"Unlike the health FSA, there are no FMLA continuation of coverage rights for the dependent care FSA because it is not a group health plan. Employees generally will also not have any reimbursable day care expenses during the period of leave because those expenses will not be work-related."  MORE >>

"In the newly updated HIPAA Privacy Rule, reproductive health care records have received enhanced protection from disclosure, including as to attempted access by state law enforcement agencies. Employers should take note of upcoming compliance deadlines and obligations imposed by this new HIPAA Privacy Rule."  MORE >>

"In general, the Submission Instructions and User Manual provide clarifications and more detail about the process. Changes include definitions of key terms and a new section describing what agreements are subject to the requirements. The instructions also clarify that a single group health plan with more than one benefit package is a single responsible (reporting) entity and may submit a single attestation, even if some coverage types are insured and others are self-insured."  MORE >>

"[Four] states have passed legislation giving [prescription drug affordability boards (PDABs)] the purported authority to set upper payment limits (UPL) for prescription drugs deemed 'unaffordable.' ... This review focuses on legislation as opposed to implementation, given significant differences in the degree to which states have begun promulgating regulations and implementing policies and reviews. We highlight similarities and variabilities in existing legislation as well as uncertainty and potential unintended consequences amidst the rapid rise of PDABs."  MORE >>

"The single biggest flaw and potential area of danger for employers that remains under the PLAW Act, which was not addressed in any useful manner by the Rules, relates to notice requirements.... Because employers are prohibited from asking for the reason for the leave, they will have their hands tied when trying to enforce their attendance and tardiness policies."  MORE >>

"Minnesota Governor Tim Walz signed bills amending the Earned Sick and Safe Time Act and the Paid Family Leave Law. Many of amendments provide new and expanded definitions of terms. Other amendments create new penalties and appeals procedures. Rates of pay and premium rates are also addressed."  MORE >>

"The U.S. Court of Appeals for the Third Circuit has joined [the Ninth and Seventh] Circuits in finding that employers who provide paid leave for short-term absences, like jury duty or bereavement leave, may be required to provide similar paid leave for short-term military purposes under the Uniformed Services Employment and Reemployment Rights Act." [Scanlan v. American Airlines Group, Inc., No. 22-3294 (3d Cir. May 21, 2024)]  MORE >>

"[We] are increasingly seeing suits where the plaintiff is the health care provider, not the patient. In a statutory scheme where the participant is the focus, this raises questions. Should the courts treat providers differently from patients? What rights do providers have under ERISA? Must they bring their claims pursuant to ERISA, or can they bring alternative state law claims? [This] decision is the latest effort by the federal courts to answer some of these questions." [Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., No. 23-55019 (9th Cir. May 31, 2024, affirming summary judgment); Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., No. 23-55019 (9th Cir. May 31, 2024, affirming denial of motion for reconsideration)]  MORE >>

"[The] district court concluded that there is no cause of action available for health providers to enforce awards involving surprise medical billing disputes under the NSA's independent dispute resolution (IDR) process. The court also concluded that the providers lacked standing to sue in federal court under [ERISA] for unpaid IDR awards." [Guardian Flight LLC & Med-Trans Corp. v. Health Care Serv. Corp., No. 23-1861 (N.D. Tex. May 30, 2024)]  MORE >>

"If the 'rules of the road' are not established and well communicated, the result is not only inefficiency, but such a failure prevents proper administration and management of these important benefits. So, ... the noted defects ... in the J&J Rx Plan Document/SPD are very important to the proper functioning of this benefit plan. The failure to establish and communicate rules in a reasoned fashion speaks to a failure to manage and a potential failure of the required fiduciary functions related to the J&J Rx Plan." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"[If] employers with healthier workforces exit the group insurance, leaving those with less-healthy workforces behind in the conventional group insurance market, it could set in motion a dynamic that ultimately makes group insurance unaffordable ... There is good evidence ... that the health plans of self-insured employers tend to pay higher rates to hospitals and other providers than ... the same company's fully insured health plans.... Self-insuring also means the employer is taking on fiduciary responsibility for the management of health benefits."  MORE >>

"Health insurers are investing hundreds of millions of dollars into building new affordable housing units.... Stable housing is associated with less stress, fewer emergency room visits and lower health care costs."  MORE >>

"This analysis, using preliminary data reported by insurers to state regulators ... finds that insurers estimate they will issue a total of about $1.1 billion in MLR rebates across all commercial markets in 2024. Since the ACA began requiring insurers to issue these rebates in 2012, a total of $11.8 billion in rebates have already been issued to individuals and employers, and this analysis suggests the 2012-2024 total will rise to about $13 billion when rebates are issued later this year."  MORE >>

"The fundamental lesson from the case is that an attack on an expert's methodology typically must include a showing that the expert's analysis ignores relevant factors, relies on assumptions for which there is no evidence or otherwise lacks logical rigor." [Trauernicht v. Genworth Fin., Inc., No. 22-0532 (E.D.Va. May 29, 2024)]  MORE >>