"The information provided in this resource is only intended to highlight key steps in the EHB-benchmark Plan Modernization Grant for States with a Federally facilitated Exchange Grant Program.... [1] Eligible applicants.... [2] Available funding.... [3] EHB-benchmark plan modernization grant for states with a FFE program overview.... [4] Application preparation and submission.... [5] Application review and award selections."  MORE >>

"Both the IRS and [the] agencies tasked with issuing rules under the [ACA] have released guidance on new items considered preventive and medical care, as well as some further requirements around existing items plans are required to cover. Some of the guidance related to high deductible health plans (HDHPs) is effective retroactively presumably because some HDHPs may have already covered those items believing them to be preventive care."  MORE >>

"The case alleges that the three largest PBMs -- Caremark, Express Scripts and OptumRX -- used unfair rebate schemes to artificially inflate the price of insulin. In mid-October, the PBMs each moved for separate proceedings, arguing that a consolidated trial could create confusion. The judge held that the factual differences in each of the cases were 'minimal and manageable.' " [In the Matter of Caremark Rx, No. 221-0114 (FTC Nov. 14, 2024)]  MORE >>

"Express Scripts, Caremark and Optum Rx ... are arguing in a new lawsuit the FTC's recent actions and administrative process subvert the U.S. Constitution by reforming an industry by 'regulatory fiat.' ... The PBMs claim the FTC's viewpoint on PBM pricing and contracting strategy is subjective and would force PBMs to rework agreements." [Express Scripts, Inc., v. FTC, No. 24-1549 (E.D. Mo. complaint filed Nov. 19, 2024)]  MORE >>

"There are many new models of pharmacy program service delivery under consideration and their number and design are limited only by creativity. [This article discusses] three such models ... [1] Product/service disaggregation, [2] Program segmentation, and [3] Industry disruption."  MORE >>

"Regulations taking effect this month will make pharmacy benefit managers, or PBMs, publish their lists of covered drugs and directories of pharmacies in their networks. The state will also bar PBMs from steering patients to their affiliated pharmacies and allow local pharmacies to offer mail-order and home delivery."  MORE >>

"[T]he average per-employee cost of employer-sponsored health insurance reached $16,501 in 2024, an increase of about 5% year over year, with employers expecting an increase of about 6% in 2025.... The fastest-growing component of health benefit cost continues to be prescription drugs. Pharmacy benefit cost rose 7.7% in 2024, following an increase of 8.4% in 2023. One driver of this spend is the growing utilization of GLP-1 drugs for diabetes and weight loss."  MORE >>

"Offering tailored benefits for parents can improve work-life balance, reduce stress, and increase loyalty. Benefits like parental leave, dependent care FSAs, and adoption assistance, as well as low-cost accommodations like flexible working hours, can have a big impact."  MORE >>

"More than half (56%) of U.S. working-age adults were insured all year with coverage adequate to ensure affordable access to care.... Among adults who were insured all year but underinsured, 66 percent had coverage through an employer,  ... Nearly three of five (57%) underinsured adults said they avoided getting needed health care because of its cost; 44 percent said they had medical or dental debt they were paying off over time."  MORE >>

"Qualified retirement plans: [1] Long-term part-time employees ... [2] Catch-up provisions ... [3] Forfeitures ... [4] Expanding automatic enrollment in retirement plans ... [5] Roth catch-up contributions ... [6] Required minimum distributions ... [7] Annual notices ... [8] Qualified plan amendments ... Health and welfare plans: [1] Gag clause prohibition compliance ... [2] End of telehealth extension ... [3] Mental Health Parity and Addiction Equity Act requirements ... [4] HIPAA privacy reproductive health protections ... [5] Health and welfare plans cybersecurity."  MORE >>

"Although employers generally outsource their ERISA plan administration to service providers, employers still retain an obligation as plan fiduciary to act prudently and in the best interests of plan participants and beneficiaries, which includes taking necessary precautions to protect sensitive data from cybersecurity risk."  MORE >>

This article describes annual cost-of-living increases for both qualified and health and welfare plans, and includes a summary table of penalties, percentages, and premiums under the employer shared responsibility requirements of Code Section 4980H.  MORE >>

"Benefits are no longer the sole domain of HR departments. Instead, they have become a crucial strategic lever as forward-thinking C-suite leaders emphasize how benefits can impact employee wellbeing, productivity and organizational culture. In this new paradigm, the role of the benefits advisor (or consultant) has also broadened from focusing on the design and efficiency of benefit plans to a holistic emphasis on how benefit strategies align with business objectives."  MORE >>