"[T]he final regulations make clear that plan sponsors are expected to take significant steps to address such material differences, including by: [1] strengthening efforts to recruit mental health providers to a network.... [2] expanding telehealth availability; [3] providing outreach to participants to help them find in-network providers; and [4] ensuring provider directories are up to date."  MORE >>

"The final regulations generally follow and adopt most of the provisions of the 2023 proposed regulation, which attracted nearly 10,000 comment letters. While the final regulations modify the proposed regulations in a handful of welcome respects, the fundamental structure of the proposed regulations remains intact."  MORE >>

"[1] The NQTL analysis has gotten more complex.... [2] Plans may need to expand their mental health provider networks.... [3] Plans may need to cover additional mental health services.... [4] Plans have a tight response timeframe for providing the NQTL analysis.... [5] Plan fiduciary certification is required."  MORE >>

"An employer wishing to use one of the affordability safe harbors will use the 2025 affordability threshold of 9.02 percent when determining if the safe harbor has been satisfied.... Employers who are not careful with the affordability of their plans may be exposed to massive penalties under IRC section 4980H(b)."  MORE >>

"[HHS] released their model attestation to support compliance with the new attestation requirement under HIPAA, which mandates covered entities (and business associates) to ensure an attestation is obtained before disclosing PHI potentially related to reproductive healthcare in certain circumstances (effective December 23, 2024) ... Covered entities may, but are not required, to use to use the model attestation."  MORE >>

"Recent changes ... to Medicare Part D plans may impact the creditable coverage status of employer-sponsored prescription drug coverage beginning in 2025.... [T]raditional health plans will likely still be determined to have creditable coverage.... HDHPs and some uncommon plan designs maybe affected and be determined non-creditable."  MORE >>

"The start date for payroll withholdings and submissions of quarterly wage reports under the Maine Paid Family and Medical Leave (MPFML) Program is January 1, 202 ... Under the current rules, employers may not apply for private plan substitutions until after April 1, 2025, and will be responsible for payroll contributions until their plans are approved."  MORE >>

"Effective November 1, 2023, the Massachusetts Department of Family and Medical Leave required employers to permit an employee, in the employee's sole discretion, to supplement or 'top off' their Massachusetts Paid Family and Medical Leave (MA PFML) benefit with any accrued paid leave so the employee could receive 100% of their regular wages during the MA PFML leave.... After becoming effective, the Department quietly updated its 'topping off' guidance to appear to permit employees to make this election only if the employer's policies permitted them to do so. In other words, an employer policy, not an employee's choice, now dictates whether 'topping off' may occur."  MORE >>

"A former firefighter sued the city of Sanford, Florida, claiming it discriminated against her when it shortened the duration of health benefits for disabled retirees. The U.S. Court of Appeals for the Eleventh Circuit upheld the city's decision to scale back the retiree health benefit to conserve funds. The Supreme Court of the United States will hear the case during its current term, which will end in June 2025." [Stanley v. City of Sanford, Florida, No. 22-10002 (11th Cir. Oct. 11, 2023; cert. pet granted No. 23-997, Jun. 24, 2024)]  MORE >>

"Express Scripts characterizes the FTC Report as 'unfair, biased, erroneous, and defamatory.' ... Due to these alleged false conclusions, the Complaint charges that the FTC Report violates federal and state law several times over[.]" [Express Scripts v. FTC, No. 24-1263 (E.D. Mo. complaint filed Sep. 17, 2024)]  MORE >>

"The proposed law ... would require PBMs to apply for a license by 2027 and would mandate that licensed PBMs pass along 100% of pharmaceutical manufacturers' rebates to health plans or insurers.... The law would also mostly bar PBMs from steering patients to pharmacies they own, which includes the major mail-order pharmacies. And it would prohibit them from giving independent pharmacies lower insurance reimbursements than they offer the big chains[.]"  MORE >>

"Lockdowns and periods of limited access to health care providers associated with the COVID-19 pandemic in 2020 did not seem to have a substantial effect on the portion of people with ESI who used health care services. ... [In] 2020, 23% of people with ESI did not use any health care services, the same proportion as 2019. In 2021, however, the share of non-utilizers is slightly lower than 2020 (suggesting more people used services), which may be due to care that had been deferred in 2020."  MORE >>

"[T]he court ruled that Reliance's challenge was untimely ... The regulation had been the same for many years, Reliance had never challenged it before, and thus could not now.... Reliance argued that the Department's regulation dictated the standard of review ... But the court responded that 'the regulation merely sets a time limit for claim exhaustion; it does not mandate or direct the courts to apply a particular standard of review as Reliance suggests.' " [Cogdell v. Reliance Standard Life Ins. Co., No. 23-1343 (E.D. Va. Sept. 11, 2024)]  MORE >>

"Now, federal courts must exercise independent judgment when determining the best interpretation of a statute and cannot simply defer to agency interpretations, even when they are reasonable. This will likely increase courts' scrutiny of federal agency regulations that are subject to legal challenges. These FAQs provide high-level information about the case and its potential impact on employee benefit plans and their sponsors."  MORE >>