"After two consecutive years of substantial decreases in the affordability percentage, the increase for 2025 will be a help to employers by providing additional flexibility in the amounts they can charge. Although the increase is substantial, 9.02% is still the second lowest percentage (after 8.39%) since the employer mandate has been in effect."  MORE >>

"A federal trial court ruled that the plan exclusion constituted discrimination based on sex and permanently enjoined the employer from any further enforcement or application of the exclusion. On appeal, a three-judge panel of the Eleventh Circuit upheld that order ... The court agreed to a rehearing and vacated the panel's prior opinion." [Lange v. Houston County, Georgia., No. 22-13626 (11th Cir. Aug. 15, 2024)]  MORE >>

"[T]he Fourth Circuit concluded that the defendant did not terminate the plaintiff because he took FMLA leave. Instead, it focused on the defendant's belief that the plaintiff submitted contradictory medical paperwork in connection with this FMLA leave ... The company continued to investigate by taking a statement from the plaintiff. Only then, based on its full investigation, did it terminate the plaintiff." [Shipton v. Baltimore Gas and Elec. Co., No. 23-1360 (4th Cir. Jul. 31, 2024)]  MORE >>

"The first step in a dependent eligibility audit/review is to ensure that the definition of 'eligible dependent' is consistent and uniformly stated throughout the ERISA plan document, the Summary Plan Description (SPD), benefits guides, open enrollment materials, and employee handbooks."  MORE >>

"While health and fitness clubs and on- site fitness centers promote general good health, they normally are made available without regard to sickness or disability and do not diagnose or treat specific medical conditions, so they typically do not provide medical care, benefits in the event of sickness, or any other ERISA benefit. Absent an ERISA benefit, a policy or program of paying for health club memberships or providing an on-site fitness center would not be an ERISA plan."  MORE >>

"[T]he highest projected rate of increase for all health benefit plan cost trends is for outpatient prescription drugs: 11.4 percent.... Survey respondents project the per-person cost trend for PPO/POS plans to be 7.9 percent.... Plan sponsor focus has shifted dramatically to cost- and quality-management strategies related to prescription drugs and weight loss-treatments specifically, which now account for four of the top five cost-management strategies."  MORE >>

"Measured from 2022 to 2024, annualized increases in individual stop-loss premiums range from 10.4% at a $100,000 deductible to 13.8% at a $750,000 deductible. This dynamic, known as leveraged trend, occurs as the underlying increase in expense of a catastrophic medical claimant is fully borne by an unchanged stop-loss deductible from one year to the next. The more immediate change from 2023 to 2024 reflects a lower increase not exceeding 9.1% at any deductible, potentially reflecting softer renewal pricing for the 2024 policy period."  MORE >>

"Medical care benefits were available to 72 percent of private industry workers and 89 percent of state and local government workers in March 2024 ... Forty-three percent of private industry workers had access to dental benefits and 60 percent of state and local government workers had access. Twenty-eight percent of private industry workers had access to vision benefits while 39 percent of state and local government workers had access."  MORE >>

15 pages. "If subject to the same ERISA fiduciary duties as plan sponsors, PBMs would effectively be required to act in the best interest of plan participants and help keep plan costs low.... PBMs could not engage in self-dealing or other profiteering tactics like many do today.... Congress has the flexibility to be prescriptive in defining the types of actions that a PBM may undertake that would result in ERISA fiduciary status. Or Congress may simply provide that a PBM shall become an ERISA fiduciary upon entering into an agreement to provide services to an ERISA-covered health plan. "  MORE >>

"[I]ndividuals and businesses in Pennsylvania that were affected by Tropical Storm Debby that began on Aug. 9, 2024 ... now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Lycoming, Potter, Tioga, and Union counties qualify for tax relief."  MORE >>

"[PLR 202434006] allowed a choice [among] ... [1] The 401(k) plan; [2] A Retiree Health Reimbursement Arrangement (HRA); [3] The employee's HSA account; or [4] An Educational Assistance Program to pay off student loans.... [T]he IRS agreed to these four choices for an employer contribution, which otherwise would have only been made to the 401(k) plan. It did come with some caveats however."  MORE >>