"The Proposed Arrangement would implicate the Federal anti-kickback statute because Requestor, an organization that offers EGWPs,15 would offer remuneration to a Group in the form of sharing a percentage of its savings that could induce the Group to refer its enrollees to Requestor so that Requestor, via its EGWP, would arrange for the furnishing of items or services that are reimbursable by a Federal health care program. No safe harbor would apply."  MORE >>

"[E]mployer-plan sponsors should consider including contract provisions requiring the carrier/TPA to administer the plan in accordance with MHPAEA requirements and provide a complete Comparative Analysis to include any NQTLs it imposes. They also should consider asking the service provider to assist in reviewing plan data and network information to show the plan operates in accordance with MHPAEA.... The significant rise in plans offering telehealth benefits with no participant cost-sharing ... creates potential challenges for plans in passing the 'substantially all' portion of the test (e.g., that the same type of cost-sharing must apply to at least 2/3 of claims in a classification in order to be applied to MH/SUD claims in that classification)."  MORE >>

"At its heart, MHPAEA, as outlined in the Final Rule, imposes a burden of presumptive discrimination on all managed care functions and requires Health Plans to prepare and maintain parity compliance documentation that is ready to rebut that presumption at any time upon request."  MORE >>

11 pages. "The final rules represent a major overhaul of the existing parity regulations. Plans and insurers will need to conduct additional analysis to determine the rules' impact in general and for a particular plan.... Self-funded plan sponsors have more compliance obligations and will require assistance from one or more service providers to comply. The final rules' numerous examples illustrating how the parity requirements work should be reviewed carefully for insight into plan design, application and outcome red flags."  MORE >>

"The agencies anticipate that the final rules will result in changes in network composition and medical management techniques related to MH/SUD care, more robust MH/SUD provider networks, and fewer and less restrictive prior authorization requirements for MH/SUD care. But opposition has already been registered by a Congressional committee, and legal challenges seem likely[.]"  MORE >>

"[T]he IRS announced the new [ACA] affordability percentage of 9.02% for 2025 employer health care plans. After three years of decreases, this percentage increase gives employers more flexibility in setting employee premiums without making their coverage unaffordable under the safe harbor."  MORE >>

"The IRS provides three optional affordability safe harbors that allow an ALE to calculate affordability of its health coverage without requiring information on an employee's household income: the federal poverty line (FPL), the W-2, or the rate of pay. There are advantages and disadvantages to each of these safe harbors."  MORE >>

"The FAQs restate the IRS's prior guidance on educational assistance programs and, for the first time, provide guidance regarding the treatment of student loans.... Employers who offer, or intend to offer, an educational assistance program should: [1] maintain a written plan and provide reasonable notice of the availability of the program to employees; [2] if providing student loan assistance as part of the program, ensure the terms of the plan reflect that; [3] and review the IRS sample plan[.]"  MORE >>

"The IRS released final regulations dated April 3, 2024, and a related fact sheet, regarding short-term, limited-duration insurance and the consumer notice required for certain fixed indemnity coverage.... [T]he IRS reiterated its concern regarding fixed indemnity policies and other arrangements where premiums for the coverage are paid pretax and cash payments are made even though no medical expenses are incurred or the medical expenses are reimbursed through other coverage. It explained that these payments generally are taxable wages subject to FICA, FUTA and FITW."  MORE >>

"[1] HIPAA privacy extends special protections to reproductive health care: Employer action required by 12/23/24 ... [2] Gag clause attestation.... [3] NQTL compliance.... [4] Transparency requirements.... [5] Fiduciary obligations ... [6] Cybersecurity compliance.... [7] Prescription drug reporting."  MORE >>

"Though intended for the benefit of Medicare, the availability of a published net price point has other benefits, both for Medicare and for other stakeholders. In particular, it provides a window into the effectiveness of negotiations by Medicare Part D plans and other U.S. payers, and competition to lower the prices of prescription drugs."  MORE >>

"The [IRS] announced ... tax relief for individuals and businesses in the entire state of Louisiana, affected by Tropical Storm Francine that began on Sept. 10, 2024. These taxpayers now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments."  MORE >>

"Proponents of ERISA preemption point to the creation of a uniform and predictable regulatory environment for employers with respect to their ERISA-governed benefit offerings, while its detractors believe that state and local governments ought to have a greater role in pursuing health care reform beyond their current ability to regulate health insurance. To better understand the value of ERISA preemption to large employers, [EBRI] and American Benefits Council conducted roundtable discussions with over a dozen benefits executives at large companies."  MORE >>

"From its origins as the Pension and Welfare Benefits Program through its elevation to a sub-cabinet position and into the 21st century, EBSA has worked with many members across the employee benefits community ... Beginning with developing effective regulations, the input in the rulemaking process from voices across the employee benefits community has been critical to developing informed rules to implement the goals of ERISA."  MORE >>