"This proposed rule expands on previous regulations concerning the PSHB Program and is intended to provide greater detail and clarity necessary to properly implement PSHB in 2025 and beyond. In particular, this proposed rule includes details on: reconsideration of PSHB eligibility decisions, various applications of the Medicare Part B enrollment requirement, allocation of reserve credits, calendar year alignment of Government contribution requirements, financial reporting and actuarial calculations, premium payment prioritization from the Postal Service Retiree Health Benefits Fund, and Medicare Part D integration."  MORE >>

"The PCORI fee is based on the average number of covered lives under the policy or plan and must be reported once a year on the second quarter IRS Form 720 and paid annually by its due date, July 31  ... The PCORI fee amount for plan years ending on or after October 1, 2023, and before October 1, 2024, is $3.22 per covered life (up from $3.00 previously).... As of the date of this writing, the IRS has not released the second quarter Form 720 reflecting the updated amount."  MORE >>

"A self-funded group health plan covered by ERISA is not subject to state-level insurance coverage mandates, and there are currently no federal coverage mandates explicitly requiring coverage for gender-affirming care. However, three federal laws must be considered in deciding whether to exclude gender-affirming care under a self-funded group health plan: Section 1557 of the [ACA], Title VII of the Civil Rights Act ... and the [MHPAEA]."  MORE >>

"[T]he beginning or ending of a domestic partner relationship may seem analogous to the listed marital events -- especially where the domestic partnership is certified or otherwise recognized by the state or municipality where the employee resides. But without further guidance from the IRS, your cafeteria plan should not allow participants to change an annual election based solely on the commencement of a domestic partner relationship."  MORE >>

"Under the new legislation, all private-sector employees will be eligible to receive paid sick leave, including per diem or temporary workers, except for seasonal and certain unionized construction workers.... The new legislation ... [adds] permissible reasons for taking leave: closure of the employer's place of business or a family member's school or place of care due to a public health emergency, or a determination that the employee or the employee's family member poses a risk to the health of others due to a communicable disease."  MORE >>

"The West Virginia Office of the Insurance Commissioner recently took regulatory actions against four unaffiliated Pharmacy Benefit Managers (PBMs) that were operating in West Virginia without a PBM license. These regulatory actions are summarized [in this article.]"  MORE >>

"The Healthcare Protection Act bans prior authorization for mental health treatments ... It would also ban step therapies for private insurance and Medicaid.... [and] crack down on ... health insurance directories that are inflated with doctors who no longer practice in areas, or doctors who are no longer in network. Health insurance companies would be required to conduct audits on themselves every 90 days and report their findings to the Department of Insurance."  MORE >>