Updated Sep. 19, 2024. "These FAQs supersede earlier FAQs that were posted ... on Feb. 9, 2024.... The revisions and additions are as follows: Updated Affordability of employer coverage for employees and for family members of employees Q11."  MORE >>

"In choosing not to adopt the 'no more restrictive' test that they proposed, the Departments have conceded that the required mathematical calculations would have presented various operational and feasibility challenges.... [T]he decision to remove these potentially problematic provisions and to replace them with a restatement of the express statutory requirements ... seems to signify a defensive posture by the Departments[.]"  MORE >>

"The Final Rule indicates that plans and issuers are ultimately responsible for MHPAEA compliance but that TPAs or other service providers who act as fiduciaries for ERISA-covered group health plans must work with those plan sponsors or issuers to ensure such compliance ... The Departments declined to follow commentators' suggestion that the Final Rule require that plans enter into contracts with TPAs similar to HIPAA business associate agreements that would require TPAs to cooperate with the plans' compliance obligations pursuant to the MHPAEA."  MORE >>

"[T]he Final Rule did not fully resolve all of the matters related to the hospital and fixed indemnity plans ... The proposed rule spoke to new requirements for fixed indemnity plans to be considered excepted benefits and alluded to some important taxation changes for accident and health plan benefits. While the Departments opted not to delve further into these issues in the Final Rule, they did signal that they would potentially pick the topic back up at a later date."  MORE >>

"With more employees working from home or following a hybrid schedule ... it's increasingly likely that employees who previously worked in San Francisco are now working somewhere else that may not be within the boundaries of the Ordinance ... Conversely, employers could also become subject to the HCSO if they have employees who telework and live in San Francisco ... visit clients or provide services to companies located in San Francisco."  MORE >>

"If an employer honestly believes an employee committed what would be a legitimate ground for termination, and takes action against the employee based on that belief, then the action is not unlawful. This rule applies even if it turns out that the employer was mistaken." [Shipton v. Baltimore Gas and Elec. Co., No. 23-1360 (4th Cir. Jul. 31, 2024)]   MORE >>

"Given that dependents are typically not employees of the plan sponsor, meticulous gathering of key demographic and relevant information is paramount during the enrollment process.... Certain life events that alter dependent eligibility ... may go unnoticed unless reported by the employee. Consequently, plan administrators should periodically assess the dependent status of individuals currently enrolled in the plan."  MORE >>

"Start with a pre-enrollment audit to identify and correct any data errors. Schedule early meetings to review your benefits portfolio, develop a renewal strategy, and create a clear communication plan to keep employees informed. Make sure to prepare engaging and educational materials to help employees make informed decisions and reduce last-minute questions."  MORE >>

"Direct purchase from a pharmaceutical company of GLP-1 medications effective in obesity treatment at this point remains cost-prohibitive for most plan members with obesity who don't have coverage in their employer-sponsored plans.... Generic medications represent a good value, and employers should design plans to encourage generic prescribing when available. Employers and consultants can be alert that in some cases, 'spread pricing' ... can erase some of the generic drug price advantage."  MORE >>

"Fewer than one-third of 200 large employers said they were satisfied with their employees' access to behavioral health services. More than four of five employers (84%) felt that in choosing plans, behavioral health access and quality were as important as ensuring control of behavioral health costs. Offering behavioral health networks with an insufficient supply of providers also reduces the value of plans to employees, who must then turn to out-of-network behavioral health services, for which they pay out of pocket."  MORE >>

"Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients' ability to afford out-of-pocket payments -- even when covered by insurance."  MORE >>

"Employee benefit plans are targets for cybercriminals because of the large amounts of sensitive data they require. As new threats become increasingly complex and continue to emerge, fiduciaries can work to better protect participant data and mitigate their own losses by establishing adequate compliance now."  MORE >>