"This document describes updated timelines and clarifies processes with regard to Failure to File and Reconcile (FTR) operations for plan years 2024, 2025, and beyond. The guidance referenced in this document is applicable to all Exchanges and provides specific operational details for consumers in Exchanges using the federal eligibility and enrollment platform. This guidance supersedes the previously issued guidance, Failure to File and Reconcile Operations Flexibilities for Plan Year 2023, released on July 18, 2022, "  MORE >>

"Most likely, neither your company nor your self-insured health plan is currently subject to the Section 1557 nondiscrimination rules simply because the plan's third-party administrator (TPA) also sells policies through the Exchanges -- but the law in this area continues to evolve. "  MORE >>

"The IRS notes that these programs are frequently incorporated into EAPs or bundled with other employer services, although the IRS notes the FAQs only address the federal tax treatment of the services and not the direct or indirect payment for life-management resources or similar services offered through an EAP. Some employer programs cover both referrals for resources and the actual resources themselves. The IRS' statement is intended to limit the scope of the FAQs to exclude WLR programs that offer the actual resources themselves."  MORE >>

"The 400-page final rule provides an expansive, employee-friendly interpretation of the PWFA and clarifies who is covered, the types of limitations and medical conditions covered, and how to request reasonable accommodations.... The final rule includes examples of limitations and medical conditions for which employees can seek reasonable accommodations ... The final rule emphasizes that informing employers of limitations and requesting reasonable accommodations should not be complicated or difficult."  MORE >>

"The court determined that by alleging a systematic denial of his MH/SUD benefit claims and citing the state report's conclusion that the insurer was applying a more stringent algorithmic review process to such claims, the participant had plausibly alleged that the insurer had applied an improper internal process to his claims in violation of the MHPAEA." [Ryan S. v. UnitedHealth Group, Inc., No. 22-55761 (9th Cir. Apr. 11, 2024)]  MORE >>

"Though her degenerative cervical spine condition was not diagnosed or suspected during the look-back period, the district court found that it caused symptoms of neck pain for which she sought treatment.... The [Ninth Circuit] explained that the exclusion does not require a diagnosis during the look-back period. Second, the urgent care notes support the conclusion that Roeder suffered symptoms and received treatment for two separate complaints." [Roeder v. Guardian Life Ins. Co., No. 22-56226 (9th Cir. Apr. 15, 2024)]  MORE >>

"The Zavislak decision is one of the most detailed analyses by a court on the scope of ERISA Section 104(b)(4). As such, it is likely that Zavislak will be cited by both litigants and courts in similar disputes involving participant requests for documents, including service provider agreements. Nevertheless, the legal issue of whether service provider agreements must be disclosed remains unsettled. Plan administrators who receive such requests should consider the extent to which agreements must be provided based on case law in the applicable jurisdiction." [Zavislak v. Netflix, Inc., No. 21-1811 (N.D. Cal. Jan. 31, 2024)]  MORE >>

"Witnesses shared stories of interrupted cash flows, high-interest loans, substantial administrative burdens, fragmented care coordination and resulting confusion for patients in testimony before the House Energy and Commerce Committee's Subcommittee on Health.... UnitedHealth Group, the parent company of Change Healthcare, was invited to participate in the session but did not attend. "  MORE >>

"[T]he majority (60 percent) of [HSA] accountholders reported that they are using the account to take advantage of employer contributions. Similarly, 58 percent opened their HSA to save for future health care expenses and 52 percent to save on taxes.... Almost one-half of accountholders would be more likely to accumulate and invest unused funds if they were provided an annual review of their HSA balance, and one-third (35 percent) would be more likely to accumulate and invest unused funds if information about the account benefits and how it works were sent to them via email."  MORE >>