"This 2025 Final Letter provides updates on operational and technical guidance for the 2025 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2025 Final Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs).... The 2025 Final Letter focuses on guidance that has been updated for the 2025 plan year[.]"  MORE >>

"The Letter 226J is the first letter sent by the IRS notifying the employer that it may be subject to an ESRP.... [T]he assessments often result from misunderstandings or failures to properly complete Forms 1094-C and 1095-C, thus employers oftentimes avoid the proposed assessment entirely, or at least in part, early in the process with relatively little cost."  MORE >>

29 presentation slides. Topics: [1] Washington update; [2] STLDI and fixed indemnity regulations; [3] Wellness incentives/surcharges: benefits areas of concern; [4] Updates to HIPAA online tracking; and [5] Compliance corner.  MORE >>

"The final regulations ... include modifications to the definition of short-term limited-duration insurance (STLDI) as well as new notice requirements for all STDLI policies and marketing materials ... The new notice requirement applies for plans years beginning on or after January 1, 2025. In the group market, it must be provided at or before the time participants are given the opportunity to enroll or reenroll in coverage."  MORE >>

"Depending on how the underlying program is structured, some services might be reimbursable if presented as a requirement implicating the plan's cost sharing features, such as member copays. In such instances, part or all of the fee might actually satisfy IRC Section 213(d), thereby qualifying for reimbursement on the basis of a qualifying and eligible individual healthcare related expense."  MORE >>

"The city of Duluth, Minnesota, repealed its Earned Sick and Safe Time (ESST) ordinance effective Jan. 17, 2024.... Minnesota's statewide ESST statute went into effect on Jan. 1, 2024. The Duluth City Councilors ... stated that Minnesota's state-wide ESST law rendered the city's ordinance unnecessary. The ESST ordinances in Minneapolis and St. Paul remain in effect."  MORE >>

"The Paid Leave Ordinance implements two separate requirements: [1] that employees earn up to 40 hours of paid leave for any purpose, and [2] that employees earn up to 40 hours of paid sick leave per 12-month period.... The Paid Leave Ordinance applies to any employer with at least one employee, and to any employee who works at least 80 hours in Chicago during a 120-day period. Once an employee meets that threshold, they are deemed a 'covered employee' for the duration of their employment with that employer."  MORE >>

"The Johnson & Johnson lawsuit is one of the first of its kind, stemming from the disclosure and transparency in coverage requirements, mirroring the retirement plan excessive fee lawsuits that have come before it.... [G]roup health plan fiduciaries may want to evaluate their current governance structure, including any policies and procedures, especially regarding selecting and monitoring plan providers and determining the reasonableness of plan costs and fees. Here are ten best practices health plan fiduciaries should consider for their fiduciary processes[.]" [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"As a group health plan sponsor, an employer's responsive obligations arising in the context of certain cybercrime events depends largely upon the underlying funding status of the employer's core employee benefit plans ... Additional privacy and security related obligations for the employer may be detailed in various state-level statutory mandates or even within certain international laws or other global-scope regulations.... Several notifications may be required as a consequence of a data breach.... Communication with employees is important[.]"  MORE >>

"The National Compensation Survey (NCS) provides features, costs, and limits of employer-sponsored health care plan benefits for private industry and state and local government workers in the United States. The Excel tables (ZIP) present 2023 estimates of health care plan provisions for private industry workers by occupation, industry, average wage category (percentile), work status (part-time/full-time), bargaining status (union/nonunion), establishment size, and census area."  MORE >>

"Federal legislators and regulators have increasingly expressed concern that PE investors and other for-profit operators of health care companies strip their investments down to bare bones, recapitalize them with debt and make distributions to themselves and other investors with the proceeds of the indebtedness, pay themselves handsome management fees and engage in expensive real estate sale-leaseback transactions. These practices, they argue, are designed to enrich the owners of these organizations at the expense of patient care and safety and the livelihoods of health care workers."  MORE >>

"To adjust payments, insurers and other health care payers use statistical models to determine what providers should be paid based on their patient's expected future health care costs.... Risk adjustment methods vary across payers and programs.... Risk adjustment assumes that all data are complete, accurate, and consistent. But that may not be the case for all patients, and coding practices may be inconsistent across plans."  MORE >>

"[1] SECURE 2.0 optional provisions & additional regulatory guidance.... [2] Prescription drug prices and state PBM legislation.... [3] Welfare plan compensation disclosure and fee litigation.... [4] Cybersecurity.... [5] Gender affirming care considerations.... [6] ACA affordability threshold."  MORE >>

Video of April 11 hearing. Opening statement by Chair Kevin Kiley (R-CA); testimony from [1] Ms. Kristin Sharp, Flex Association; [2] Ms. Gabriella Hoffman, Independent Women"s Forum Center for Economic Opportunity; [3] Dr. Katie Wells, Georgetown University; and [4] Dr. Liya Palagashvili, Mercatus Center at George Mason University.  MORE >>