460 pages. "This proposed rule includes payment parameters and provisions related to the HHS-operated risk adjustment program, as well as 2025 user fee rates for issuers offering qualified health plans (QHPs) ... This proposed rule also includes proposed requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file and reconcile; non-standardized plan option limits and an exceptions process; standardized plan options; special enrollment periods (SEPs) ... network adequacy; public notice procedures for section 1332 waivers; prescription drug benefits ... and State flexibility on the effective date of coverage in the Basic Health Program (BHP)." [Also available: Fact Sheet]  MORE >>

"[T]he 2025 maximum annual limitation on cost sharing is $9,200 for self-only coverage and $18,400 for other than self-only coverage. This represents an approximately 2.6 percent decrease from the 2024 parameters of $9,450 for self-only coverage and $18,900 for other than self-only coverage.... [T]he 2025 required contribution percentage under section 5000A of the Code [is] 7.28 percent ... a decrease of approximately 0.69 percentage points from the 2024 value."  MORE >>

27 pages. "This 2025 Draft Letter provides updates on operational and technical guidance for the 2025 plan year for issuers seeking to offer qualified health plans (QHPs) ... It also describes how parts of this 2025 Draft Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs).... The 2025 Draft Letter focuses on guidance that has been updated for the 2025 plan year[.]"  MORE >>

23 pages. "The AV Calculator represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation.... [CMS] will accept comments on the draft 2025 AV Calculator [XLXM], as well as the draft 2025 AV Calculator User Guide and [this] draft 2025 AV Calculator Methodology until ... January 2, 2024. "  MORE >>

"More than a dozen jurisdictions focused on leave issues during the third quarter of 2023 ... Several states announced 2024 PFML rates. Illinois, New Jersey and Puerto Rico passed laws affecting pharmacy benefit managers (PBMs) and prescription drugs. States passing health insurance coverage mandates included California, Illinois, New Jersey and Oregon.... A new commuter benefit mandate will apply to many Chicago-area employers next year."  MORE >>

"The [Office of Insurance Regulation] recently ... published additional information about the application process, including the application forms and instructions ... The Florida Administrator application requirements are some of the most challenging and robust of any state that licenses TPAs."  MORE >>

"A class-action lawsuit ... [alleges] UnitedHealth Group is using a faulty artificial intelligence algorithm to wrongly deny coverage for Medicare patients who need rehabilitation care following hospitalizations.... The litigation comes amid signs of growing consumer and government suspicion that health insurers are frequently denying payment for medically necessary services." [Estate of Lokeken v. UnitedHealth Group, Inc., No. 23-03514 (D. Minn. complaint filed Nov. 14, 2023)]  MORE >>

"Ketamine is an anesthetic that is perhaps better known as a party drug. But some studies have indicated that it can be effective as a treatment for some types of clinical depression ... and is starting to be offered as an employee benefit by a handful of companies ... A full course of ketamine treatment typically costs $6,000 to $8,000, and depending on the benefit design, companies may spend between $35 to $200 per employee annually to cover it."  MORE >>

"Zepbound is expected to be commercially available in the U.S. after the Thanksgiving holiday in six different doses. Its projected list price is approximately $1,060, which is roughly 20% lower than Wegovy."  MORE >>

"[T]he agencies that purchase health insurance for [the more than 15 million] public employees ... are often the largest commercial purchaser of health care services in their state and therefore have market power to exert pressure on insurance companies and providers.... [T]heir efforts to shift health plan and provider behaviors and encourage greater efficiencies can have ripple effects for other commercial purchasers."  MORE >>

"[I]ncreasing access to HSAs and encouraging investment among HSA account holders can help reduce the cumulative retirement savings shortfall, particularly for demographic cohorts projected to face the largest deficits.... Maximizing HSA enrollment accounts for more than half of the difference in the retirement saving shortfall relative to the baseline with HSA. Maximizing contribution and limiting distribution behavior have minor impacts."  MORE >>

"[EBSA] resources have generally remained unchanged while oversight responsibilities have increased over the last decade.... Although EBSA officials said they use several strategies to manage declining resources, the agency does not have a clear or systematic decision-making process for doing so.... Without [such a] process, EBSA officials may not have adequate information for making informed decisions about how to manage resource reallocations to meet its increased responsibilities." [GAO-24-105667 Published Oct 24, 2023; Released: Nov 16, 2023.]  MORE >>