"Use a separate Form 7206 for each trade or business under which an insurance plan is established."  MORE >>

45 pages. Topics: [1] Year-end Washington update; [2] End of the Public Health and National Emergencies and Outbreak Period; [3] Developments in prescription drug coverage; [4] CAA, 2021 Updates: TiC and IDR; [5] Preventive services developments; [6] HIPAA developments; [7] 2023 Mental Health Parity proposed regulations; and [8] Grab bag report and reminders.  MORE >>

"An exception is available for small employers that employed an average of at least two ... but no more than 50 employees ... during the preceding calendar year.... An increased cost exemption is available for plans that make changes to comply with the mental health parity rules and incur an increased cost of at least 2% in the first year that the MHPAEA applies to the plan ... The federal mental health parity requirements do not apply to group health plans that provide only excepted benefits[.]"  MORE >>

"[T]he Departments have proposed several revisions to the batching regulations that permit parties to submit multiple claims together for a single adjudication....The Departments have also proposed significant modifications to the provisions of the regulations governing the mandatory open negotiation process that precedes the initiation of arbitration under the Act.... Finally, the Departments have proposed modifications to the non-refundable administrative fee parties must pay to access the Act's arbitration proceedings."  MORE >>

"The court acknowledged that prior case law has established that criminal theft indisputably constitutes gross misconduct but noted that the former employees had not admitted to stealing the data and the city had not offered admissible evidence proving the employees' actions." [Johnson v. City of Kewanee, No. 21-4051 (C.D. Ill. Nov. 21, 2023)]  MORE >>

"This case is one of a growing number of lawsuits alleging improper self-dealing by third-party administrators (TPAs) for charging 'savings fees' to self-funded plans based on alleged savings achieved for the plans through the TPAs' processing of out-of-network claims." [Hudson Hospital OPCO, LLC. d/b/a CarePoint Health-Christ Hospital v. Cigna Health and Life Ins. Co., No. 22-4964 (D.N.J. second amended complaint filed Nov. 29, 2023)]  MORE >>

"[On] December 7, 2023, the City Council's Workforce Development Committee approved amendments to the ordinance that would delay implementation of the new requirements until July 1, 2024. The amendments would also impose a 16-day cooling off period before a worker could sue their employer for violating the ordinance and narrow the definition of workers covered under the policy to make it less likely that traveling workers in the trade show industry would be affected. The proposed amendment must still be approved by the full City Council."  MORE >>

"Unless the employer wants to modify its handbook and plan documents (and for self-funded plans, stop loss coverage) to provide continued active coverage during an unpaid leave, the employer instead should consider categorizing the coverage during the unpaid leave as COBRA coverage. Failure to do so could result in the stop loss carrier or insurance company denying claims during the period of the unpaid leave, as the employee was not actively at work, on a protected leave, or on COBRA."  MORE >>

"The deal could make an already complicated market even more opaque for health plans by lumping together two of the nation's largest PBMs ... There's already concern among employers that PBMs are making drugs more expensive, prompting the Federal Trade Commission -- which must approve a Humana-Cigna merger -- to separately investigate the industry."  MORE >>

"The settlement involves a Louisiana-based medical group of health providers that specializes in emergency and occupational medicine. The enforcement action arose after a hacker gained access, through a successful phishing attack, to an email account containing individuals' electronic protected health information (ePHI)."  MORE >>

16 pages. Articles include: [1] No-gag clause rule update; [2] DOL And IRS finalize changes to Form 5500; [3] Tightening the screws on mental health parity enforcement; [4] Increase in actuarial equivalence lawsuits; [5] U.S. Supreme Court declines to resolve split regarding enforceability of ERISA plan arbitration provisions [6] Is your health plan secure? [7] The aftermath of Hughes V. Northwestern University; and [8] Will AI replace ERISA counsel?  MORE >>