"This reporting obligation encompasses both self-funded and fully insured group health plans, and it is mandatory, regardless of whether the prescription drug coverage functions as the primary or secondary option alongside Medicare.... Completing the disclosure to CMS form ... Disclosure to plan participants ... Plans exempt from the filing process."  MORE >>

"The salary basis provision requires full compensation in the predetermined amount for weeks in which any work is performed by the exempt employee and prohibits reductions from that pay unless covered by a specific exception. One such exception is for full-day absences unrelated to sickness or disability.... [If] the exempt employee has run out of the accrued PTO and is absent for less than a full day, the pay can't be reduced to account for no available PTO, and the employer must pay the entire guaranteed salary."  MORE >>

"[T]he Tenth Circuit concluded that ... requiring beneficiaries to satisfy acute-care criteria for mental health or substance-use benefits, while not requiring the same of those seeking medical or surgical benefits, would constitute a discrepancy between treatment limitations on benefits for mental health or substance-use and for analogous medical or surgical benefits." [E.W. v. Health Net Life Ins. Co., No. 21-4110 (10th Cir. Nov. 21, 2023)]  MORE >>

"Navigating the complexities of day-to-day operations and meeting fiduciary obligations necessitates a comprehensive understanding of applicable laws and regulations, compelling the need for a well-crafted Plan Administration Manual. The absence of such a manual places plan administrators at risk of regulatory non-compliance, potentially resulting in costly consequences."  MORE >>

"While the traditional turn-key approach simplifies administration and provides a network of providers, it may also limit flexibility, hindering the implementation of third-party cost containment solutions not supported by the chosen carrier.... [B]efore embracing change, sponsors must assess their readiness to navigate the fiduciary challenges associated with such a transition."  MORE >>

"In a 2023 survey of global employers, 80% reported they have or are developing a globally consistent well-being strategy, a significant upward trend and a shift compared to prior years. Before developing such strategies, employers need to understand the macro challenges and trends influencing the need for effective global well-being plans and outcomes."  MORE >>

"[E]mployers can advise employees to shop around for their healthcare needs, just as they would shop around for other products or services.... By encouraging your employees to establish regular care with a primary care physician, you can expect to see a reduced overall cost of healthcare and improved outcomes.... Virtual care options can be seamlessly integrated into an organization's current benefit plan offerings, enabling employees to access care when and where they need it."  MORE >>

"Instead of a vibrant marketplace driven by competition and consumer choice, the pharmaceutical sector resembles an arena where a few dominant players wield disproportionate influence ... Into this multifaceted drama enters the CAA ... [T]he fiduciary duty of prudence is no longer just about selecting and monitoring plan options. It's about ensuring that these options are presented and operated with a level of transparency that leaves no room for ambiguity or concealment. Plan sponsors are now under a microscope, with every decision subject to scrutiny, not just by regulatory bodies but by the very individuals they serve -- the plan participants."  MORE >>

"[The authors] argue that methods for valuing drug therapies need updating. Such improvements would make the estimated value of some, although not all, prescription drugs more favorable in economic assessments. In the long run, these improvements will have the effect of promoting the continued development of drugs that produce health benefits that are worth more than what society must spend to invent those drugs in the first place."  MORE >>