"This new mandatory notice is designed to highlight the differences between fixed indemnity insurance policies and traditional health insurance so that employees are aware of the type of coverage they are purchasing, including the limitations of such coverage. The intent is to ensure that employees do not mistakenly purchase a fixed indemnity policy as an alternative or replacement for comprehensive medical coverage."  MORE >>

"CMS [final rules specify] how and when it will calculate and impose civil money penalties (CMPs) when group health plan and non-group health plan RREs fail to meet their Medicare Secondary reporting obligations. Going forward, CMS plans to randomly sample 1,000 records per year to ensure that RREs are reporting all of the required data.... The final rule becomes applicable on October 11, 2024. Penalties may be imposed beginning one year later, as of October 11, 2025."  MORE >>

"This alert aims to provide a comprehensive overview of the critical compliance dates and deadlines for the fourth quarter, helping you navigate the complexities of employee benefits administration with confidence. [This] fourth quarter guide is categorized by federal and state deadlines in chronological order with additional notice requirements due at open enrollment."  MORE >>

"As with the proposed rule, the final rule requires that group health plans provide their NQTL analyses to state authorities and health plan participants upon request.... In the final rule, the Departments did not include a mechanism related to network compensation that would have required plans to analyze access to in-network mental health and substance use disorder care compared to medical and surgical care."  MORE >>

"Employer groups have said the administrative burden in documenting NQTLs could force employers to drop mental health coverage altogether.... Though the final rule eliminated a requirement from the proposed version to use mathematical tests to evaluate whether a restriction has been used in 'substantially all' benefits, employer plans must still show they are collecting and evaluating relevant data to show the impact of NQTLs and demonstrate parity. They will also be required to comply with additional design and application standards to back up their NQTL use."  MORE >>

"A covered entity must take reasonable steps to provide meaningful access and communication to everyone with LEP. This includes providing, for free and to the extent required, language assistance, qualified interpreters and translators, and other services such as translation of patient notices and forms."  MORE >>

"In a rare win for Massachusetts employers, the Supreme Judicial Court just ruled that employers generally have no obligation to allow employees to continue accruing benefits, such as seniority, vacation, and sick time, while they are on the Commonwealth's mandated paid family and medical leave.... While the accrual of benefits like vacation time is not mandatory, you must maintain an employee's health insurance at the same level during their PFMLA leave[.]" [Bodge v. Commonwealth, No. SJC-13567 (Mass. Sep. 13, 2024)]  MORE >>

"Pharmacy benefit manager Express Scripts sued the [FTC] over the regulator's recent drug pricing report, calling the report's conclusion that the prescription middlemen raise drug costs defamatory.... The FTC said in the July report that market consolidation has led to PBMs favoring their own affiliated businesses, which creates conflicts of interest that prevent smaller independent pharmacies from staying competitive by steering patients away from them." [Express Scripts v. FTC, No. 24-1263 (E.D. Mo. complaint filed Sep. 17, 2024)]  MORE >>

"There are currently four bills under consideration that would have a direct or indirect impact on PBMs, as well as health plans, prescription drug manufacturers, wholesalers and pharmacies. The pending legislation has bipartisan support in the House and Senate, indicating a strong desire to further regulate PBMs at the federal level.... [T]he proposed legislation mirrors similar developments at the state level to increase transparency and reduce prescription drug costs."  MORE >>

"CMS's price-substitution policy has saved Medicare and its enrollees $74.3 million since 2013, including nearly a million dollars for 2022.... If CMS expanded its price-substitution criteria to include more drugs, Medicare and its enrollees could have saved up to an additional $8.5 million for 2022."  MORE >>

"Voya's research indicates a shift in employee priorities as nearly three-quarters (72%) of employed Americans strongly or somewhat agree they would take a job with a slightly lower salary for better health care and medical coverage, including lower premiums and out-of-pocket costs. This sentiment is felt even higher among millennials (80%) compared to Generation Z (60%), Generation X (69%) and baby boomers (72%)."  MORE >>

"[T]he 224th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held via a teleconference on Tuesday, October 22, 2024.... The purpose of the open meeting is for the members of the ERISA Advisory Council to discuss potential recommendations for the Secretary of Labor on the issues of: [1] Claims and Appeals Procedures, and [2] Qualified Default Investment Alternatives (QDIAs) -- Start to Finish, Default to Payout"  MORE >>

"This paper will explore how ERISA welfare funds can help their participants through the provision of an employee housing assistance benefit. Starting with the early efforts asking how pension plans might help create housing assistance in the form of direct mortgage loans, the paper will then discuss the 1990 amendment to Taft-Hartley and the structural challenges ERISA plans have in providing housing assistance and how, with legislative and/or agency assistance, ERISA benefit plans might work in conjunction with federal, state and local government initiatives to create housing that is affordable, climate resilient, and energy efficient for low- and moderate-income workers."  MORE >>