"This NQTL Comparative Analysis process is complex requiring the collection of detailed clinical data from group health plan vendors that establish and administer NQTLs, an associated analysis of that data ... testing of NQTL data ... and the preparation of a report that comports with onerous content requirements.... [E]mployers and plan sponsors who sponsor ERISA covered plans are now required to certify that they have engaged in a prudent process to select and monitor at least one qualified service provider to complete the required NQTL Comparative Analysis."  MORE >>

"A critical aspect of the new rules is the emphasis on transparency. Health plans are now required to disclose how they develop their NQTLs, which include prior authorization requirements, treatment management techniques, standards for network composition, and methodologies for determining out-of-network reimbursement rates. Insurers must demonstrate that their NQTLs for MH/SUD benefits are applied no more restrictively than those for medical benefits."  MORE >>

"Proposed rules issued by the DOL, HHS, and Treasury are designed to increase coverage for over-the-counter contraceptives ... without a prescription. If finalized, the proposed rules would be the first time that male contraceptives will be covered under the ACA preventive care requirements. The public has until December 27, 2024, to submit comments on the proposed rules."  MORE >>

"[To] comply with the 2024 Final Privacy Rule, a covered entity is only required to disclose PHI to the individual the PHI belongs to and to the individual's personal representative. All other disclosures are permissive.... This article ... discusses compliance hurdles that covered entities may face when refusing to provide requested information in permissive circumstances."  MORE >>

"Covered Entities (i.e., health plans) and Business Associates must train applicable workforce members and amend their HIPAA policies and procedures by December 23, 2024 with respect to the requirements of this new guidance. These entities must also update their Notice of Privacy Practices (NPP), but the updated NPP is not required until February 16, 2026."  MORE >>

"The proper standard in an FMLA interference claim, according to the opinion, requires a plaintiff to 'establish that the defendant denied or otherwise interfered with a benefit to which she was entitled under the FMLA.' If an employer 'impeded' the exercise of an employee's FMLA rights, that would allow the claim to go forward.... [T]he court also noted that limiting remote work is not the same as interfering with FMLA rights." [Kemp v. Regeneron Pharmaceuticals, Inc., No. 23-0174 (2d Cir. Sep. 9, 2024)]  MORE >>

"To comply with ERISA, employers and plan sponsors should structure an employee surcharge policy that retroactively reimburses the surcharge to the those that cease using tobacco mid-year or begin participation in a wellness cessation program mid-year. To comply with HIPAA, employers and plan sponsors are required to have a reasonable alternative standard available for participants who continue to smoke or use tobacco.... A reasonable alternative standard may include attending an education class or similar tobacco cessation program."  MORE >>

"As health and welfare plan fiduciaries prepare for the year ahead, how can they remain vigilant in identifying and executing their responsibilities in a climate of increasing compliance demands and associated risk? ... [1] Set up a fiduciary committee.... [2] Document decision-making.... [3] Mindfully negotiate and monitor service provider contracts.... [4] Ensure plan expenses are reasonable.... [5] Conduct an internal audit."  MORE >>

"The poll of 2,000 U.S. adults found three-quarters (73%) consider healthcare options an important factor if they were looking for a new job, and 63% wouldn't be afraid to ask about their options during a job interview.... 42% believe their employer only offers them the bare minimum for health insurance options. In fact, 44% believe they'd have better health options if the issue was brought to the attention of their employer."  MORE >>

"[T]he bill is intended to address NYC's mental health crisis. The bill acknowledges the emotional bond many people share with their pets and offers a way to balance work responsibilities with the care of their animals. The availability of paid leave can help reduce the stress and anxiety of employees in balancing pet care with their work responsibilities."  MORE >>

"Prior to the passage of the ACA, small businesses and self-employed workers had limited access to affordable health insurance. In 2011, roughly 3 in 10 self-employed workers were uninsured. The Marketplaces established by the ACA introduced new coverage options for self-employed workers and others without access to affordable employer-sponsored health insurance. According to tax data from the U.S. Department of the Treasury, 3.3 million small business owners and self- employed adults obtained health insurance through the Marketplaces in 2022."  MORE >>

"While firms are still concerned with helping workers prepare for retirement, firms are expanding the areas they wish to address with their financial wellbeing offerings. Now, in addition to retirement planning, top issues include helping workers deal with high health care costs, high costs of living, financial-related stress, daily living expenses, and budget and money management."  MORE >>