"To the extent a term in a contract, either directly or indirectly prevents a plan from providing, accessing, or sharing the information and/or data, that term in the contract violates the gag clause prohibition.... For plans unsure of whether a violation exists and whether they can make an absolute declaration of compliance, the plan may be unable to file a gag clause attestation and will want to document the due diligence the plan sponsor took in collecting and reviewing material in accordance with the regulations.... It is unclear at this time what, if any, penalties will apply if a plan sponsor fails to make an attestation."  MORE >>

"The IRS recently finalized guidance confirming that ALEs must furnish the Forms 1095-C to employees no later than March 1, 2024. ALEs must file the Form 1094-C, as well as copies of the Forms 1095-C, with the IRS electronically no later than April 1, 2024. New IRS rules have effectively eliminated the ability to file by paper in 2024 ... [E]mployers should ensure they engage with an ACA reporting vendor that can complete the electronic filing on their behalf."  MORE >>

"[T]he Departments are proposing that payers be required to provide additional information at the time of initial payment or notice of denial of payment ... [and] that payers use standardized codes to communicate whether a claim for an item or service furnished by an out-of-network provider or facility is or is not subject to the NSA's surprise billing provisions and the Federal IDR process.... The Departments propose several changes to the open negotiation process to encourage disputing parties to engage in meaningful open negotiations before initiating the Federal IDR process.... This proposed rule would establish a Departmental eligibility review process that could be invoked when dispute volume is high so that the Departments could support eligibility determinations to facilitate faster dispute processing."  MORE >>

"The proposed rule addresses specific issues critical to improving the functioning of the Federal IDR process ... [If] finalized, this proposed rule would [1] facilitate improved communications between payers, providers, and certified IDR entities; [2] adjust specific timelines and steps of the Federal IDR process; [3] establish new batching provisions; [4] create more efficiencies; and [5] change the administrative fee structure to improve accessibility of the process."  MORE >>

"In an apparent unprecedented move, the Third Circuit has permitted a Pennsylvania district court's appointment of a special master to conduct an independent review of an insurance company's claim denial.... The Third Circuit held that the court 'correctly recognized the potential for structural conflict where an insurer "both determines eligibility for benefits and pays for benefits," and it correctly noted that 'reliance on a non-examining physician's opinion premised on a records review alone is suspect and [can] suggest[] that the insurer is looking for a reason to deny benefits.' " [Lewis v. Hartford Life & Accident Ins. Co., No. 23-2431 (3d Cir. Oct. 26, 2023)]  MORE >>

"[This case involves] multi-district litigation (MDL) of consolidated actions brought by health insurance subscribers against Blue Cross under the Sherman Antitrust Act as well as antitrust claims brought by healthcare providers against Blue Cross.... The DOL filed a statement of interest in the proposed settlement, expressing concern that the settlement agreement might affect employers' and plan fiduciaries' obligations under ERISA and did not account for ERISA at all. The district court rejected this concern, overruled all objections, and approved the settlement." [In re Blue Cross Blue Shield Antitrust Litig. MDL 2406, No. 22-13051(11th Cir. Oct. 25, 2023)]  MORE >>

"While this data paints a grim picture of future prescription drug costs, there are still opportunities to manage these costs more effectively ... [1] Leverage technology to increase employee understanding and compliance ... [2] Manage plans carefully ... [3] Find the right partners ... [4] Take advantage of disruptions to the status quo."  MORE >>

"The number of Californians taking paid family leave to bond with a new child doubled from fiscal year 2005 to fiscal year 2023. Fathers accounted for most of that growth."  MORE >>

"Traditional questionnaire-based evaluations and SOC 2 reports are insufficient for giving current information about a vendor's security posture. Plan fiduciaries must adopt a more intelligent and scientific approach ... to protect sensitive data, stay ahead of new threats, and ensure their providers are committed to upholding a solid security posture. Plan fiduciaries can improve their cybersecurity defenses and reduce the risks related to vendor relationships by employing continuous monitoring, quantifiable metrics, and rigorous testing."  MORE >>

"Evaluating and designing a benefits package that packs a punch is a big lift that requires the involvement of an organization's top decision makers and leaders. Too often, however, companies relegate all benefit-related tasks to just the human resources department ... The C-suite possesses the data and information necessary to make key benefits strategy decisions, such as growth and profit projections, anticipated personnel needs, merger and acquisition possibilities, financial analyses, and product-development goals."  MORE >>