"[HHS] issued updated FPL figures effective Jan. 11, 2024, that will apply for 2025 calendar-year plans and noncalendar-year plans beginning in 2024. Employers with calendar-year plans can't rely on those higher FPLs for 2024 affordability testing. Instead, 2024 calendar-year plan sponsors must use the 2023 FPL amounts."  MORE >>

"Notice 2023-70 sets the adjusted applicable dollar amount used to calculate the fee at $3.22.... [T]his fee is imposed per average number of covered lives for plan years that end on or after October 1, 2023, and before October 1, 2024. For self-funded plans, the average number of covered lives is calculated by one of three methods: [1] the actual count method; [2] the snapshot method; or [3] the Form 5500 method."  MORE >>

"The [Ninth Circuit] cautioned that not 'all assignments of the right to benefits ... necessarily confer the right to sue under ERISA' and expressly limited its decision ... The Ninth Circuit's decision ... came on the heels of pair of appeals before the Eleventh Circuit that also raised questions regarding the assignment of ERISA claims.... In both cases, the Eleventh Circuit held that [the provider] ... lacked standing under ERISA." [South Coast Specialty Surgery Ctr., Inc. v. Blue Cross of Calif., No. 22-55717 (9th Cir. Jan. 10, 2024); Griffin v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., No. 23-11414 (11th Cir. Dec. 19, 2023); Griffin v. AT&T Services, Inc., No. 23-11408 (11th Cir. Dec. 21, 2023)]  MORE >>

"Court decisions continue to demonstrate the uncertainty surrounding the scope of Section 1557 as applied to employer-sponsored health plans. As we wait for the Section 1557 regulations proposed in 2022 to be finalized, this court has already rejected the 2020 regulations based on a plain reading of the statute's text." [C.P. v. Blue Cross Blue Shield of Ill., No. 20-6145 (W.D. Wash. Dec. 19, 2023)]  MORE >>

"Of course, employees do sometimes do get caught ... taking fraudulent FMLA leave ... If it turns out that the employee's activity was consistent with her alleged medical condition and that the activity had been authorized by her health care provider, then the leave is almost certainly not fraudulent. Which means that if you fire without considering these possibilities and conducting an adequate investigation, you could be liable -- in one way or another -- for terminating an employee on a legitimate FMLA leave." [Burnett v. East Tallahatchie School Dist., No. 23-183 (N.D. Miss. Jan. 11, 2024)]  MORE >>

"Traditional treatment for depression, like SSRIs, doesn't serve everyone.... Yet, coverage of alternatives, such as generic ketamine, that might just stand to get people off of ineffective SSRIs altogether, is scarce among major commercial health insurance plans.... Employers across industries, from trucking, to software, gaming, financial services, healthcare, and retail, are adding this medicine to health benefits packages."  MORE >>

"[D]espite a high volume of claims being submitted to independent dispute resolution (IDR), the law's components appear to be working ... Health care providers typically accept the initial payment made by health insurance providers ... [T]wo-thirds of health insurance providers report their provider networks have increased since the NSA became law, with none reporting an overall reduction in participating providers."  MORE >>

"The debate about cost often moves between unit cost and utilization. However, [the authors] believe it's a combination, with utilization the bigger concern. Also, the most critical requirement is keeping quality of care high. This article will examine these issues and explores how value-based care models, directed by primary care physicians, are a potential solution."  MORE >>

"The large employer group health insurance market lacks a standardized source for nationwide premium development information. California regulations require issuers of these health insurance products to submit rate filings to their regulator(s). This whitepaper summarizes key statistics from the first four years of these filings."  MORE >>

"In addition to being cognizant of requirements and best practices, employers now must understand how new innovative technologies and solutions, namely artificial intelligence (AI), will impact their businesses and benefit offerings.... [As] employers consider the best way to leverage AI, they should be aware of the impact it may have on data privacy and security, sensitive personal information, and potential breaches."  MORE >>