"[T]here are significant changes coming to Medicare Part D in 2025 that will make it more difficult for group health plans to be considered Creditable. Fortunately, for 2025, the simplified method for determining creditability is still available. However, [CMS] has indicated that it will revise the simplified method in future years. As a result, employers will need to keep a close eye on this determination and make any necessary adjustments to their notices in future years."  MORE >>

"The paid leave ballot proposal, initially adopted as the ESTA, will be reinstated effective February 21, 2025, replacing Michigan's Paid Medical Leave Act (PMLA).... In considering whether an employer's leave policies for Michigan employees is compliant under the ESTA, employers need to consider whether they are now considered a covered employer, how sick leave accrues, employee eligibility for earned sick time, and an employee's use of earned sick time, among many other considerations.... [A side-by-side chart identifies] certain key differences between the ESTA and the PMLA."  MORE >>

"The fact that the plans expressly provided for cross-plan offsetting was a key element here ... Self-insured plan sponsors may wish to review their plan documents and, if applicable, make sure they understand the implications of cross-plan offsetting for the plan, plan sponsor, and participants. The topic could also be raised in negotiations with the TPA." [Smith v. UnitedHealth Grp., No. 23-2369 (8th Cir. Jul. 8, 2024)]  MORE >>

"The plaintiffs had attempted to 'make their case' by identifying a single medical benefit that was handled differently from the mental health benefits they sought. However, the relevant statutory provision requires that treatment limitations applicable to mental health benefits be no more restrictive than treatment limitations 'applied to substantially all medical and surgical benefits covered by the plan[.]' " [Midthun-Hensen on behalf of K.H. v. Grp. Health Coop. of S. Cent. Wisconsin, Inc., No. 23-2100 (7th Cir. Aug. 5, 2024)]   MORE >>

"AI stands poised to revolutionize the healthcare employee benefits experience as well. This article explores how the healthcare industry can successfully incorporate AI into personalizing and maximizing employee benefits, offering helpful takeaways for companies that want to achieve better engagement and increase employee satisfaction, productivity, and cost savings."  MORE >>

"CMS said 8.8 million people used the 10 drugs in 2023, and the savings are estimated to amount to $6 billion, including $1.5 billion in out-of-pocket costs.... Although CMS said participation by drug companies is voluntary, that description essentially refers to the fact that the companies can terminate their Medicare and Medicaid participation if they prefer not to negotiate. Most of the affected companies have filed lawsuits since the IRA provisions were announced, arguing that the legislation is unconstitutional"  MORE >>

"The maximum fair prices (MFP) set by Medicare lead to discounts between 38% and 79%. In fact, the real discounts are larger since the figures ... are discounts off of 2023 prices (rather than 2024 prices).... [H]ow exactly did CMS arrive at these prices? This is not clear. In fact, CMS said it won't make public an explanation of the agreed-upon negotiated prices until March 2025."  MORE >>

"After a comprehensive cost-benefit analysis, you can make an informed decision.... There are some who will decide that facing the Part D penalty is a less bad option than paying the monthly premiums and IRMAA, and losing HSA contributions.... Those who are already enrolled in Part A can add a standalone Part D drug plan during the Open Enrollment Period, October 15-December 7."  MORE >>

"In 2022, 30.4 percent of commercially insured patients and 24.4 percent of MA patients used TH services. Living in a metropolitan area, an area with a high proportion of Black, Indigenous, and People of Color (BIPOC) residents, having greater disease burden, and being younger were associated with a greater likelihood of using telehealth. Living in an area with limited broadband access reduced the likelihood of telehealth use. Two patient subgroups more likely to use telehealth -- younger patients in metropolitan areas and high-risk patients with depression -- received a similar proportion of ambulatory visits via telehealth."  MORE >>

"[A Florida district court judge] enjoined the FTC from implementing or enforcing the Noncompete Rule against the plaintiff, and was careful to note that he was granting an injunction against the FTC only for the plaintiff, and was not entering a nationwide stay of the Noncompete Rule. [A]ll eyes remain on the Northern District of Texas, where the Ryan court has promised a final decision on or before August 30 as to whether it will issue a permanent injunction and a nationwide stay of the Noncompete Rule." [Properties of the Villages, Inc. v. FTC, No. 24-0316 (M.D. Fla. Aug. 15, 2024)]  MORE >>