"The proposed coverage month amendment generally would provide that, in computing a PTC, a month may be a coverage month for an individual if the amount of the premium paid, including by advance payments of the PTC (APTC), for the month for the individual's coverage is sufficient to avoid termination of the individual's coverage for that month. The proposal also would amend the existing regulations relating to the amount of enrollment premiums used in computing the taxpayer's monthly PTC if a portion of the monthly enrollment premium for a coverage month is unpaid."  MORE >>

"Meaningful benefits require that the plan cover a 'core treatment' for the MH or SUD condition in each classification where core treatments are provided for medical or surgical conditions.... In these final rules, the Departments may have gone a step too far by mandating meaningful benefits and outcome-driven data analyses. These components of the final rules may be vulnerable to challenge particularly considering the US Supreme Court's decision in Loper Bright[.]"  MORE >>

"Under California Labor Code Section 230.8, employers with 25 or more employees working at the same location must provide parents, guardians, or grandparents with custody of a child in grades kindergarten through 12 or attending a licensed daycare facility with up to 40 hours of unpaid leave per year."  MORE >>

"ESTA's definition of 'employee' does not include the requirement that payment be subject to tax withholding. When the Michigan legislature adopted and amended ESTA to create the Paid Medical Leave Act, they sought to eliminate any ambiguity as to who could be considered an employee by adding the tax withholding requirement. When the Michigan Supreme Court reinstated ESTA, this ambiguity returned."  MORE >>

"The Court reasoned that the absence of a clinical diagnosis relating to long-COVID should not preclude eligible persons such as Plaintiff from being designated as Totally Disabled when their self-reported symptoms, observed and documented by physicians, indicate an inability to complete the material tasks of their job." [Cogdell v. Reliance Standard Life Ins. Co., No. 23-1343 (E.D. Va. Sept. 11, 2024)]  MORE >>

"The central issue in [this] case was Reliance's failure to issue a timely decision on Ms. Cogdell's appeal, a clear violation of ERISA's procedural safeguards.... At oral argument, Reliance ... argued that the Loper decision ... should also apply to ERISA's regulations, rendering the [DOL's] authority to enforce the appeal deadlines invalid.... [T]he judge ruled that Loper did not apply to ERISA's regulations because Congress had clearly delegated rulemaking authority to the [DOL]." [Cogdell v. Reliance Standard Life Ins. Co., No. 23-1343 (E.D. Va. Sept. 11, 2024)]  MORE >>

"Designed to offer greater flexibility and control, ICHRA allows employers to reimburse employees for individual health insurance premiums and qualified medical expenses on a tax-free basis."  MORE >>

"Today, thanks largely to digital technology and its impact of consumer experiences across employees' lives, employees expect more from their employee benefits experiences: [1] A broader array of health and voluntary benefits. [2] The ability to manage their benefits via a connected technology experience. [3] Personalized guidance to help them choose and use benefits effectively."  MORE >>

"[This study] sheds light on the perspectives of employed Americans, particularly frontline workers, on various employee benefits and workplace features.... 84% of employed Americans believe all employers should offer mental health services, with 43% strongly agreeing. ... Gen Z employees are less likely (76%) to agree compared to Millennials (87%) and Baby Boomers (87%)."  MORE >>

"A [recent paper] quantifies the degree of of pharmacy benefit manager (PBM) market concentration.... Three PBMs dominate in most all markets. In fact, these three large PBMs (CVS Caremark, Optum Rx, and Express Scripts) account for 73.6% of retail prescriptions filled. This does vary by payer type. "  MORE >>

"[The People and Animals Well-being (PAW) Act (HR 9508)] would allow pet owners to use their HSA or FSA accounts to pay for up to $1,000 for veterinary care or a pet health insurance plan, while permitting an unlimited amount of these funds for service animals.... [T]he bill maintains current HSA and FSA contribution limits, ensuring that there will be little to no impact on federal expenditures."  MORE >>

"The ERISA Advisory Council hosted a panel [September 12] on health plan claim denials and appeals. Panelists testified that it is needlessly difficult to appeal, and suggested reforms.... Recommendations of this kind, transparency and accountability for delayed responses to appeals and related inquiries have been made by other advocates before the Council in previous hearings."  MORE >>

"The passage of [ERISA] in 1974 launched a new era of financial security for America's workers, providing critical protections that have safeguarded their retirement, health, and other job-based benefits for 50 years.... This landmark legislation protects the interests of participants and their beneficiaries in employee benefit plans. Title I of ERISA is enforced by the Employee Benefits Security Administration (EBSA)."  MORE >>