"Under Notice 2024-75, a plan will not fail to qualify under section 223(c)(2) if it provides benefits for OTC birth control with or without a prescription, including emergency contraceptives and male condoms. The guidance also expands the coverage of breast cancer screenings initially set out in Notice 2004-23 to include other options like ultrasounds and MRIs. Finally, the guidance makes clear that benefits for continuous glucose monitors for diabetes patients and selected insulin products described in section 223(c)(2)(G) of the Code are treated as preventive care."  MORE >>

"The FAQs explain that plans and insurers must cover items or services coded as preventive without cost-sharing unless the plan or insurer has individualized information to establish that the item or service is not preventive.... [P}lans and insurers that provide medical and surgical services for mastectomy and are subject to WHCRA are required to provide coverage for all stages of breast reconstruction."  MORE >>

"[In] response to the RFI, several commenters urged broader coverage of OTC contraceptives and argued that the current prescription requirement on birth control is based only on agency guidance and not on the Public Health Services Act or its implementing regulations.... [The] agencies gave health plans and insurance issuers the green light to impose so-called medical management techniques to contain costs and potentially minimize abuses of a new expansion in insurance coverage for OTC products."  MORE >>

"The GCPCA attests to a health plan's (or insurer's) compliance with the prohibition against 'gag clauses' in any agreements with providers, provider networks, or entities offering provider network access.... An attestation must be made by December 31 each calendar year."  MORE >>

"[A] table shows the 2025 adjusted amounts for health FSAs, QSEHRAs and qualified LTC policies, along with the limits for 2024 and 2023. The health FSA carryover limits shown reflect the maximum unused funds that can carry over to the next plan year."  MORE >>

"Plan fiduciaries should continue to focus on their health plan’s cyber hygiene, but also review the cybersecurity measures of other welfare plans, such as accident, disability, life and on-site clinics that aren’t subject to HIPAA but may face similar cyber risk....  Consider asking all existing ERISA health and welfare plan service providers for details on their cybersecurity practices, past breaches and insurance policies."  MORE >>

"Seattle has announced the 2025 calendar-year health care expenditure rates that certain hotel industry employers must make on behalf of each covered employee for medical care.... [C]overed employers under the Ordinance include those that own, control, or operate either a Seattle hotel or motel with 100 or more guest rooms or an 'ancillary hotel business' of 50 or more employees worldwide."  MORE >>

"Two-thirds of large employers say that lowering the cost of coverage is a priority ... Employers are also finding ways to remove financial barriers for workers by offering plans with no/low deductibles or telehealth services.... Even though specialty medications contributed to overall health care cost increases this year, ... employers are more likely to add coverage for these medications than drop it.... 62% of employers will offer one or more of the listed reproductive health benefits next year, up from 46% in 2024."  MORE >>

18 pages. "[The OIG] determined that OPM does not have comprehensive documented plans, policies, and procedures for the operation of what OPM describes as its customer support experience for PSHBP customers during the PSHBP Open Season 2024 and thereafter.... [T]he lack of a substantial overall plan may result in inadequate customer support for Postal Service members."  MORE >>

"A bill introduced ... in the NY City Council would require employers to provide employees paid sick leave for pet care. ... [The measure would] amend the Earned Safe and Sick Time Act to include the care of a companion or service animal that needs medical diagnosis, care, or treatment of a physical illness, injury or health condition or that needs preventive medical care."  MORE >>

"This Sidebar begins by providing a brief legal background of the relevant statutes and case law prior to Corner Post. It then discusses the procedural history of Corner Post and summarizes the opinion and separate statements in that case. The Sidebar concludes with several considerations for Congress." [Corner Post v. Bd. of Gov. of the Federal Reserve System, No. 22-1008 (S. Ct. Jul. 1, 2024)] [LAB11197; Oct. 24, 2024]  MORE >>