"The 2023 Guidance proposes a number of changes to MHPAEA compliance, primarily with respect to NQTL requirements. The NQTL provisions are intended to prevent plans from designing and implementing NQTLs with greater limits on access to MH/SUD benefits as compared to M/S benefits. ... New 3-prong test for NQTLs ... Content requirements for NQTL comparative analysis ... Meaningful benefits."  MORE >>

"[T]he amended rules make several changes to how the ESSTA will be implemented, including clarifying how employer size will be determined, illustrating how remote workers will be counted, and expounding on notice requirements and accrual methods."  MORE >>

"[T]o avoid Employer Shared Responsibility Penalty risk employers should ensure that: [1] The employee's premium payment amount is within the ACA's 8.39% threshold for affordability. [2] Any 'cash-in-lieu of' benefits for employees who decline coverage satisfy the eligible opt-out arrangement rules. [3] Any wellness program surcharges (except for tobacco use) do not increase the employee's cost of coverage beyond the affordability percentage."  MORE >>

"Because of the plan's use of the terms 'some, may, and typically,' the court found the exclusion was 'susceptible to more than one meaning.' The court observed that the ambiguity was further demonstrated because Z.A. received similar treatment at both BlueFire and Uinta, but the plan covered some of the treatment at Uinta while completely rejecting the charges from BlueFire.... [T]he court found that ... the disparate treatment demonstrated a patent ambiguity in plan language." [M.A. v. United Healthcare Ins., No. 32-0084 (D. Utah Sep. 28, 2023)]  MORE >>

"According to the lawsuit, the health benefits plan provided by the state for public and school employees discriminates against people with obesity by failing to provide coverage for treatments and medications, like Wegovy and Ozempic, which are increasingly used to achieve rapid weight loss." [Simonton v. Washington State Health Care Authority, No. 23-2-03017-34 (Thurston Cty. Wash. complaint filed Sep. 18, 2023)]  MORE >>

"Health plan fiduciaries should retain a qualified independent pharmacy consultant, specialized auditor, and ERISA legal counsel to assist with PBM monitoring. Various audits are recommended to assess compliance, market changes, claims data, pricing, and performance, among other factors. Consider conducting RFPs every few years to adjust to market changes and business needs."  MORE >>

"[1] Affordability of group health plan.... [2] HDHP/HSA limits.... [3] Updated CHIP notice.... [4] HIPAA notice of privacy practices.... [5] Summary of Benefits and Coverage.... [6] Annual compliance notices.... [7] Wellness program notices.... [8] Life insurance evidence of insurability.... [9] Premium payments for fixed indemnity/specified disease insurance.... [10] Coordinate with insurer/TPA on ... [NQTL] comparative analysis ... and ... gag clause prohibition compliance attestation[.]"  MORE >>

12 pages. "[This letter] highlight[s] the topline policy proposals ERIC urges [Congress] to consider in upcoming legislation. Many of these policies address questions one and four outlined in the Request for Information (RFI). Employers can and should be important partners in this effort, helping to forge solutions that result in improved health care access, affordability, quality, transparency, and safety for all Americans."  MORE >>

"[T]his notice postpones [certain] due dates ... until October 7, 2024 ... [T]he following types of taxpayers are ... eligible for the relief provided in this notice: [1] Any individual whose principal residence, and any business entity or sole proprietor whose principal place of business, is located in the State of Israel, the West Bank or Gaza (covered area); [2] Any individual affiliated with a recognized government or philanthropic organization and who is assisting in the covered area, such as a relief worker; [3] Any individual, business entity or sole proprietor, or estate or trust whose tax return preparer or records necessary to meet a deadline for postponed acts are located in the covered area; [4] Any spouse of an affected taxpayer, solely with regard to a joint return of two married individuals; and [5] Any individual visiting the covered area who was killed, injured, or taken hostage as a result of the October 7, 2023 Terrorist Attacks."  MORE >>

"After years of mortality improvements, a slowing of life expectancy gains resulting from the COVID-19 pandemic has triggered uncertainty for life insurers and annuity providers.... But while the number of deaths increased (to the degree that average U.S. life expectancy dropped by almost two years), new business strain from record-setting premium growth in 2019 to 2021 (also driven by the pandemic) had a greater impact on life insurers' earnings[.]"  MORE >>