"Effective July 1, 2024 ... The Paid Leave and Paid Sick Leave Notice must be issued to the employee in several ways ... [1] New hire notice ... [2] Annual notice ... [3] Workplace notice/poster."  MORE >>

"The opinion held ERISA preempted an out-of-network provider's state law claims arising from verification of benefit and preauthorization communications with a health plan administrator ... This opinion ... will limit the ability of health care providers to 'plead around' ERISA preemption or expand the scope of ERISA benefits actions by asserting non-derivative state law claims." [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 >>

"[B]oth the district and appellate court analyzed whether the 'catch-all' remedial provision under ERISA Section 502(a)(3) allowed for such a financial award. Both courts held that the money relief sought in the lawsuit was not a 'benefit' that could be recovered under the terms of the employer's health plan.... The Fourth Circuit's decision in Rose diverges from seven other circuits, all of which have concluded in published decisions that surcharge is an equitable remedy available under 502(a)(3)." [Rose v. PSA Airlines, Inc., No. 21-2207 (4th Cir. Sep. 11, 2023; cert. pet. denied Apr. 15, 2024)]  MORE >>

"[T]he defendant terminated the plaintiff for theft, which discredited the defendant and violated its Employee Manual. The Employee Manual noted that conduct that discredits the defendant may result in corrective action, including discharge. Since the plaintiff acknowledged receiving the Employee Manual and had no evidence that she didn't at least violate it, it was pretty clear that she would not have retained her job absent taking FMLA leave." [McBeath v. City of Indianapolis, No. 22-1216 (S.D. Ind. Apr. 29, 2024)]  MORE >>

"[1] Whether a provider has sufficiently pleaded the existence of a valid assignment clause to withstand a Motion to Dismiss in light of recent Third Circuit precedent.... [2] Whether Plaintiff's disability related to COVID-19 fell under a pre-existing condition exclusion in the long-term disability policy.... [3] Whether the insurance company's letter communicated rational reasons for its decision to deny a long-term disability claim.... [4] Did Plaintiff's complaint adequately plead the existence of a federal question such that defendant's notice of removal was untimely? ... [5] Whether the insurance company satisfied its fiduciary duty as mandated under ERISA to consider Plaintiff's claim fully and provide specific reasons for denial."  MORE >>

"The [Lewandowski] complaint outlined a multitude of factors ... that a plan fiduciary may want to use when engaging in the process of selecting and monitoring a PBM. [1] Traditional v. pass-through PBMs ... [2] Rx drug rebates ... [3] PBM-owned specialty pharmacies ... [4] Mail-order pharmacies ... [5] Specialty PBM carve-out model ... [6] Drug prices ... [7] Broker and consultant conflicts of interest ... [8] RFP processes ... [9] Audit rights." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"By bypassing insurance carriers and forging direct relationships with health care providers, pharmacies and other service vendors, companies aim to streamline costs, enhance employee access to quality care and gain greater control over benefit design and administration. However, this strategy brings its own set of challenges and considerations."  MORE >>

"Following the 2022 slowdown in health care spending that led to the overall health care sector reaching its smallest share of the economy since 2014 (17.3%), there has been a gradual resurgence in health care spending beginning in early 2023.... [In this article, the authors] put 2023's above-average health care utilization increases into perspective historically and break down utilization trends by the different major health care spending categories."  MORE >>

"Medicare shelled out $5.7 billion in 2022 for three popular GLP-1 drugs, up from $57 million in 2018 ... That spending will continue to skyrocket as the benefits of these drugs pile up.... The drugs are likely choices for Medicare haggling, according to the Congressional Budget Office. But just how much will prices come down?"  MORE >>

"Take a fresh look at ways to communicate mental health benefits to employees.... Recognize the desire for online and digital mental health support.... Leverage Awareness Days and Months to bring mental health to the forefront.... Establish mental health days for employees.... Teach managers about the importance of employee mental health."  MORE >>

"[I]ndividuals and businesses in West Virginia that were affected by severe storms, straight-line winds, tornadoes, flooding, landslides, and mudslides that began on April 2, 2024 ... now have until Nov. 1, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Boone, Brooke, Cabell, Fayette, Hancock, Kanawha, Lincoln, Marshall, Nicholas, Ohio, Preston, Putnam, Tyler, Wayne and Wetzel counties qualify for tax relief."  MORE >>

"[I]ndividuals and businesses in Kentucky that were affected by severe storms, straight-line winds, tornadoes, landslides, and mudslides that began on April 2, 2024 ... now have until Nov. 1, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Boyd, Carter, Fayette, Greenup, Henry, Jefferson, Jessamine, Mason, Oldham, Union, and Whitley counties qualify for tax relief."  MORE >>