"[It] is crucial that Medicare-eligible individuals who don't have creditable prescription drug coverage be notified of that fact.... [T]he Inflation Reduction Act has created some changes to Medicare Part D that impact the actuarial method. Most notably, the Medicare Part D Program Redesign Instructions include an updated definition of creditable coverage according to this method for 2025:"  MORE >>

"HHS released a model attestation that Regulated Entities may but are not required to use. Regulated Entities may develop their own attestation form, as long as the attestation is not combined with any other document and the attestation includes [specified] elements."  MORE >>

"ERISA requires that a Summary of Material Modifications (SMM) be issued when the plan makes a material modification.  ... The ACA requires 60 days advance notice of any changes that impact the Summary of Benefits and Coverage (SBC).  ... Cafeteria plans may also allow changes to elections based on significant cost changes, which can be increases or decreases.... Providing advance notice is both a courtesy to employees, and likely helps the reduce the number of questions from employees. Not providing advance notice may also conflict with state payroll laws "  MORE >>

"As Biogen's relentless patent defense for blockbuster multiple sclerosis med Tecfidera came up short in the U.S., the company separately worked to fend off competition through an anticompetitive kickbacks scheme, a multi-employer health benefit plan claimed in a new lawsuit.... 'Had Biogen not bribed the PBMs, the PBMs would have given generic Tecfidera more favorable placement on their formularies to promote the use of generic Tecfidera over the higher-cost Tecfidera and Vumerity,' the plaintiff's lawyers explained in the complaint." [Local No. 1 Health Fund v. Biogen, Inc., No. 24-7387 (N.D. Ill. complaint filed Aug. 16, 2024)]  MORE >>

"Family building benefits continue to be top of mind as employers and plan sponsors implement new benefit programs to support family building journeys for their employees. At the same time, there have been a few recent lawsuits challenging health plan eligibility criteria for infertility treatment coverage. This post summarizes the recent litigation and challenges for employers and plan sponsors in this space."  MORE >>

"An employer's worksite leave of absence policies must comply with relevant federal and state laws, while also conforming to the provisions of its underlying health and welfare plans, insurance underlying guidelines, and stop loss requirements Discrepancies between contract provisions and actual administration of a leave policy can lead to horrific consequences, such as retroactive terminations of coverage and retroactive claims reimbursement demands.... [E]mployers should regularly review their internal leave policies and cross-verify them with carrier and stop loss contracts."  MORE >>

"The ruling ... is favorable to HIPAA-covered health care providers and health plans and their business associates to the extent it limits when a HIPAA violation occurs from a regulated entity's use of a cookie, web beacon, or other tracking technology on its website. Nevertheless, it underscores the increasing privacy concerns about technologies that provide insight about website users and the need for regulated entities to carefully evaluate their use of such technologies." [Am. Hosp. Assoc. v. Becerra, No. 23-1110 (N.D. Tex. June 20, 2024)]  MORE >>

"[M]ore than 70% of benefits leaders believe AI will have a positive impact on benefits administration.... Just 31% of survey respondents agree they’re even somewhat knowledgeable about current AI solutions, and many have concerns about how AI will influence their jobs and the lives of the employees they serve."  MORE >>

"With this approach, companies can offer health care options that don’t cost their employees anything to access, as long as they visit the doctors or facilities that the company has a direct contract with ... [T]he company could respond to employees’ needs by adding contracts for other kinds of care throughout the year, like networks for chiropractic, mental health and physical therapy network, Woodard added."  MORE >>

"Issuing a nationwide injunction halting the Rule's enforcement, the Texas court deemed the Non-Compete Rule unlawful, set it aside, and ordered that the 'Rule shall not be enforced or otherwise take effect on its effective date of September 4, 2024, or thereafter.' ... Although it is possible that the FTC will appeal this decision and/or seek alternative methods to limit competition it deems unfair, the current Rule cannot be enforced on or after September 4, 2024." [Ryan LLC v. Federal Trade Commission, No. 24-0986 (N.D. Tex. Aug. 20, 2024)]  MORE >>