"MHPAEA compliance has never been about coverage mandates, and self-insured group health plans have no obligation to cover any mental health services if they choose not to. In these final rules, the Departments may have gone a step too far by mandating meaningful benefits and outcome-driven data analyses. These components of the final rules may be vulnerable to challenge particularly considering the US Supreme Court's decision in Loper Bright[.]"  MORE >>

"The new final rules: [1] Formalize and expand the components required to be included in the NQTL comparative analysis.... [2] Require plans to review and evaluate claims and other relevant data to determine the impact of the plan's NQTLs on participants' access to MH/SUD benefits and take reasonable action to address any material issues. [3] Create a new 'meaningful benefits' standard for MH/SUD benefits."  MORE >>

"Myth 1: Every coverage tier must be affordable ... Myth 2: If employers offer multiple plan options, they all must be affordable ... Myth 3: Employers can use the same plan to meet affordability for all employees ... Myth 4: The Rate of Pay Safe Harbor is based on how many hours the employee works ... Myth 5: The W-2 Safe Harbor is based on the employee's annual salary or gross income ... Myth 6: Wellness programs do not impact affordability."  MORE >>

"The CMS 2025 Program Instructions included two provisions that should assist plan sponsors with maintaining creditable coverage status for 2025. First, CMS clarified that plan sponsors can exclude prescription drug manufacturer discounts when calculating actuarial value. Second, while CMS considered removing the simplified determination method due to the changes to Part D under the IRA, the instructions clarified that the option remains available for sponsors for 2025 (although future guidance will determine whether the option remains available in future years)."  MORE >>

"Cafeteria plans must follow the general principle that participant elections cannot be changed during the period of coverage (generally, the plan year) but there are some limited exceptions.... The terms HIPAA special enrollment rights, change in status, and qualifying life events are often used interchangeably.... It is important for Plan Sponsors to understand the distinctions between each term to know the impacts each may have on an individual's eligibility."  MORE >>

"[B]reast cancer screening is listed as a safe harbor by the IRS (see Notice 2004-23). The safe harbor states that preventive care includes cancer screenings, specifically listing 'Breast Cancer (e.g., Mammogram)' -- which leaves open what other cancer screenings besides mammograms are included."  MORE >>

"Governor Newsom has signed Senate Bill (SB) 1105, which expands existing paid sick leave provisions to allow agricultural employees to use paid sick leave for additional reasons. These changes take effect on January 1, 2025 ... to require that employers provide paid sick days to agricultural employees who [1] work outside and [2] request sick leave to avoid smoke, heat, or flooding conditions created by a local or state emergency, including sick days necessary for preventive care due to their work or such conditions."  MORE >>

"The proposed rules provide greater detail as to how the DOL plans to implement and enforce the new program. Although they are substantially similar to the initial proposal, the revised rules contain a number of relatively minor changes and reorganizations and seven significant changes:"  MORE >>

"[The administration] asked the U.S. Supreme Court to protect preventative care services offered under the [ACA] in a case that could affect access to cancer screenings and HIV prevention drugs, among many other services that have been available to patients without charge under the ACA." [Braidwood Mgmt, Inc. v. Becerra, No. 23-10326 (5th Cir. Jun. 21, 2024; cert. pet. filed Sep. 19, 2024)]  MORE >>

"The court found that '[n]o explanation was provided or offered' for United's denial, and that its letter 'said nothing about the plan provisions or how E.D.'s medical circumstances were evaluated under the plan.' The court cited cases from the Ninth and Tenth Circuits in stating, 'We therefore join a growing number of decisions rejecting similar denial letters issued by United across the country.' " [Dwyer v. United Healthcare Ins. Co., No. 23-50439 (5th Cir. Sept. 19, 2024)]  MORE >>

"As new employees to the workforce, some Gen Z employees might still be on their parents' health plans and have no idea what the difference is between copayment and coinsurance. They have never seen an Explanation of Benefits or Summary of Benefits and Coverage.... Start by surveying your employees to ascertain their health insurance knowledge. Understanding where the gaps are can help you tailor your educational programming to where it is needed the most."  MORE >>

"Menopause-specific benefits may include access to menopause health professionals and hormone replacement therapy coverage by health insurance plans.... Supportive policies could include sick leave, paid time off and flexible work arrangements.... Training and workshops can also help build awareness of this health condition in the workplace and guide managers' conversations."  MORE >>

"In the updated guidance, the DOL ... indicated that the plan fiduciary should find out if the service provider has any insurance that would cover losses caused by cybersecurity and identity theft breaches ... added additional detail on multifactor authentication (MFA) ... [and] advised that participants should use longer passwords, not common passwords, and change their longer passwords only annually instead of more frequently."  MORE >>

"A recent IRS private letter ruling (PLR) paves the way for a 401(k) plan sponsor to give employees flexibility to allocate an employer nonelective contribution among other tax-favored benefit options.... [E]mployees can't receive the contribution in cash or as another taxable benefit."  MORE >>

"[M]ore than two-thirds of those surveyed said that the availability of Federal Employees Health Benefits, the Thrift Savings Plan and the retirement annuity greatly or moderately influenced their decision to take a federal job. Similarly, more than three-quarters of employees reported that the trio of benefit programs influenced their decision to remain in a government job."  MORE >>