"According to the DOL, the 2018 AHP Rule was a significant departure from the DOL's longstanding pre-rule guidance on the definition of 'employer' under ERISA and substantially weakened the DOL's traditional criteria in a manner that would have enabled the creation of commercial AHPs functioning effectively as health insurance issuers."  MORE >>

"Mandatory changes: HIPAA special enrollment events  ... What about dental and vision? ... Are tag along changes [for dependents] allowed? ... (Optional) permitted changes: Section 125 cafeteria plan permitted changes  ... Examples."  MORE >>

"If the entity administering the HSA is not a local financial institution, then the governing documents for the HSA, but not those of the HDHP, would need to be filed with Hacienda to obtain an administrative determination confirming that, both in its terms and operation, the HSA meets the requirements of PRIRC Section 1081.04.... [The] local limits are comparable to the U.S. 2012 limits. Since the limits are established by PRIRC Section 1081.04, rather than through Hacienda's administrative guidance, and are not indexed for inflation, Hacienda cannot approve a higher limit."  MORE >>

"The main exception to the HDHP minimum deductible requirement is the ability of an HDHP to provide first-dollar coverage (i.e., not subject to the deductible) for preventive care without affecting HSA eligibility. [1] First dollar telehealth coverage expiration for plan years beginning on or after January 1, 2025.... [2] First-dollar Covid testing/treatment expiration for plan years ending on or after January 1, 2025."  MORE >>

"Oklahoma's insurance department asked the U.S. Supreme Court to review the Tenth Circuit's decision in PCMA v. Mulready ... which held that parts of an Oklahoma law regulating pharmacy benefit managers (PBMs) were preempted by ERISA and by Medicare Part D. In its petition, the state says that Mulready 'is irreconcilable with [the Supreme Court's] unanimous decision in Rutledge,' and that Mulready also created a 'textbook' circuit split with the Eighth Circuit." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. filed May 10, 2024, No. 23-1213)]  MORE >>

"The Eleventh Circuit also concluded that the county, which had been delegated the functions of administering and providing health insurance for a county sheriff's office employees, was an employer for Title VII purposes.... Much of the recent litigation over health plan exclusions for gender-affirming care is being brought under ACA Section 1557.... Title VII can also be the basis for a successful challenge to such exclusions." [Lange v. Houston County, Georgia., No. 22-13626 (11th Cir. May 13, 2024)]  MORE >>

"For plans and insurers relying on out-of-network providers squeezed by the surprise billing protections and seeking ad hoc arrangements regarding payment for services, this case rather clearly demonstrates that ERISA preemption prevails when the payment amount is determined by referencing the terms of a plan." [Peer Grp. for Plastic Surgery, PA v. United Healthcare Servs., Inc., No. 23-2073 (D.N.J. Mar. 28, 2024)]  MORE >>

"Initially geared towards ERISA-governed retirement plans, the DOL has subsequently stated that its 2021 cybersecurity best practices also apply to ERISA-governed group health plans.... [T]he DOL lists 12 best practices to help ERISA plan fiduciaries to mitigate cybersecurity risks: ... [E]mployers are encouraged to consider adopting these best practices to help withstand any DOL scrutiny related to cybersecurity."  MORE >>

"A majority of employers (69%) advocate for shared fiduciary responsibility between themselves and carriers, emphasizing collaboration in decision-making and goal alignment. There is a near-even split between those employers who handle CAA document filing internally (51%) and those who enlist third-party vendors (43%), indicating a reliance on external assistance and potential gaps in employer knowledge. Notably, a percentage (6%) of employers were unsure about their company's filing method, signaling a need for increased understanding and education on CAA requirements."  MORE >>

"State and local officials are increasingly turning their policy focus to efforts to eliminate or prevent medical debt, complementing recent efforts at the federal level to tackle the crisis. [This] article highlights these efforts, underscoring the exciting policy boomlet currently underway. It also offers recommendations for further policy steps needed to eliminate, alleviate, and prevent medical debt."  MORE >>

"More companies are using AI to deliver a more intuitive and effective user experience for choosing benefits as generative AI applications become more sophisticated. However, the possibilities of AI go far beyond open enrollment to deliver an improved benefits experience year-round. ... [1] Content creation ... [2] Personalization ... [3] Data analytics ... [4] Improved efficiency ... [5] Benefits offerings and selection ... [6] Improved call centers."  MORE >>

"Mercer CEO and President Pat Tomlinson ... focused on two legislative priorities for employers: preserving ERISA's long-standing preemption and protecting current tax incentives for employer-sponsored healthcare and retirement plans. He talked about studies that have shown that for every $1.00 of tax expenditure, multiples of that amount are paid by employers to finance health and retirement benefits. He also discussed the importance of pharmacy data transparency to employers."  MORE >>