"Employers are permitted to educate Medicare-eligible employees about the program.... [E]mployers cannot support Medicare-eligible employees by assisting them with Medicare premium payments.... [HHS] representatives have informally indicated that no violation of MSP rules occur when employees entitled to Medicare have the same cash-out rights as employees who are not entitled to Medicare under a bona fide cafeteria plan meeting the requirements of Code Section 125."  MORE >>

"What does the annual update process involve? ... How does CMS set the new benchmarks for Medicare Advantage plans? ... How is the risk adjustment process updated? ... How do Medicare Advantage plans submit bids? ... How does CMS use plan bids to make final decisions?"  MORE >>

"The benefit is available to most civilian federal employees and allows for the substitution of up to 12 weeks of paid parental leave (PPL) for unpaid leave guaranteed by the Family and Medical Leave Act (FMLA), which can be used for the arrival of the employee's new child by birth, adoption, or foster care placement and for bonding with that child." [IF12420, updated Mar. 5, 2024]  MORE >>

"The court found that CEA's refusal to comply with EEOC and HHS mandates on the grounds of their faith would result in significant monetary penalties and therefore, the mandates 'substantially burdened' the organization." [Christian Employers Alliance (CEA) v. EEOC, No. 21-0195 (D. N. Dak. Mar. 4, 2024)]  MORE >>

"In litigation under Section 1557 of the [ACA], a California district court has concluded that a health plan participant plausibly alleged that the plan insurer's artificial insemination coverage standards under the insurer's infertility policy were discriminatory. The court therefore declined to dismiss the claim." [Berton v. Aetna, Inc., No. 23-1849 (N.D. Cal. Feb. 29, 2024)]  MORE >>

61 pages. "[Recommendations for DOL actions:] [1] Encourage Congress to adopt LTD insurance parity requirements consistent with the spirit of MHPAEA mandates for MH/SUD and physical conditions, and strongly encourage employers to consider whether exclusions and MH/SUD limitations are necessary in the current environment.... [2] Commission research of LTD plans to address unknown actuarial and cost implications of removing the duration limits and to identify the underlying rationale for these limitations, if any.... [3] Urge the insurance industry to present plan sponsors with coverage options without duration limits for MH/SUD conditions.... [4] Provide education to LTD plan sponsors on impact of duration limitations in LTD plans."  MORE >>

"Many modern plan designs are meant to incentivize members to be savvy buyers -- meaning they find the top providers for the service they require and compare prices -- a practice we call healthcare consumerism. However, opaque pricing and the pressure of making the 'right' decision as it pertains to our families' health -- often in stressful situations -- makes shopping for providers difficult. Only 14 percent of adults reported going online in the prior six months to research the price of a treatment at a hospital."  MORE >>

"Some 56% of companies said that child-care benefits are their most pressing issue this year, up from 46% in 2023, according to a survey from Care.com. The new perks -- from an extra bank of paid time off when a kid is sick to cash stipends for a babysitter -- beat out paid family leave and mental health benefits as being top of mind for corporate human resources departments."  MORE >>

"[T]he plaintiff was a school teacher who alleged that, due to the mask requirements occurring under COVID-19 protocols, she experienced symptoms of anxiety.... In affirming the trial court, the Court of Appeals held that the record did 'not explain how wearing a mask induced anxiety that substantially limited [Plaintiff's] work, sleep or breathing.' " [Tyler v. Kalamazoo Public Schools, No. 363249 (Mich. Ct. App. Jan. 18, 2024)]  MORE >>

15 pages. "[AHIP supports] the Tri-Departments' interest in increasing access to OTC preventive health care options, starting with OTC contraception, with appropriate guardrails. [AHIP's comments] emphasize the need for health insurance providers to promote access and affordability by directing them to preferred retail settings ... [and] provide recommendations on ensuring implementation places minimal burdens on consumers, providers, pharmacists, and health insurance providers."  MORE >>

"Pharmacists and pharmacies are asking [PBM executives and other insurance payers] for assurances that claims fulfilled during this outage will be paid, and paid in a timely manner ... The pharmacy organizations also asked Change Healthcare to work with the appropriate partners to expeditiously implement less onerous means for all willing pharmacies to process impacted manufacturer patient assistance programs."  MORE >>