"All too frequently the service provider is not submitting the Forms 1094-C and 1095-C to the IRS on behalf of the employer despite performing other payroll functions for the employer.... [T]his has led to the employer receiving a late filing penalty. Recently, the IRS appears to have shifted its position and not allowed these late filing penalties to be abated.... [E]very employer should ask its ACA service provider for a receipt ID prior to April 1, 2024. The receipt ID is a collection of letters and numbers a service provider receives when the service provider submits the Forms 1094-C and 1095-C to the IRS on behalf of an employer."  MORE >>

"Because fiduciaries are now required to have increased access to cost and pricing information of underlying plan benefits, considering how to use data to help evaluate and control plan costs should be top of mind for ERISA group health plan fiduciaries. Identifying the responsible fiduciaries for this function is critical as ERISA plaintiffs' firms begin using the same or similar data to support claims regarding excessive fees paid by group health plans." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"[CMS urges] insurance companies and other payers to: [1] Make interim payments to impacted providers.... [2] Ease the administrative burden on providers by simplifying electronic data interchange requirements and timelines and by accepting paper claims. [3] Pause prior authorizations and other utilization management requirements; use all available leeway on deadlines."  MORE >>

"For organizations with potential exposures arising from the Change Healthcare cyber incident, it's imperative to connect with your internal stakeholders to proactively identify possible financial impacts.... [O]rganizations who have been impacted should strongly consider putting their cyber insurers on notice. Further, organizations that use UnitedHealthcare, Optum or Change Healthcare, but are not yet sure they have been impacted by this incident, should ... determine whether proactively issuing a notice of circumstance is the right course of action."  MORE >>

"What types of formulary structures are there? ... What considerations do payers take into account when developing a formulary? ... What are key trends to consider in formulary development?"  MORE >>

"If your organization offers an FSA grace period, take time to help employees protect their health and avoid becoming one of the nearly 40% of FSA users who forfeit funds each year....There are thousands of products that are FSA eligible ... An FSA can help employees prepare their skin for spring ... [] Menstrual care products are FSA eligible ... Over-the-counter medications are covered."  MORE >>

"Navigating the complex landscape of employee benefits poses a challenge for employers, especially those seeking to support part-time workers or individuals exempt from mandatory benefit provisions. Cost-effective options, particularly standalone telehealth services, can not only significantly improve access to care but also lead to enhanced employee productivity and improved retention rates."  MORE >>

"The Court noted that ... Unum relied on the same physician opinions to initially deny Plaintiff's claim and to deny her appeal. The Court ... stated that while ERISA does not require the reviewing physician to have the exact same specialty as the claimant's treating physician, Unum's reviewer was not a physician, and Unum did not even contend that she had the appropriate training and experience." [Black v. Unum Life Ins. Co. of Am., No. 22-2116 (N.D. Tex. Feb. 29, 2024)]  MORE >>