"[1] If an ACA-eligible employee elects coverage during the eligible year as well as the following year, but does not meet the eligible hour requirement in the second year, is the employer required to offer COBRA for the second year? ... [2] Is an employer required to send 1095-Cs to union employees whose eligibility is entirely determined and administered by the union? ... [3] Is it possible for an employer to change its established lookback method to a different lookback period to align with annual enrollment? ... [4] Can an employer provide a dependent's date of birth if the SSN cannot be obtained?"  MORE >>

"There is now broad agreement that the group medical stop-loss captive rests on a sound legal and regulatory foundation ... Critical to their operation, however, is that the group medical stop-loss captive itself does not traffic in plan assets. This means that participant contributions, which are always plan assets, must never be applied to the purchase of stop-loss coverage."  MORE >>

"How do employers determine their Medicare payer status? ... How do carriers determine how much to pay if a member is eligible but not enrolled in Part B? ... California carrier practices vary.... Employers whose Plans are primary to Medicare are prohibited from offering incentives to drop group coverage for Medicare.... Once enrolled in Medicare, an individual can no longer contribute to their own Health Savings Account."  MORE >>

Video with transcript. "New laws require Illinois and Cook County employers to provide employees with paid leave that can be used for any reason, while a new Chicago law, effective July 1, 2024, requires Chicago employers to provide both paid leave that can be used for any reason and paid sick leave."  MORE >>

"[1] Establish clear, written call-in procedures for when an employee will be late or absent ... [2] Enforce the call-in requirements consistently.... [3] Excuse non-compliance where there are 'unusual circumstances' that prevent the employee from calling-in timely.... [4] If additional information is needed to clarify whether the incident is FMLA- or ADA-covered, put the request in writing." [Crispell v. FCA US, LLC, No. 23-1114 (6th Cir. Jun. 18, 2024; unpub.)]  MORE >>

"The district court's ruling in this case is narrow -- vacating only one scenario in guidance that includes several examples. However, the disputed scenario was especially challenging for CEs from a compliance perspective in that it implicated an individual's subjective intent (information the court characterizes as unknowable). HHS will likely need to revise its bulletin guidance again -- this time to reflect the court's ruling and to clarify what remains of the guidance." [Am. Hosp. Assoc. v. Becerra, No. 23-1110 (N.D. Tex. June 20, 2024)]  MORE >>

"How far does ERISA's fiduciary duty of prudence extend? What level of oversight of and negotiation for medical service costs and prescription drug pricing is considered prudent for a plan administrator? With drug costs and prescriptions both growing each year, plan fiduciaries may soon need to reconsider how they monitor their health and welfare plans' service providers and associated fees." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"Without federal legislation that preserves access to IVF services and addresses the liability implications for providers delivering these services, states are free to make determinations around these issues. The LePage ruling may bring embryo disposition questions into focus for states like Alabama that have 'fetal personhood' laws, and as a result, these states may extend abortion bans or other laws to apply to extrauterine embryos."  MORE >>

"Despite higher healthcare cost trends, fewer than half of large employers -- those with 500 or more employees -- are likely to take cost-cutting measures in 2025 like raising deductibles or copays ... Many will use high-performance provider networks or other strategies to steer employees to higher-quality, lower-cost care next year. While the survey found employers will continue to enhance their health programs, they are likely to be more selective than in past years."  MORE >>

"63% provide coverage for diabetes only; 26% provide coverage for both diabetes and weight loss. Of those that currently only offer GLP-1 coverage for diabetes, 15% are considering offering the drugs for weight loss.... Those employers and plan sponsors covering GLP-1 drugs rely heavily on utilization management (82%) to control costs."  MORE >>

"While health care historically has been one of the hottest political potatoes in the lead‑up to a U.S. presidential election, discussions this campaign have been more subdued. Perhaps the biggest issue at stake is in relation to the future of the [ACA] ... with potentially binary impacts depending on the election outcome. Both leading candidates have voiced concerns about rampant health care cost inflation, and each appears committed to reducing the high cost of prescription drugs."  MORE >>

"[I]ndividuals and businesses in southern New Mexico that were affected by the South Fork Fire, Salt Fire, and Flooding that began on June 17, 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 Lincoln and Otero counties, and on lands of the Mescalero Apache Tribe qualify for tax relief."  MORE >>

June 27 hearing. Opening statement: Rep. Bob Good (R-VA); Witness: The Honorable Lisa M. Gomez, Assistant Secretary, EBSA.  MORE >>