"This combined call letter outlines OPM's policy goals and initiatives for benefit and rate proposals from Carriers in the 2025 Plan Year.... Carriers must submit their benefit and rate proposals on or before May 31, 2024, for the contract term beginning January 1, 2025. OPM expects to complete benefit negotiations by July 31, 2024, and rate negotiations by mid-August to ensure a timely Open Season."  MORE >>

"[The final rules provide] guidance on a number of important topics including ... [1] Whether and when employees accrue and can use ESST for time spent on call. [2] Appropriate procedures for frontloading ESST in lieu of allowing employee to accrue ESST. [3] Using an existing PTO policy to satisfy ESST requirements.... [4] Requesting documentation to support ESST leave requests."  MORE >>

"The filing deadline is 60 days following the first day of the plan year.... The Disclosure to CMS Form requires employers to provide detailed information to CMS including but not limited to, the name of the entity offering coverage, whether the entity has any subsidiaries, the number of benefit options offered, the creditable coverage status of the options offered, the period covered by the Disclosure to CMS Form, the number of Part D eligible individuals, the date of the notice of creditable coverage, and any change in creditable coverage status."  MORE >>

"The court explained that Section 1132(a)(1)(B) allows suits for benefits that are 'due…under the terms of [a] plan.' Because Mr. Watson had not converted his coverage according to the plan terms, no benefits were 'due under the plan' and thus Ms. Watson could not bring an (a)(1)(B) claim. As a result, Ms. Watson's only alternative was Section 1132(a)(3) ... The Tenth Circuit ruled that the district court had conflated these two sections. By imposing (a)(1)(B) requirements, i.e., complying with the plan's conversion rules, to Ms. Watson's (a)(3) claim ... the district court 'legally erred' and thus reversal was required." [Watson v. EMC Corp., No. 22-1356 (10th Cir. Feb. 9, 2024)]  MORE >>

"The court's ruling clarified that the party seeking to enforce its lien bears the burden of proving the existence of a fund over which a lien can be asserted, and also established the need to prove the ongoing existence of the funds at issue. Prior to this ruling, those issues were unsettled." [Verizon Sickness and Accident Disability Benefit Plan for New England Assoc. v. Rogers., No. 21-0110 (D.R.I. Jan. 29, 2024)]  MORE >>

"About 22 percent of emergency visits in 2015 resulted in a surprise out-of-network physician bill. The No Surprises Act limits the amount patients can be billed for those services ... But behind the scenes, the new law has created more chaos in an already chaotic system.... Some companies prospered by issuing surprise bills -- it was part of their business model. It is perhaps no surprise that 46 percent of requests for baseball-style arbitration came from physician staffing companies that were wholly or partially owned by private equity firms."  MORE >>

"By partnering with the right vendor, employers can address these issues head-on and get more out of benefits budgets. [1] Claims payment errors ... [2] Billing and payroll errors ... [3] Ineligible dependents ... [4] Poor enrollment decisions ... [5] Poor benefit utilization."  MORE >>

"[T]here are many layers to leave management, and it requires clearly written guidelines. These policies ensure that employees understand their rights and obligations and reduce the risk of disputes or grievances. ..[C]onsider ... federal requirements, state and local regulations, and your current leave policies."  MORE >>

"With each generation that enters the workforce, so does a unique set of benefit requests that suit their lifestyles, aspirations, and shifting medical needs.... [By] identifying the things that each group values the most, you can begin to craft a benefits program that resonates with each generation."  MORE >>

"The J&J case provides a valuable glimpse into the potential liabilities of being a fiduciary when these duties are not upheld. Fiduciaries that do not adhere to the basic standards of conduct (aka, their fiduciary duties) can very easily find themselves personally liable for restoring any losses to the plan, or for restoring any profits made through improper use of the plan’s assets that result from their actions."  MORE >>

"[F]ederal legislators are starting substantial conversations to find a viable bipartisan approach that expands retirement or paid family medical leave to cover all U.S. workers. These federal discussions build on the work happening in more than a dozen states, yet the players are not always talking to and learning from each other.... [This article provides] a framework of the seven essential elements to enact sustainable public-private partnerships that create universal retirement and/or paid family medical leave [along with] two elements to leave out of legislation to avoid insolvency, unnecessary constraints and the potential for partisanship."  MORE >>