"[T]he rule tackles protections around nonquantitative treatment limitations, or requirements that restrict scope or duration of benefits, the rule explains. This includes prior authorization, step therapy and provider network standards that can be utilized by health plans to make it harder for individuals to access healthcare."  MORE >>

"The new provisions will force health insurance plans to collect and report more robust data on how they limit and deny mental health claims. If disparities exist between mental and medical care, insurers will need to lay out how they are attempting to address these gaps."  MORE >>

"The Inflation Reduction Act (IRA) of 2022 introduces significant changes to Medicare Part D, which improves coverage for retirees but presents financial challenges for employers sponsoring group Medicare Part D plans (EGWPs). To mitigate potential cost increases, employers might consider directing retirees to individual Medicare Part D plans through marketplace exchanges, leveraging Health Reimbursement Arrangements (HRAs) for funding."  MORE >>

"The 2025 ACA affordability threshold increases to 9.02%. The easiest way to ensure affordability in 2025 is to meet the federal poverty line affordability safe harbor by offering at least one medical plan option (that provides minimum value) for which the monthly employee-share of the premium for employee-only coverage does not exceed $113.20. Otherwise, employers will need to calculate the applicable affordability threshold under one of the other safe harbor approaches, which are based on employee compensation levels."  MORE >>

"The [ACA] benchmark for determining the affordability of employer-sponsored health coverage will increase significantly -- to 9.02% of an employee's household income for the 2025 plan year -- up from the 2024 plan-year level of 8.39% ... This affordability percentage can affect individuals' eligibility for federally subsidized coverage from a public exchange, as well as employers' potential liability for shared-responsibility (or 'play or pay') assessments."  MORE >>

"The premium tax credit is only available to people without another offer of affordable and adequate coverage; in most cases, this will mean that people with an offer of employer-sponsored coverage will not be eligible for the premium tax credit. [This] Q&A explains how employer-sponsored health insurance affects a family’s eligibility for a premium tax credit, and when employees and their family members can forgo an offer of employer coverage and purchase coverage in the health insurance marketplace with the help of a premium tax credit."  MORE >>

This MEC Reference Chart is a reference tool that lists whether various types of coverage are considered MEC and whether eligibility for that coverage makes an individual ineligible for premium tax credits (PTC) in the marketplace.  MORE >>

45 pages; updated Sep. 3, 2024. "As of July 2024, [15 states] and Washington, DC, mandate paid leave for an employee's own serious health condition or disability.... Despite some common elements, differences in these laws make compliance and administration particularly challenging for multistate employers.... [T]wo states ... have adopted voluntary paid family and medical leave (PFML) insurance programs.... This semiannual GRIST provides a high-level summary of these programs."  MORE >>

"(CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) are notifying people whose protected health information or other personally identifiable information (PII) may have been compromised in connection with Medicare administrative services provided by WPS.. ... CMS and WPS are mailing written notifications to 946,801 current people with Medicare whose PII may have been exposed, informing them of the breach and explaining actions being taken in response."  MORE >>

Sep. 10 hearing; video available, along with opening statement of HELP Subcommittee Member Rep. Bob Good (R-VA) and testimony of witnesses: [1] Ms. Ilyse Schuman, American Benefits Council; [2] Ms. Holly Wade, National Federation of Independent Business Research Center; [3] Mr. Anthony Wright, Families USA; [4] Dr. Paul Fronstin, Employee Benefit Research Institute.  MORE >>

"There are proven solutions to increase access to mental health and substance use disorder care, including more effectively connecting patients to available providers, expanding telehealth resources and improving training for primary care providers.... [T]his rule promotes none of these solutions. Instead of expanding the workforce or meaningfully improving access to mental health support, the final rule will complicate compliance so much that it will be impossible to operationalize, resulting in worse patient outcomes.' "  MORE >>

"[T]he final rule updating how the Mental Health Parity and Addiction Equity Act (MHPAEA) is applied will likely have negative impacts on the availability of quality care, adding red tape and lowering standards for providers that could lead to less robust mental health care, not more. The rule will create significant operational challenges to demonstrate compliance with MHPAEA, taking focus away from ongoing efforts by employers to expand mental health benefits for their employees."  MORE >>

"[I]ndividuals and businesses in Connecticut that were affected by severe storms, flooding, landslides, and mudslides that began on Aug. 18, 2024 ... now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... individuals and households that reside or have a business in Fairfield, Litchfield, and New Haven counties qualify for tax relief."  MORE >>

"[I]ndividuals and businesses in New York that were affected by severe storms and flooding that began on Aug. 18, 2024 ... now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... individuals and households that reside or have a business in Suffolk County qualify for tax relief."  MORE >>

"[T[he DOL issued a new Compliance Assistance Release to clarify that its cybersecurity guidance applies to all employee benefit plans subject to ERISA, including health and welfare and pension plans.... The Compliance Assistance Release focuses on three areas: tips for hiring service providers, cybersecurity program best practices, and online security tips for plan participants."  MORE >>

"While the conclusion reached by the court in Guy is consistent with well-established public policy, state appellate courts in Ohio and Oregon found the ruling in Egelhoff meant that state slayer laws were preempted because they related to employee benefit plans.... [T]his issue could be resolved in one of two ways -- either the Supreme Court can issue a definitive opinion on ERISA preemption that clears up the confusion, or Congress could pass a federal slayer statute since ERISA preemption applies only to state law." [Standard Insurance Co. v. Guy, No. 21-5562 (6th Cir. Aug. 19, 2024)]  MORE >>