"[S]elf-insured plans covered by ERISA are not subject to state insurance coverage mandates, and there are currently no federal mandates that explicitly require plans to cover gender-affirming care, unless your Plan is subject to Section 1557 of the [ACA]. However, all plan administrators must continue to track many of the federal laws that can have an impact on their decision to provide these services[.]"  MORE >>

"The Student Loan provision applies to payments made before January 1, 2026.... For education expenses other than Student Loans, the employee must pay the education expenses in the same calendar year that the employer makes the reimbursement to the employee, and the employee must not have incurred the expenses prior to employment."  MORE >>

"The Paid Leave Law is set to take effect on January 1, 2026, at which time eligible employees can begin taking paid leave and employers must begin making their required contributions to the Paid Leave Program.... [The law] will provide eligible employees with partial wage replacement for up to 20 weeks of leave during a 52-week period for various family and medical reasons, qualifying exigencies, and safety leave."  MORE >>

"CMS is releasing the final part two guidance regarding plan outreach and education for the Medicare Prescription Payment Plan ... Starting in 2025, [the Plan] provides the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription."  MORE >>

"The district court determined that neither plaintiff had suffered a concrete injury from the cross-plan offsets, and that both therefore lacked constitutional standing to assert the ERISA fiduciary breach claims. The Eighth Circuit agreed[.]" [Smith v. UnitedHealth Grp., No. 23-2369 (8th Cir. Jul. 8, 2024)]  MORE >>

"Two District Courts have reached opposite conclusions on the enforceability of arbitration awards under the No Surprises Act. The two decisions, while far from the final word on the subject, highlight the most recent challenge relating to the implementation of the NSA." [GPS of New Jersey M.D., P.A. v. Horizon Blue Cross & Blue Shield, No. 22-6614 (D.N.J. Sep. 8, 2023); Guardian Flight LLC and MedTrans Corp. v. Health Care Service Corp., No. 23-1861 (N.D. Tex. May 30, 2024)]  MORE >>

"[T]he defendant had to contact the plaintiff first to allow him to 'cure any deficiencies' in the certification. Instead, the defendant did not allow the plaintiff to authenticate the form before contacting his mother's doctor -- even though it suspected fraud. Then it fired him. That's FMLA interference." [Mook v. City of Martinsville, Virginia, No. 43-0028 (W.D. Va. Jun. 14, 2024)]  MORE >>