6 pages; Jun. 2024. "1 The [IRS] is providing [this] sample plan to assist employers in establishing a qualified educational assistance program under section 127 of the Internal Revenue Code. The sample plan is intended to satisfy the requirements of section 127 of the Code and the underlying Treasury Regulations. An employer, in its discretion, may modify the sample plan and include additional plan provisions, provided that the requirements of section 127 of the Code and the underlying Treasury Regulations continue to be satisfied."  MORE >>

Jun. 20, 2024. "Did you pay premiums during your tax year for employee health insurance coverage you provided through a Small Business Health Options Program (SHOP) Marketplace (or do you qualify for an exception to this requirement)? ... See the instructions and complete Worksheets 1 through 7 as needed."  MORE >>

"If a bank or other financial institution performs functions beyond the routine payment processing activities excepted by HIPAA, it may be a HIPAA business associate, which carries important compliance obligations as a matter of law."  MORE >>

"The [HHS] Office of Civil Rights (OCR) released final rules under [ACA] Section 1557. The good news for plan sponsors is that it appears most self-funded plans will not be covered by these rules and insured plans will likely rely on their carrier for compliance. Therefore, most plans will not need to distribute the notices and taglines, in addition to other Section 1557 compliance requirements. However, given the nuanced treatment of group health plans under the rules, it is not clear whether OCR would take the same view."  MORE >>

"[EEOC] regulations covering the scope of the Pregnant Workers Fairness Act took effect on June 18. The law requires employers to provide reasonable accommodations for pregnant workers or applicants ... New York recently became the first state to enact a paid prenatal leave law, which provides up to 20 hours of paid leave per 52-week period for pregnancy-related care. New York employers are also required to provide a paid 30-minute break for lactating employees to express milk effective June 19."  MORE >>

"[R]arely will an employer's existing multi-jurisdictional leave policy satisfy the myriad state-specific requirements. Even those employers with a single employee working in Colorado need to be mindful of the nuances of the Centennial State's leave laws.... Colorado's Healthy Families and Workplaces Act (HFWA) sounds similar to many other paid sick leave laws ... but it has a number of unique aspects to its substantive employee rights and employer obligations."  MORE >>

"[T]he Court dismissed a challenge to the FDA's protocol for prescribing and dispensing the drug on procedural grounds.... However, the Justices left the door open to future challenges. Headlines about this case may prompt plan sponsors concerned with providing access to the full range of reproductive health services to review benefits coverage, documentation and communication."  MORE >>

"Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled -- on issues of first impression for both -- that ERISA expressly preempts state law breach of contract and promissory estoppel claims asserted by out-of-network providers who allege that preauthorization communications with claim administrators impose reimbursement obligations independent and irrespective of the terms and conditions contained in a patient's ERISA-governed health benefit plan." [Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., No. 23-55019 (9th Cir. May 31, 2024); Park Ave. Podiatric Care, P.L.L.C. v. Cigna Health & Life Ins. Co., No. 23-1134 (2d Cir. Jun, 3, 2024)  MORE >>

"In the dynamic landscape of healthcare benefits, self-insured plan sponsors face a myriad of challenges in delivering quality care while containing costs. Central to this endeavor is the fiduciary responsibility under ERISA that plan sponsors ensure that claims are processed accurately and correctly. But also, apart from compliance and financial considerations, plan sponsors should also consider the impact of the member experience."  MORE >>

"The job of the P.B.M.s is to reduce drug costs. Instead, they frequently do the opposite. They steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees, a New York Times investigation found."  MORE >>

"The letter comes in response to a budget proposal released in March .. that would ... cap the employee tax exclusion for employer-provided healthcare benefits at an unspecified level.... Calculations done by the American Benefits Council have shown that for each dollar in tax expenditures for employer-provided healthcare, employers spend about four to five dollars on health benefits, underscoring the joint letter's argument that the exclusion delivers value for the federal government as well as employers and millions of Americans."  MORE >>