"The provisions prohibit health plans and issuers from entering into contracts with healthcare providers, third-party administrators (TPAs) or other service providers that would preclude certain disclosures of provider-specific cost or quality-of-care information and de-identified claims."  MORE >>

"The MHPAEA Final Rule ... [places] a heavy focus of collection of data to both assess the impact of NQTLs on access to MH/SUD benefits and Med/Surg benefits and demonstrate compliance with the MHPAEA and the data's role in completing the comparative analyses. The MHPAEA Final Rule also emphasizes the need for plans to have a more robust network composition and less restrictive prior medical management techniques, such as prior authorization."  MORE >>

"A first-of-its-kind lawsuit seeking class action status against Anthem Blue Cross and Blue Shield accuses the giant insurer of intentionally misleading patients by publishing a 'ghost network' directory that falsely lists mental health professionals as being in-network when, in reality, they are not.... The complaint claims that more than 80% of listed providers either do not accept Anthem's insurance, are unreachable due to non-working phone numbers, or are mislabeled with incorrect specialties." [Doe v. Anthem Healthchoice Assurance, Inc., No. 24-8012 (S.D.N.Y. complaint filed Oct. 22, 2024)]  MORE >>

"In litigation involving whether an employer's short-term disability (STD) plan was exempt from ERISA, a district court has rejected an employer's challenges to the DOL's regulatory payroll practices exemption under ERISA based on the Supreme Court's recent Loper ruling." [Hansen v. Laboratory Corp. of Am., No. 24-0807 (E.D. Wis. Oct. 24, 2024)]  MORE >>

"More than half of 188 companies polled in September and October are considering a change to their PBM in one to three years ... 88% are currently or are considering requiring a comprehensive definition of the term 'rebate' in their contracts and 80% are currently or are considering the use of a value-based formulary versus a rebate-driven formulary in the next one to three years."  MORE >>

"Just over half (52%) of the survey respondents indicated that they are considering changing their pharmacy benefit manager. Almost two-thirds (65%) respondents indicated that they are using nontraditional pharmacy procurement to counter high-cost claims.... 38% of the respondents strongly agree that high healthcare costs will result in cost shifting to employees. 55% indicated that PBM conflicts of interest are a 'significant threat' to healthcare affordability for employers."  MORE >>

"Among the strategies that are correlated to lower costs: Employers that use a value-based formulary versus a rebate-driven are nearly three times more likely to have lower spending than average. Employers that drive patients to higher quality and lower cost providers through tiered networks are twice as likely to experience lower costs. Employers that eliminate the middleman by direct contracting with providers are 50% more likely to experience lower than average costs."  MORE >>

"[E]mployers expect their healthcare costs to increase an average of 6.7% for 2025 after accounting for changes to their plan offerings.... Employers must now more than ever keenly monitor their health plan claims experience and proactively manage costs. While traditional cost management techniques (e.g., changes to plan designs/offerings and employee contributions) are limited to annual renewal cycles, other approaches can be implemented throughout a plan year."  MORE >>

"New York City is expanding its family planning benefits for some municipal employees by offering to reimburse them up to $10,000 for costs related to adoption, surrogacy and egg and sperm donation ... Because these benefits are only available to non-union employees, only 5% of the city workforce will be able to take advantage of them. Approximately 350,000 unionized city workers will not be eligible."  MORE >>

"The City's sick leave law currently provides workers at companies with more than 100 employees with up to 56 hours of paid sick leave a year, while those at smaller businesses receive 40 hours.... The pending proposal wouldn't provide additional leave but would allow employees to use their existing sick leave for pet care. For pet owners who consider their furry companions part of the family, this potential change would be a paw-sitive development."  MORE >>

"[T]he Health Care Cost Institute is excited to introduce ... a free health care price transparency tool that shows consumers the average prices for health care services in their local metropolitan area. Access to data on prices can help consumers, employers, and other purchasers of health care better understand typical rates for the most common health care services."  MORE >>

"SECURE Act 2.0 paved the way for more flexible benefits by allowing 401(k) contributions to match student loan payments. [A recent IRS Private Letter Ruling] is another big step forward that other organizations can learn from. And these are not the only options available -- there are more possibilities than ever for companies to deliver meaningful rewards that support employee financial wellness."  MORE >>