PCMA argued that the law's restrictions affected the governance of matters central to plan administration sufficient to trigger ERISA preemption under Rutledge." [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]   MORE >>

"[1] Ensure proper and timely notification of breaches and security incidents.... [2] Shift liability for breach-related costs.... [3] Pass requirements through to subcontractors.... [4] Be prepared for an audit.... [5] Assign responsibilities to the parties."  MORE >>

"More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%), wages for physicians (~10%) and registered nurses (~5%), and medical machinery and equipment (less than 5%). Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending."  MORE >>

"With large trend rates impacting renewal costs, employers should closely examine alternative funding options -- especially those where maximum costs are capped. Under these programs, the employer is not responsible for paying excessive amounts if these projected costs do not materialize, yet there is downside protection if they do. Captive Insurance programs can also mitigate individual client risk. Another alternative is using Individual Coverage Health Reimbursement Arrangements (ICHRAs)."  MORE >>

"Self-funded employers have a few things in common: ... [1] When self-funded employers have enough cash reserves to weather claims, they almost always come out ahead of what they'd pay an insurance company in premiums, especially in the long run.... [2] [M]ost companies that transition to self-funded insurance do so when they have between 100 -- 500 employees. Large companies with 500+ employees are likely already self-funded or have a good reason for staying fully funded."  MORE >>

"Federal employees and annuitants will, on average, pay 7.7% more in FEHB premiums next year. OPM cites increased cost and use of prescription drugs, emergency room care, and outpatient care as the primary reasons for the increase in premiums.... [This article will describe] changes in popular plans, discuss which ones saw their premiums increase above and below the average, provide enrollment advice for two-person families, and discuss FEDVIP dental and vision plan premium changes."  MORE >>