"Q1: Are providers and facilities required to provide uninsured (or self-pay) GFEs to individuals who are members of health care sharing ministries and not enrolled in other health coverage? A1: In general, yes.... Q2: Are providers and facilities required to verify with an individual's plan or issuer whether the individual is enrolled in a group health plan, group or individual health insurance coverage, federal health care program, or FEHB plan? ... Q3: Does the requirement to provide GFEs to uninsured (or self-pay) individuals apply to dental and vision providers and facilities? A3: Yes. ... Q4: Are GFEs required when students who are not licensed providers furnish health care items or services under the supervision of a licensed provider or facility (such as a university clinic)? A4: Yes. ... Q5: Are uninsured (or self-pay) GFEs for items or services scheduled fewer than 3 business days before the date of service eligible for the patient-provider dispute resolution (PPDR) process? A5: No."  MORE >>

"The year was packed with developments for health and welfare benefits plans ... from new data privacy rules to disaster tax relief. [1] Final rule for [MHPAEA] compliance; [2] Final HIPAA regulations on handling reproductive health and substance use disorder records; [3] Health plan fiduciary guidance and litigation update; [4] Lingering uncertainty over the incoming Trump Administration's policy priorities."  MORE >>

"[T]he DOL rejected the idea that 'voluntary' treatments are not covered by the FMLA, because, in essence, all medical treatments are voluntary and because employers should not second-guess a health care provider's judgment that treatment is advisable by questioning whether it is 'necessary.' ... [T]he DOL does not consider the efficacy of medical treatments to be a relevant factor in the analysis."  MORE >>

"An employer cannot require an employee to choose one leave type over another or require an employee to exhaust one type of leave before using paid prenatal leave.... All private-sector employees are entitled to paid prenatal leave, regardless of the size of the employer.  ... Paid prenatal leave does not accrue. All employees automatically have 20 hours of paid prenatal leave after January 1, 2025."  MORE >>

Dec. 2024 update. "The Departments and OPM are aware of three options ... that have potential for providers to transmit GFE information to payers.... [In this memo,the Departments] discuss each option, highlight some of the standards development work that remains to be done, and indicate the information the Departments and OPM expect industry to make available."  MORE >>

"Encouraging employees to research pricing, compare options, and strategically use their benefits accounts not only reduces out-of-pocket costs but also fosters a sense of control over their healthcare journey. As the year-end deadline approaches, employers should take proactive steps to remind and support employees in maximizing their benefits."  MORE >>

"With just over a week before government funding runs out on December 20, Congress is racing to decide what healthcare measures might ride on a short-term funding plan including an extension of telehealth flexibilities and new Pharmacy Benefit Manager reforms. The likelihood is that any healthcare package will be small relative to the slew of bipartisan legislation that has advanced in this Congress."  MORE >>

"The head of UnitedHealthcare's parent company responded to the killing of the insurance giant's CEO Brian Thompson in a New York Times guest essay ... mourning his death while also calling for work to improve the nation's 'patchwork' health insurance system. In the piece, Andrew Witty admitted the health care system is 'not perfect' and needs to be overhauled so that it works better for everyone, but it is filled with good people who shouldn't be demonized."  MORE >>

"The business coalition is challenging Proposition A on several counts: [1] The Missouri Constitution requires ballot initiatives to contain a single subject. Proposition A contains at least two clear, unrelated subjects ... [2] The Missouri Constitution requires the title of the ballot measure to clearly express its single subject. Proposition A's title is unclear and contains multiple subjects. [3] The ballot measure's summary statement and fiscal note summary ... are misleading and insufficient. [4] By exempting government entities and certain workers, Proposition A violates the Equal Protection Clause." [McCarty v. Missouri Secretary of State, No. SC100876 (Mo. complaint filed Dec. 6, 2024)]  MORE >>

"Sponsors of benefit plans that are subject to ERISA need to ensure they comply with all applicable reporting and disclosure requirements of these federal agencies: [DOL, CMS, IRS, and PBGC] ... The [50 page] guide is organized by plan type, regardless of agency: [1] All plans; [2] Health and welfare plans; [3] All retirement plans; [4] DB retirement plans; [5] DC retirement plans."  MORE >>