"The final rules are extensive and focus on NQTLs, offering compliance guidance to plans and insurers.... [E]mployers should connect with their insurers and TPAs to inquire about assistance with a comparative analysis.... These final rules will likely prompt insurers and TPAs to take a more active role in supporting employer-provided group health plans.... Fully insured employers should confirm the insurer's obligation to comply with MHPAEA is acknowledged in the carrier agreement."  MORE >>

"For health plans offering benefits that cover mental-health and SUD conditions, the final rule calls for ensuring the benefits are meaningful as determined by whether the benefits are comparable to medical/surgical benefits in the same classification and cover at least one core treatment in each classification.... Compliance with the rule will be monitored via results of a comparative self-analysis conducted by plans ... The departments can then review a plan's analysis, with plans required to submit the analysis within 10 business days of the request."  MORE >>

"[The ACA] affordability threshold is increased from 8.39% for 2024 to 9.02% for 2025.... The initial [Employer Shared Responsibility] penalty amount of $3,000 (in 2015) is now $4,350 for 2025, a decrease from 2024's annualized penalty of $4,460 per affected employee."  MORE >>

"For 2025 ... a job-based health plan's employee-only coverage needs to cost 9.02% or less of the employee's household income to be considered affordable.... [E]arlier this year the IRS released some of next year's indexing adjustments and benefit limits for health and welfare plans, including 2025 HSA contribution limits, minimum annual HDHP deductibles, and plan out-of-pocket maximums for HSA eligibility."  MORE >>

"At least some of the cybersecurity best practices addressed by the DOL's guidance (for example, access controls, encryption, and breach notification) will seem familiar to HIPAA CEs from the HIPAA Security Rule context. However, the DOL's updated guidance also draws in health and welfare arrangements beyond group health plans[.]"  MORE >>

"C-suite executives who are at least 65, or will turn 65 during a COBRA continuation period, and are not already enrolled in Medicare when they experience separation from their employer ... may decide not to elect COBRA and instead enroll in Medicare. If the executive would have otherwise negotiated or is already entitled to subsidized COBRA premiums, the executive may alternatively try to negotiate a cash payment or other benefit from their employer ... in exchange for relieving the employer of its obligation to pay subsidized COBRA premiums and otherwise cover the executive under its health plan."  MORE >>

28 pages. "This report investigates how actuaries and regulators are approaching actuarial innovations during the regulatory approval process. It explores some actuaries' biggest successes -- including how they obtained regulatory approval for their ideas -- and explores the regulatory perspective of such filings."  MORE >>

28 pages. "In 2023, most people, 92.0 percent or 305.2 million, had health insurance, either for some or all of the year.... [E]mployment-based insurance was the most common, covering 53.7 percent of the population for some or all of the calendar year ... [T]he employment-based coverage rate declined by 0.7 percentage points to 53.7 percent in 2023. At the same time, the rate of direct-purchase coverage increased by 0.3 percentage points to 10.2 percent in 2023."  MORE >>

"While both employers and employees are accustomed to SDI contribution rates and wage limits changing each year -- the 2023 wage cap was $153,164 -- the removal of a wage cap is new for 2024. Some California employers are considering offering a private or voluntary disability insurance (VDI) option to enhance the benefit and save their employees money. But how do you determine if it's right for your organization?"  MORE >>

"While most PBM reform proposals have centered around making prices and deals more transparent, reforms may not be successful without addressing the larger market ... Not only are there three PBMs that control the majority of the market, but many PBMs own their own pharmacy businesses, making it difficult for non-affiliated pharmacies to get favorable prices on drugs."  MORE >>

"[Compliance Assistance Release No. 2024-1] makes clear that the cybersecurity guidance issued in 2021 is applicable to ALL types of ERISA plans -- including health and welfare plans. The EBSA estimates that there are 153 million participants in private sector ERISA-governed plans, which includes 2.18 million health plans."  MORE >>

"[I]ndividuals who own both a health savings account (HSA) and a limited purpose flexible spending account (LPFSA) ... contribute more to their HSAs compared to those who only have an HSA. But based on distribution activity, workers are not fully taking advantage of these accounts and their tax saving benefits."  MORE >>