Version 5.0, Dec. 2024. 9 pages. "The purpose of this document is to provide the details on cost-sharing reduction (CSR) attestation files that issuers submit to the Multidimensional Insurance Data Analytics System (MIDAS)."  MORE >>

Version 5.0, Dec. 2024. 20 pages. "The purpose of this document is to provide the details on cost-sharing reduction (CSR) reconciliation files that issuers submit to the Multidimensional Insurance Data Analytics System (MIDAS)."  MORE >>

"Health plans and issuers must ensure their agreements with providers, TPAs and other service providers do not include prohibited gag clauses. Health plans and issuers must submit an annual attestation of their compliance with the CAA's gag clause prohibition. The Departments may take enforcement action against plans and issuers that do not timely submit the required attestations."  MORE >>

"Effective in 2025, Alaska, Missouri and Nebraska will introduce brand new sick leave laws and several states' laws will debut new requirements. Employers with employees in any of these states -- and in particular, employers with employees in multiple states with sick leave laws -- should review their sick leave or paid time off policies to ensure compliance."  MORE >>

"[U]nless Congress provides an extension of relief that allowed first-dollar telehealth benefits without jeopardizing HSA contributions (either by the employer or employee), those provisions will expire on that last day of the plan year that began in 2024, thus disallowing HSA contributions in plan years beginning in 2025 and beyond in plans with that telehealth coverage."  MORE >>

"[1] Update your HIPAA policies ... [2] Prepare for the Mental Health Parity requirements ... [3] Submit your gag clause attestation ... [4] Review your high-deductible health plan (HDHP) to ensure it meets the requirements for 2025 ... [5] Insure your premiums are affordable under the ACA."  MORE >>

"Beginning January 1, 2025, employers must provide at least 20 hours of paid prenatal personal leave (PPPL) during any 52 week calendar period, in addition to the existing statutory paid sick leave entitlement.... New York State recently released a website, including FAQs, regarding the new PPPL mandate. It remains to be seen whether the State will also release proposed and/or final regulations on the new mandate."  MORE >>

"A federal district court was recently called upon to determine the impact of Loper Bright on regulations issued by the [DOL] regarding [ERISA] claims and appeals.... [T]he U.S. District Court for the Southern District of New York overruled a disability insurer's argument that those regulations were unenforceable.... The regulations include time frames for submitting appeals of denied claims, as well as deadlines for deciding claim appeals." [Rappaport v. Guardian Life Ins. Co. of Am., (SDNY Nov. 22, 2024)]  MORE >>

"The court's final judgment finds that the 'compelled notice condition' [1] 'exceed[s] statutory authority' and [2] the language of the compelled notice 'was not a logical outgrowth of the compelled notice identified in the notice of proposed rulemaking.' The court set aside and vacated several provisions of the 2024 Rule relating to the 'compelled-notice criterion'[.]" [Manhattan Life Ins. Co. v. HHS, No. 24-0178 (E.D. Tex. Dec. 4, 2024)]  MORE >>

"Anthem Blue Cross Blue Shield is backing down from a plan that would have set limits on the amount of time it would pay for anesthesia in certain surgeries. In November, Anthem had told health care providers that its plans in Connecticut, New York and Missouri would no longer pay for anesthesia care if the surgery or procedure were to go beyond a specified time limit, regardless of how long the surgical procedure took. The change was to take effect Feb. 1, 2025."  MORE >>

Article provides an explanatory list of common acronyms primarily used in discussions of cafeteria plans, consumer-driven health care, self-insured health plans, and miscellaneous fringe benefits.  MORE >>

"The shocking, targeted killing of UnitedHealthcare CEO Brian Thompson Wednesday struck a nerve on social media, triggering an outpouring of negative experiences with the tangled health care system in the U.S. Many people shared searing stories of health care denials from health insurers."  MORE >>