"On October 21, 2024, the Departments of Labor, Health and Human Services, and the Treasury issued FAQs Part 68 relating to preventive services and the Women's Health and Cancer Rights Act.... Non-grandfathered group health plans subject to the ACA preventive care mandate should ensure they are covering, without cost sharing, all required preventive care, including, for plan years beginning on or after August 31, 2024, specified oral and injectable formulations of PrEP and specified baseline and monitoring services."  MORE >>

"New insurance coverage mandates dominated activity in the third quarter, with California and Illinois leading the way. Paid family and medical leave (PFML) laws saw minor changes ... A long-awaited state supreme court decision struck down Michigan's existing paid sick and safe leave (PSSL) law, replacing it with an earlier version originally approved in 2018. States were mostly quiet on the prescription drug (Rx) front, although Alaska did enact a comprehensive bill applicable to fully insured plans. Likewise, telehealth received only scant attention. San Francisco announced changes for its two major healthcare ordinances."  MORE >>

"The new law will require certain fully insured health policies to cover the diagnosis and treatment of infertility. SB 729 will cover certain policies issued, amended, or renewed on or after July 1, 2025."  MORE >>

"The Oct. 30 decision restores language from prior regulations and means insurers can continue to incorporate or exclude certain disputed factors in calculating the [qualifying payment amount (QPA)], which in turn is one of the components for arbitrators to consider in the independent dispute resolution (IDR) process. When applied, the factors at issue in the case generally would decrease the tallied QPA." [Texas Medical Assoc. v. HHS, No. 23-40605 (5th Cir. Oct. 30, 2024)]  MORE >>

"The Fifth Circuit upheld challenged provisions regarding calculating qualifying payment amounts (QPAs) under the NSA's federal IDR process and QPA-related disclosure. However, the court concluded that a provision governing the deadline for notice of payment denials conflicted with the NSA, and therefore should be vacated." [Texas Medical Assoc. v. HHS, No. 23-40605 (5th Cir. Oct. 30, 2024)]  MORE >>

"Plaintiff ... argued that Unum was a functional fiduciary because it was Unum and not Mass General that denied Plaintiff's claim, upheld that denial, and conducted some medical analyses to reach those decisions.... The Court found that these acts were all contemplated by the ASO, which makes clear that Unum undertakes these administration and management functions consistent with Mass General's general or specific direction and interpretation of the Plan." [Shea v. Unum Life Ins. Co., No. 24-10402 (D. Mass. Oct. 28, 2024)]  MORE >>

"The lawsuit alleges that the regulatory requirements for STLDI and fixed indemnity policies exceed the tri-departments' rulemaking authority, contradict statutory provisions and legislative intent, ignore procedural requirements, provide an inadequate record, and 'invade[] the province of state regulatory authority.' The complaint includes sweeping claims concerning the 'true intent' behind the STLDI and fixed indemnity regulation, alleging it seeks 'to eliminate health insurance options for Americans ... all under the guise of consumer protection.' " [Amer. Assoc. of Ancillary Benefits v. HHS, No. 24-0783 (E.D. Tex. complaint filed Sep. 27, 2024)]  MORE >>

94 pages. "This GRIST summarizes potential year-end 2024 and expected 2025 compliance and policy developments affecting health and leave benefits and suggests action steps for employers. Topics covered include ... [1] Congressional outlook.... [2] Regulatory outlook.... [3] Outlook for 2025 election-related policy changes.... [4] Litigation outlook.... [5] State outlook."  MORE >>

"The best way to satisfy these legal obligations is to create a strategic plan for fulfilling your ERISA fiduciary responsibilities.... It will help your efforts to control the cost of health care, manage risk, root out fraudulent and wasteful spending, and develop benefit offerings with the potential to improve the health and financial security of your employees."  MORE >>

"Voters in three states -- Alaska, Missouri, and Nebraska -- will have a chance to vote on establishing paid sick leave in their states. The states could join the eighteen states and Washington, D.C., that already have paid sick leave laws."  MORE >>

"American healthcare isn't broken. It operates precisely how the enormous hospital chains, gluttonous insurers, pilfering prescription benefit managers, and slothful governmental bureaucrats want it to -- for their benefit in every instance. Who's left holding the bag? Employers and employees."  MORE >>