160 pages. "This document covers details on composing and submitting Forms 1094/1095-B and Forms 1094/1095-C by transmitters to IRS. The scope of the document addresses the A2A-application based via SOAP messages exchanged between client and exposed Web Service endpoints and the Web UI-browser-based requiring human initiation."  MORE >>

100 pages. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for information returns transmitted electronically through the AIR System.... The procedures in this publication should be used when the following information returns are transmitted electronically for Tax Year (TY) 2015, TY2016, TY2017, TY2018, TY2019, TY2020, TY2022, TY2023, TY2024 in PY2025: [1] Form 1094-B, Transmittal of Health Coverage Information Returns; [2] Form 1095-B, Health Coverage; [3] Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; [4] Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. This publication does not contain information or procedures for filing Form 1095-A."  MORE >>

"For 2025, with the Inflation Reduction Act lowering the out-of-pocket maximum to $2,000 (from $8,000 in 2024), many employer prescription drug plans -- and especially those with High Deductible Health Plans -- may find that their plans are no longer creditable.... CMS provides model notices to send to participants for creditable coverage in both English and Spanish. Noncreditable model notices in English and Spanish are also provided."  MORE >>

"The CAA added a MHPAEA requirement for group health plans to make available upon request to the DOL, HHS, and IRS a comparative analysis of the design and application of non-quantitative treatment limitations (NQTLs) on the plan mental health and substance use disorder benefits. New MHPAEA regulations require that the employer as a fiduciary certify within the document that they have engaged in a prudent process and monitored their service provider."  MORE >>

"The final rule strengthens compliance requirements for health plans under the MHPAEA, specifically relating to non-quantitative treatment limitations (NQTLs) ... It requires that plans and issuers implement certain compliance processes to ensure that the processes, strategies, evidentiary standards, and other factors used in applying NQTLs to mental health and substance use disorder (MH/SUD) benefits are comparable to those used for medical/surgical benefits, and not more restrictive."  MORE >>

"For health and welfare plan sponsors, the good news is that that in many cases, these practices are already a focus of their vendors, especially given legislation from 2021 designed to encourage HIPAA covered entities to adopt some security practices. Still, the [updated guidance] provides a good roadmap for all sponsors of plans (including those not covered by ERISA) to consider when evaluating their service providers as part of their fiduciary due diligence."  MORE >>

"CMS published regulations regarding Civil Money Penalties (CMPs) in the Federal Register on October 11, 2023.... These regulations are applicable as of October 11, 2024, and will be enforced as of October 11, 2025. While this section discusses compliance and CMPs, RREs are reminded to always refer to the GHP User Guide for information and instructions pertaining to the specifics of mandatory insurer reporting requirements.... [T]he published User Guides take precedence over this information and should be referenced."  MORE >>

"A growing dispute between pharmacy benefit managers (PBMs) and government regulators intensified Sept. 20 when the [FTC] filed suit against the three leading PBMs and their affiliated group purchasing organizations. The complaint ... seeks to address a system in which PBMs use their negotiating clout with drug manufacturers in a way that skews prices. Insulin costs are the specific concern in the lawsuit, with one leading brand increasing in list price from $21 to $274 between 1999 and 2017, the FTC said[.]" [In re Caremark et al., No. 9347 (FTC admin. complaint filed Sep. 20, 2024)]  MORE >>

"The [Massachusetts Supreme Judicial Court] held that this part of the statute simply required that an employee's benefits remain unchanged, not increased or decreased, from when they begin leave to when they return from leave. Thus, an employee returning from PFMLA leave can continue to accrue benefits as if the employee never took the leave, but the employee does not have the right to continue accruing benefits during the leave." [Bodge, et al. v. Commonwealth, SJC-13567 (Mass. Sept. 13, 2024; slip op.)]  MORE >>