"An employer can be subject to a significant shared employer responsibility payment (ESRP) ... if it fails to offer sufficient health coverage causing a full-time employee to qualify for a premium tax credit.... Employers are also required to timely report information on health coverage ... under IRC Sec. 6056.... Currently, the IRS is issuing ESRP and information reporting penalty notices to employers that relate back to the 2020 and 2021 tax years."  MORE >>

"This proposed rule regulates the financial requirements, quantitative treatment limitations (QTLs), and non-quantitative treatment limitations (NQTLs) that Health Plans use when designing and administering Plan benefits and provides crucial instruction to the Departments aimed at facilitating increased enforcement of MHPAEA’s requirements and stricter penalties for noncompliance.... [O]nce finalized, the 2023 Proposed Rule will be effective for group Health Plans on January 1, 2025 and effective for individual Health Plans on January 1, 2026."  MORE >>

"Five years ago, New Jersey's legislature amended the law covering family leave insurance to expand its benefits and provide a private cause of action for retaliation for using those benefits.... New Jersey Courts have not yet grappled with how this statute would interact with the New Jersey Family Leave Act's inapplicability to small employers. This article explores the differences between the parameters of these leave and benefits laws, explores a case that addressed this issue, and discusses how small employers and their lawyers can prepare to defend against a new and possibly unintended retaliation claim."  MORE >>

"[T]he class plaintiff argues J&J had the duty to ensure that decisions were made in the best interest of the plan and its participants, including reviewing the plan's prescription drug costs and taking steps from such reviews to save the plan and participants millions of dollars. If J&J is ultimately found to have breached its fiduciary duties in this area, there could be a wave of claims targeting similar situations." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"[T]he court ... [observed] that it could not conclude as a matter of law that mailing the notice to the wrong address after being informed of the correct address 'months before' counts as 'reasonably calculated to ensure actual receipt.' " [Schinnerer v. Wellstar Health, Inc., No. 22-0383 (N.D. Ga. Feb. 7, 2024)]  MORE >>

"Plaintiff argued that the interpretation of “on assignment by” to mean requiring “pre-authorization” or specific instruction from Honeywell to Decedent to travel to Texas was an unfair interpretation when Decedent’s work assignment included travel to Texas as needed and his role and authority included making decisions about how to accomplish his objectives there. The court disagreed. Interpreting “on assignment by” to mean requiring Honeywell’s knowledge and approval was reasonable, not ambiguous, and in any event, a reasonable exercise of National Union’s interpretive discretion." [Krishna v. National Union Fire Insurance Company of Pittsburgh, Pennsylvania, No. 23-20289 (5th Cir. Mar. 11, 2024; unpub.)]  MORE >>

"Some companies are now facing employee questions/demands to cover the new weight loss medications ... Employers that opted to cover them, quickly found these drugs soared to their top five most expensive health plan costs within 90 days of initiating coverage ... The reality is the benefit of these new weight loss drugs in the health journey of Americans struggling with obesity remains an open question as sustained use is required to measure their long-term effects."  MORE >>

"Arguably, the incident itself is not remarkable as ransomware attacks are common. The entity that was targeted, and its effect on the broader ecosystem, however, is notable. This incident highlights the healthcare system's interconnected nature and nationwide reach, and the broader impact of the disruption on economic activity." [IN12330 Mar. 12, 2024]  MORE >>

"Prescription drug costs remain a critical concern for consumers, payers and policymakers alike.... This paper discusses an alternative to policy solutions: reimagining pharmacy financing in the commercial space using a value-based reimbursement model. The model aims to increase transparency in drug pricing, encourage pharmaceutical competition, align stakeholder incentives and mitigate total cost of care increases. This paper demonstrates that it is possible to implement such a methodology under the current infrastructure but acknowledges potential limitations."  MORE >>

"These proposed regulations would remove the physical presence requirement for formal continuing professional education programs required for active enrolled actuaries and the physical location requirement from course certifications. These proposed regulations also would modify the continuing professional education requirement for certain actuaries who seek to return to active enrollment from inactive status due to their failure to timely satisfy the renewal requirements in the first enrollment cycle after their initial enrollment cycle. Finally, the proposed regulations would add a requirement that certificates of instruction for continuing professional education courses include the number of hours counted towards the required number of hours for formal programs."  MORE >>

"[P]laintiffs contend that Section 42's 'equivalent benefits' provision is preempted by ERISA because it 'relates to' their employee benefit plans by having a 'connection with or reference to' those plans. The court agreed ... The [Illinois DOL] objected, arguing that Section 42's cash alternative allowed the law to escape preemption because it enabled the plaintiffs to comply without involving their benefit plans. The court rejected this argument[.]" [Staffing Servs. Ass'n of Ill. v. Flanagan, No. 23-16208 (N.D. Ill. Mar. 11, 2024)]  MORE >>