"The applicable dollar amount that must be used to calculate the fee imposed by sections 4375 and 4376 for policy years and plan years that end on or after October 1, 2024, and before October 1, 2025, is $3.47. The increase from the prior applicable dollar amount is calculated by multiplying $3.22 (which is the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year) by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on June 10, 2024."  MORE >>

"[T]his article [reviews] the key considerations based on both U.S. federal and state laws regarding pregnancy and work (job-seeking and employment). To help clarify how different state laws can impact the way in which employers support their employees, [the article includes] a couple of fictional (but realistic!) examples where employers need to treat employees differently due to state-specific considerations around pregnancy and childbirth."  MORE >>

"WHD opined that employees may take FMLA leave irrespective of whether the 'treatment' is new, experimental, or a placebo.... WHD noted that the [DOL] has historically interpreted the term 'treatment' broadly. WHD also noted that the FMLA regulations do not require employees to disclose their precise treatment plan nor their prescribed medication in order to take FMLA leave. WHD also alluded to the policy goals that would be served by including clinical trials in the definition of 'treatment'."  MORE >>

18 pages. "Group health plan (GHP) sponsors are subject to many state reporting requirements, which essentially fall into three categories: individual health coverage mandate reporting, health plan covered-lives assessment (CLA)/surcharge reporting, and other health plan-related reporting. As a reminder, ERISA arguably preempts some, but not all, state reporting requirements for GHP sponsors, but there are no current legal challenges to these mandates."  MORE >>

"The court explained that the insurer's permitted actions under the ASA ... were insufficient to confer fiduciary status. According to the court, functions such as 'nondiscretionary administrative functions including the application of rules determining eligibility for participation or benefits, the calculation of benefits, and the processing of claims' do not create fiduciary authority.' " [Shea v. Unum Life Ins. Co, No. 24-10402 (D. Mass. Oct. 28, 2024)]  MORE >>

"Rejecting the insurer's arguments, the district court concluded that Loper did not affect the court's process for determining the appropriate standard of review. The court reasoned that the DOL's claims regulations did not impose a judicial standard of review. Rather, the regulations address issues such as claims processing time limits and content requirements for benefit denial notices." [Rappaport v. Guardian Life Ins. Co. of Am., (SDNY Nov. 22, 2024)]  MORE >>

"A new wave of ERISA class action litigation is targeting companies that charge an additional insurance premium (e., surcharge) for participants who use tobacco products by claiming that the wellness programs violate ERISA's nondiscrimination test."  MORE >>

"As a result of the growing scrutiny of PBMs by regulators, litigation involving PBMs has only increased.... [It] is important for plans to be aware of their fiduciary obligations under ERISA as it relates to their pharmacy programs. [This article provides] concrete steps plan sponsors and plan administrators can take now that can curtail any resulting liability arising from this litigation or any subsequent actions that follow."  MORE >>

"The allegations stem from an October article ... [which] reported that these three firms secured the $400 million in rebates and fees from Purdue Pharma across a yearlong period ending in late 2017 ... [and] largely pocketed the rebates rather than passing those savings on to consumers ... Beyond the opioid crisis, the letter also slams the major PBMs for being integrated with large health insurers as well as group purchasing organizations, pharmacies and other healthcare businesses."  MORE >>

"[1] Health care costs are growing at historic rates -- sparking an impetus for change.... [2] Employers must tackle rising pharmacy costs to control overall expenses.... [3] Employers may need to defend physical well-being programs; more sophisticated approaches are needed.... [4] Progress has been made in mental health, yet more challenges lie ahead.... [5] Employers and vendors must better enable employees to find the right support at the right time.... [6] Employers will hold their vendor partners to higher standards.... [7] U.S. policy changes and global economic shifts will affect both employers and employees."  MORE >>

"The Hospital Price Transparency Rule, which took effect in January 2021, mandates that hospitals disclose their standard charges for services and procedures, including gross charges, discounted cash prices, and payer-specific negotiated rates.... In this article, [the authors] review CMS enforcement data and the recent GAO report, identify several key lessons, and discuss policy implications and recommendations."  MORE >>

"The Employer-Provided Childcare Credit is designed to incentivize employers to offer childcare services by providing a tax credit of up to $150,000 per year.... To qualify for this credit, an employer must have incurred expenses related to providing childcare services to their employees during the tax year. These expenses can include costs associated with acquiring, constructing, rehabilitating or expanding a qualified childcare facility, and operating expenses such as training childcare workers and offering scholarship programs."  MORE >>

"ERIC outlined concerns about the Proposed Rules and shared alternative approaches the Division could take to improve employer compliance and enhance the operational effectiveness of the PFML Program.... ERIC highlighted the inordinate amount of administrative responsibility that the Proposed Rules seek to place directly on independent employers, which similar state paid leave insurance programs do not do."  MORE >>

"[C]ash gifts are never a de minimis fringe benefit, no matter how frequent or valuable.... Cash equivalents such as gift cards are also not de minimis fringe benefits ... [D]onation matching may be the gift that keeps on giving.... Amounts paid by a corporate employer as a contribution to a charitable institution are deductible by the corporation in the manner allowable for charitable contributions.... [N]othing prevents an employer from giving taxable gifts to employees."  MORE >>