"[T]he Final Instructions ... kept the simplified methodology, without modification, as an alternative to the actuarial value test for 2025 for plans not seeking the RDS.... [E]mployers need to be prepared for modifications or a completely new 'simplified' method for 2026 and beyond.... Plan sponsors, particularly calendar year plans, should begin analysis ... to see what, if any, changes need to occur for their 2025 prescription drug plans."  MORE >>

"The court began by clarifying that Ryan did not need to allege a categorical denial practice, or the 'uniform denial of his benefits,' which the district court appeared to require. Simply handling MH/SUD claims more stringently constitutes a Parity Act violation, regardless of whether it leads to uniform denial decisions. The Ninth Circuit further held that Parity Act claimants need not 'identify an analogous category of claims with precision.' " [Ryan S. v. UnitedHealth Group, Inc., No. 22-55761 (9th Cir. Apr. 11, 2024)]  MORE >>

"The [CAA's] compensation disclosure rules are of particular interest to plaintiffs' attorneys, as they may lead to increased scrutiny of the underlying fees and result in litigation related to unreasonable vendor fees and services.... [Here are] clear, actionable steps employers can take to prepare for this potential new wave of litigation.... [P]olicies and procedures related to retirement plans will serve as a useful guide for health and welfare plan fiduciaries seeking protection from these novel lawsuits."  MORE >>

"Out of all the consumers expected to make an out-of-pocket payment for health care, Gen Z is the least likely (32%) to be aware that they would need to make such a payment. This lack of awareness reverberates into their saving habits with one-third of employees under the age of 30 contributing nothing to their HSA annually, and only 14% contributing over $3,000 per year."  MORE >>

"When plan sponsors -- employer groups, multiemployer trusts, or associations -- want to offer their participants choice in health coverage through either multiple carrier or benefit plan options, there will be an inherent selection risk and therefore additional cost that needs to be considered. Risk adjustment can be used to quantify and reallocate this cost."  MORE >>

"Despite experiencing such profound symptoms, claimants seeking disability benefits for long COVID frequently face a major challenge in qualifying for benefits. Because symptoms such as fatigue and pain are unmeasurable, disability insurers often dispute long COVID claims, asserting a lack of objective evidence. This blog offers a guide to winning a long COVID disability insurance claim."  MORE >>