"[CMS released] preliminary technical Medicare Part D bid information for contract year 2025 ... For 2025, the base beneficiary premium is expected to increase by $2.08 for people with Medicare Part D ... Additionally, CMS is announcing a voluntary demonstration to support implementation of the redesigned Part D benefit and improve stability and address variation for people with Medicare Part D in 2025."
[Also available: Fact Sheet]  MORE >>

"The IRA is designed to limit yearly premium increases from contract year 2024 to 2029. Because Part D and prescription drug plans can result in plan price variation for beneficiaries, CMS is creating the Part D Premium Stabilization Demonstration to 'improve premium stability for participating stand-alone prescription drug plans' ... This should result in a smoother rollout in how the IRA requires Medicare to support Part D prescription plans."  MORE >>

"[As] a practical matter, few employees will elect COBRA coverage for their FSAs, except where they have meaningful account balances that would otherwise go unused.... However, employers are required by law to offer eligible qualified beneficiaries the option to elect COBRA continuation coverage for their Health FSAs."  MORE >>

"ERISA does not preempt the Hawaii mandates, and penalties for noncompliance can be substantial. In addition, the state's temporary disability insurance law mandates coverage through an authorized insurer or an approved self-insured (self-funded) plan. Compliance with Hawaii laws is increasingly important for multistate employers, given an uptick in hybrid and remote workers."  MORE >>

"Providing MCC is not an employer mandate, but many employees use employment-based health coverage to satisfy the individual mandate. ... Deductibles and out-of-pocket maximums (OOPMs) are reviewed annually and typically adjusted.... For 2025 plan years, Bulletin 02-24 keeps the maximum MCC deductibles at 2024 levels... MCC rules set the OOPM to match federal ACA limits, which decreased (for the first time ever) from 2024 levels"  MORE >>

"[T]he court determined that ... [the plan] abused its discretion in terminating Plaintiff's long-term disability benefits because the Plan relied on a vocational report which listed Plaintiff's job as a Mine Superintendent instead of a Section Supervisor, which are two completely different positions."
[Mullins v. Consol Energy, Inc. Long Term Disability Plan, No. 22-2930 (3d Cir. Mar. 22, 2024; unsealed Jul. 29, 2024)]  MORE >>

"The court determined that the plaintiffs could not assert a breach of ERISA by merely arguing a plan's terms were inconsistent with federal benefits law. Rather, plaintiffs must also show a concrete injury."
[Smith v. UnitedHealth Grp., No. 23-2369 (8th Cir. Jul. 8, 2024)]  MORE >>

"The Ninth Circuit ruled that ERISA preempts state law claims arising from preservice coverage communications between healthcare providers and health plan administrators, including those for verifying benefits and preauthorizing services.... The communications referenced the ERISA plans because determining reimbursement would require an inquiry into the plan terms. Furthermore, the communications connected with ERISA plans as preauthorization are central to the administration of those plans."
[Bristol SL Holdings Inc. v. Cigna Health and Life Ins. Co., No. 23-55019 (9th Cir. May 31, 2024)]  MORE >>

"Among its many provisions, the law addresses patient steering, requires reimbursement parity with PBM-owned or affiliated pharmacies, defines specialty drugs and specialty pharmacy, ensures network adequacy, limits audit error recoupment, strengthens PBM reporting, and provides broad oversight and enforcement authority to the Pennsylvania Department of Insurance."  MORE >>

"[H]ere are six items in the proposed regulations that [the author] would like to see changed or clarified. [1] Application of the Quantitative Testing Requirements to NQTLs ... [2] Mental health carve-out vendors ... [3] Fiduciary certifications ... [4] Network adequacy ... [5] Meaningful benefits ... [6] [E]nforcement relief and clear compliance standards."  MORE >>

"[I]ndividuals and businesses in Missouri that were affected by severe storms, straight-line winds, tornadoes, and flooding that began on May 19, 2024 ... now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Barry, Bollinger, Butler, Carter, Howell, Madison, McDonald, New Madrid, Oregon, Reynolds, Ripley, Scott, Shannon, Stoddard, and Texas counties qualify for tax relief."  MORE >>