18 pages. "Employers with 50 or more full-time employees (including full-time equivalent employees) in the previous year use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees." [Also available: 2024 Form 1094-C and 2024 Form 1095-C]  MORE >>

"Group health plan sponsors are required to prepare a comparative analysis documenting compliance for any NQTLs. The final rules ... [provide] much more detail about what is expected to be evaluated and included in the written analysis ... [A] thorough, compliant analysis cannot be quickly pulled together within the timeframe required to comply with a request from an agency or plan participant. It is necessary for employers to complete it and have it ready and on file prior to any request."  MORE >>

"This restriction is purpose based, meaning it doesn't prohibit the use and disclosure of this type of PHI for all purposes, but instead prohibits uses and disclosures for the limited purposes of identifying an individual for criminal or civil liability or administrative investigation. Covered entities can still use and disclose this information for other permitted purposes, subject to the general HIPAA Privacy Rule requirements."  MORE >>

"Governor Newsom has signed into law SB 729, which will increase access to in vitro fertilization (IVF) and other infertility/fertility services. The new California law applies to fully insured health policies issued, amended, or renewed on or after July 1, 2025. Among the mandates, the headline is that large group plans (100+) must cover up to three cycles of oocyte (egg) retrievals for IVF purposes."  MORE >>

"[T]he Massachusetts Department of Family and Medical Leave (DFML) announced an increase to the maximum weekly Massachusetts Paid Family Medical Leave (PFML) benefit, effective January 1, 2025, while contribution rates from employers and employees that fund the public program will remain the same. Additionally, on an issue of first impression, the Massachusetts Supreme Judicial Court (SJC) recently held that an employer does not need to allow employees to accrue certain benefits, such as vacation, sick time, and length-of-service credit during PFML." [Bodge v. Commonwelth, No. SJC-13567 (Mass. Sep. 13, 2024)]  MORE >>

"Express Scripts' 58-page complaint challenges the [FTC's interim report], alleging, among other things, that the FTC ignored dispositive evidence in drawing its conclusions and exhibited unfair bias.... The complaint requests, among other things, declaratory judgments finding the interim report to be unlawful, an order vacating the interim report and an injunction recusing [FTC Chair Lina Kahn] from all FTC action pertaining to Express Scripts." [Express Scripts v. FTC, No. 24-1263 (E.D. Mo. complaint filed Sep. 17, 2024)]  MORE >>

"[The FTC] filed an administrative complaint against three [PBMs] ... alleging that they artificially inflated the price of insulin drugs through 'anticompetitive and unfair' rebate practices ... According to a ... report chronicling the FTC's two-year investigation into the industry, the three PBMs named in the complaint handle nearly 80% of prescription drug claims in the United States, covering over 270 million people. Express Scripts sued the FTC ... to compel the agency to withdraw the report, which it claims is 'false and defamatory.' " [In re Caremark et al., No. 9347 (FTC admin. complaint filed Sep. 20, 2024); Express Scripts v. FTC, No. 24-1263 (E.D. Mo. complaint filed Sep. 17, 2024)]   MORE >>

"The participants alleged that the rebates were plan assets because they were obtained through the exercise of discretionary authority by MetLife in negotiating the contracts and in allocating the rebates to itself at the expense of plan participants.... The district court granted MetLife's motion to dismiss, concluding that plaintiffs did not have standing to pursue their claims." [Knudsen v. MetLife Grp., Inc., No. 23-2420 (3d Cir. Sep. 25, 2024)]  MORE >>

"CMS does not have assurance that pricing data hospitals report are sufficiently complete and accurate, and CMS has not assessed such risks to determine if additional enforcement actions are needed. Without an assessment, CMS does not know whether the data are usable to help increase competition. While CMS officials stated that they do not have the resources to check the accuracy and completeness of all hospital pricing data, the agency has cost-effective enforcement options it could consider, if needed, such as using risk-based or random sampling." [GAO-25-106995 Oct. 2, 2024]  MORE >>

"As health insurance costs continue to rise, employers are eyeing [individual coverage health reimbursement arrangements (ICHRAs)] to control their health care spending while still providing a benefit that workers value. Some consumer advocates are concerned the plans could result in skimpier, pricier coverage for certain consumers, especially sicker, older ones."  MORE >>

"Sen. Ron Wyden, D-Oregon, chair of the Senate Finance Committee, as well as committee member Sherrod Brown, D-Ohio, wrote a letter to the FTC ... expressing concern about units formed recently at two major PBMs that seek to manufacture biosimilars that challenge high-cost branded drugs."  MORE >>

"Insurers: Betting on you staying sick ... Hospitals: The 'chargemaster' scam ... PBMs and pharma: Who needs a cure when you can have a lifetime supply of pills? ... Politicians and government agencies: Keep the machine well-oiled ... Brokers: We've rebranded, but we still don't work for you ... Medical groups: The disappearing independent doctor ... Employers: The last line of defense (and your only hope) ... So, how do we fix it?"  MORE >>

"Taxpayers in these areas now have until May 1, 2025, to file various federal individual and business tax returns and make tax payments. Among other things, this includes 2024 individual and business returns normally due during March and April 2025, 2023 individual and corporate returns with valid extensions and quarterly estimated tax payments.... Besides all of Alabama, Georgia, North Carolina and South Carolina, this currently includes 41 counties in Florida, eight counties in Tennessee and six counties and one city in Virginia."  MORE >>

"[I]ndividuals and businesses in parts of Illinois that were affected by severe storms, tornadoes, straight-line winds, and flooding that began on July 13, 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 Cook, Fulton, Henry, St. Clair, Washington, Will, and Winnebago counties qualify for tax relief."  MORE >>

"[D]ue to recent terrorist attacks in Israel, the agency is providing additional tax relief to affected individuals and businesses, postponing until Sept. 30, 2025, a wide range of deadlines for filing federal returns, making tax payments and performing other time-sensitive tax-related actions.... [A]ffected individuals and businesses have until Sept. 30, 2025, to file returns and pay any taxes that are due during this period."  MORE >>

"[PLR 202434006] approved an employer's program allowing employees to allocate an employer contribution among the 401(k) plan, retiree health reimbursement arrangement (HRA), health savings account (HSA), or educational assistance program (offering student loan repayments). The PLR provides welcome guidance to employers seeking to offer more tailored benefits to their employees."  MORE >>