"This final rule expands on previous regulations concerning the PSHB Program and is intended to provide greater detail and clarity necessary to properly implement PSHB in 2025 and beyond. In particular, this final rule includes details on reconsideration of PSHB eligibility decisions, the Medicare Part B enrollment requirement, allocation of reserve credits, calendar year alignment of Government contribution requirements, financial reporting and actuarial calculations, premium payment prioritization from the Postal Service Retiree Health Benefits Fund, and Medicare Part D integration."  MORE >>

"[T]he rule expanded the definition of protected health records (PHRs), clarified that the rule applies to online platforms and mobile apps, and revised the method, time, and content for reporting data breaches to the FTC and impacted individuals. The revisions to the HBNR follow recent FTC action against companies for violations of the rule, signaling a renewed focus on data breach notifications within the health care marketplace."  MORE >>

"The 2024 final rule imposes a number of administrative requirements on covered plans, in addition to the core nondiscrimination requirements ... Although some of these reinstate provisions of the 2016 final rule, there are new requirements. To the extent a group health plan is a covered entity on account of its receipt of federal financial assistance, [these] requirements will apply[.]"  MORE >>

"[1] Limits for fringe benefits and other code-governed health and welfare arrangements ... [2] ACA affordability percentage (employer mandate penalties) ... [3] ACA premium tax credit ... [4] ACA information reporting ... [5] PCOR dollar amount ... [6] HSA limits for 2024 ... [7] Excepted benefit HRAs (EBHRAs) ... [8] ACA cost-sharing limits (CMS guidance)."  MORE >>

"Grabbing headlines recently is a growing number of proposed class action lawsuits against employer group health plan sponsors (mostly self-funded) for allegedly wrongfully imposing tobacco-use surcharges on employee premiums or contributions. In all of these cases ... employees who use tobacco (smoke, vape or chew) pay higher health plan premiums than similarly situated non-users. Premium differentials based on tobacco-use status is okay, as long as the HIPAA nondiscrimination rules for health-contingent, outcomes-based wellness programs are followed. Unfortunately, according to the allegations made in these complaints, these employer plan sponsors missed a few of the major requirements."  MORE >>

"As of January 1, 2025, California PSL will now be available to victims of 'qualifying acts of violence,' i.e., conduct, or patterns of conduct that justify safe time ... The HWHFA previously limited use of PSL for safe time to when an employee was a victim. The combination of SB 1105 and AB 2499 extends this category of leave to employees whose family members are victims as well."  MORE >>

"America's largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people.... EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.... Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment."  MORE >>

"Since the regulations were established, and adjusting for inflation, the top 25% of prices fell by 6.3%. However, the bottom 25% of prices increased by 3.4%. Meanwhile, the middle 50% of prices decreased just 1.1%."  MORE >>

"As workplaces become more diverse, employers are challenged to create an array of voluntary benefit offerings that are attractive to and work for a range of employees.... [V]oluntary benefits that are trending include: [1] Mental health benefits, including access to apps such as Calm or online mental health tools. [2] Maternity benefits such as milk storage. Identity theft protection and cyber theft protection. [3] Legal services."  MORE >>

"The change in coverage comes at a time when interest in expensive GLP-1 drugs for weight loss is skyrocketing, and employers, Medicare, and other insurance providers are grappling with how to respond.... [E]mployers that cover GLP-1 drugs for weight loss generally do so as a special perk to attract top talent, not for the potential long-term savings — which they may never see ... And only some employers are willing to take on the up-front costs."  MORE >>

"This blog is intended to help employers seek feedback from parent employees on child care needs and understand what on-site options would entail, like how to operate, start-up time, investment and ongoing costs. It can be intimidating to get started. States may offer support for employers getting started with on-site care and/or grants or tax incentives for operation."  MORE >>