68 pages. "What's New: [1] New Form 7206.... [2] New employer-coverage affordability rule for family members of employees.... [3] Applicable federal poverty line percentages."  MORE >>

"Some companies mistakenly claim that notes from doctors based merely on self-reported health information can convert non-medical food, wellness and exercise expenses into medical expenses ... Such a note would not establish that an otherwise personal expense satisfies the requirement that it be related to a targeted diagnosis-specific activity or treatment[.]"  MORE >>

"[A] graphic illustrates this complexity by highlighting four key PFML substantive areas -- [1] qualifying absences, [2] covered family members, [3] length of benefits and duration of leave, and [4] amount of pay.... Mandatory PFML programs are comprised of more than 30 substantive, technical requirements, many of which have additional layers, such as definitions, formulas, and administrative standards. When examined, it is clear that many of these measures are mismatched and misaligned."  MORE >>

"Medical management techniques within a specific contraceptive category will be considered reasonable if the plan covers, without cost sharing, all FDA-approved contraceptive drugs and drug-led devices, other than those for which there is at least one therapeutic equivalent drug or drug-led device that is covered without cost sharing. When a therapeutic equivalent treatment is covered, the departments expect health plans to have a reasonable exceptions process available."  MORE >>

"[On] January 4, 2022, the NYSDOH adopted the CDC's COVID-19 isolation and quarantine recommendations in its own guidance for the general population. Based on the CDC guidance at that time, the NYSDOH recommended five [5] days of isolation for most employees diagnosed with COVID-19 ... The NYSDOH guidance directly impacts leave under the New York State COVID-19 Emergency Leave law, which was signed into law in March 2020 and remains active and in effect."  MORE >>

"This case illustrates how class action litigants are bypassing the remedial provisions in ERISA and pursing section 1557 discrimination claims to recover damages resulting from benefits denials and to obtain nationwide injunctive relief barring implementation of plan provisions that are alleged to discriminate on the basis of a protected status." [Berton v. Aetna, Inc., No. 23-1849 (N.D. Cal. Feb. 29, 2024)]  MORE >>

"The J&J Case: ERISA Fundamentals Revisited ... The words 'fiduciary' and 'fiduciaries' are used over 150 times in the J&J complaint.... Employer fiduciary duties ... When do the ERISA fiduciary duties apply? ... The core four ERISA fiduciary duties." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"Cigna's pharmacy benefits management unit struck agreements with Novo Nordisk and Eli Lilly that aim to limit spending increases for their treatments to a maximum of 15% annually, a company spokesperson told CNBC. The move comes as many insurers mull whether they should cover those treatments or drop them from their plans altogether due to the high costs of those drugs."  MORE >>

"[CMS is] actively examining [its] authority to help support these critical providers at this time and working with states to do the same. [CMS is] also in frequent communication with UnitedHealth Group and Optum and will continue to press them to swiftly communicate with the health care sector and to offer better options for interim payments to providers."  MORE >>

"Multiple suits have been filed in Minnesota as well as in Tennessee, with patients seeking a potential class action over the company's failure to protect their data. In one such suit ... a patient alleges that as of March 5 they had not been notified directly of the breach or as to the status of their own personal information."  MORE >>

"[1] Prioritise holistic wellbeing ... [2] Embrace eco-friendly benefits ... [3] Create a supportive and inclusive environment ... [4] Governance and compliance ... [5] Invest in employee engagement and development."  MORE >>

"Employers have an essential role to play in addressing stress in the workplace.... [1] Foster a positive work environment ... [2] Offer workplace wellness programs ... [3] Encourage breaks and time off ... [4] Provide clear expectations and support ... [5] Address workplace issues promptly ... [6] Manage workload and deadlines."  MORE >>

"The cross-government inquiry seeks to understand how certain health care market transactions may increase consolidation and generate profits for firms while threatening patients' health, workers' safety, quality of care and affordable health care for patients and taxpayers. The agencies issued a Request for Information (RFI) requesting public comment on deals conducted by health systems, private payers, private equity funds and other alternative asset managers that involve health care providers, facilities or ancillary products or services. The RFI also requests information on transactions that would not be reported to the Justice Department or FTC for antitrust review under the Hart-Scott-Rodino Antitrust Improvements Act."  MORE >>