"The Paperwork Reduction Act amends the ACA [HR 3797] by no longer requiring employers and health insurance providers to send ... [the] 1095-B/1095-C tax form to each covered individual showing proof of minimum essential coverage. Now, those forms must only be sent when requested by the covered individual.... The Employer Reporting Improvement Act [HR 3801] codifies IRS regulations that allow for an individual's date of birth to be substituted if the individual's Tax Identification Number is not available."  MORE >>

"[T]he Unemployment Insurance Code ... previously allowed employers to require employees to exhaust up to two weeks of accrued but unused vacation leave as a condition of an employee's initial receipt of these benefits. For any period of disability commencing on or after January 1, 2025, an employer can no longer impose such a condition.... [E]mployers can instead encourage employees to use accrued vacation to 'top off' their PFL benefits by paying an additional amount from accrued vacation to cover the difference between PFL and the regular wages or vacation that the employee might otherwise receive."  MORE >>

26 slides. "Payroll tax begins Jan. 2025; Benefits begin May 2026 ... Employee must have earnings at least 6 times the state average weekly wage in the first 4 of the last 5 completed calendar quarters. Family member includes spouse, domestic partner, child, parent, sibling, grandparent, grandchild, and a designated individual with a significant personal bond. Job protection and continued health benefit rights available after 120 days of employment."  MORE >>

"The Fourth Circuit concluded that at the time the termination decision was made, the employer had an 'honest belief' that the plaintiff had lied about the medical reason for the leave, and that this belief served as a defense to his FMLA claims.... [T]he U.S. Supreme Court declined the plaintiff's petition to review this decision." [Shipton v. Baltimore Gas and Elec. Co., No. 23-1360 (4th Cir. Jul. 31, 2024; cert. pet. denied Dec. 9, 2024)]  MORE >>

"The court noted that Unum had voluntarily provided its claims manual and some communication records, rendering further discovery on these fronts unnecessary. Moreover, the court highlighted that the administrative record, as it stood, contained sufficient information for review, and Plaintiff had failed to demonstrate any existing gaps that required filling through additional discovery." [Stallman v. First Unum Life Ins. Co., No. 23-20975 (D.N.J. Dec. 5, 2024)]  MORE >>

"The ERISA Advisory Council voted on and approved 12 recommendations for the [DOL] to improve health insurance claim denials and related appeals. These reforms range from better oversight of AI determinations to requiring payouts for prior approvals."  MORE >>

"While several states have passed legislation trying to restrict such practices amid growing public anger, insurers defend the coverage denials and 'pre-authorization' requirements. They say those measures are meant to contain rising costs and that their methods comply with federal and state regulations. According to information the insurers report to regulators, there have been only small increases nationally in the frequency of denials in recent years."  MORE >>

"Lawmakers on both sides of the aisle are open to reform of the industry, but it's not certain which provisions will be prioritized. There is danger that some reform could prove toothless.... Still, there are policies that, if enacted, could be beneficial to local pharmacies and consumers. They include a ban on spread pricing, delinking PBM compensation from the list of drugs and requiring reporting to the National Average Drug Acquisition Cost survey so PBMs must act more transparently."  MORE >>

"The latest healthcare deal ... includes a two-year extension of Medicare telehealth flexibilities and a one-year extension of pre-deductible coverage of telehealth for high-deductible health plans linked to health savings accounts. The package also is likely to include a five-year extension of the [CMS] hospital-at-home waiver."  MORE >>

"Nationally, telehealth claim lines dropped from 4.96 percent of medical claim lines in August to 4.80 percent in September, a decrease of 3.3 percent.... The data represent the commercially insured population, excluding Medicare Fee-for-Service, Medicare Advantage and Medicaid.... In both August and September, the age groups 19-30 and 31-40 accounted for the two largest shares of telehealth claim lines -- between 20 and 30 percent -- nationally and in every region."  MORE >>

"Surviving spouses have some flexibility in inheriting HSAs, but the funds will count toward the income of most other inheritors. The result can be a hefty tax bill for the inheritor, one that many don't expect given the HSA's general tax benefits."  MORE >>

Changes to benefits-related items from the Spring 2024 DOL Regulatory Agenda:

Moved from Prerule State to Proposed Rule Stage:

• Plan Reporting for Retirement Savings Lost and Found [1210-AC19]
• Review of Pension Risk Transfer Interpretive Bulletin 95-1 [1210-AC22]

Added to Proposed Rule Stage:

• Enhancing Coverage of Preventive Services under the Affordable Care Act (CMS-9887-P)[1210-AC25]
• Requirement to Provide Paper Statements in Certain Cases -- Amendments to Electronic Disclosure Safe Harbors [1210-AC27]
• Notice and Disclosure Requirements with Respect to Lump Sums [1210-AC28]
• Cost Sharing Under the Affordable Care Act [1210-AC29]

Moved from Proposed Rule Stage to Final Rule Stage:

• Exemption for Certain Automatic Portability Transactions [1210-AC21]

Added to Final Rule Stage:

• Performance Benchmarks for Multi-Asset Class Investments [1210-AC26]

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Changes from the Spring 2024 IRS Regulatory Agenda:

Added to Proposed Rule stage:

• Collectively Bargained Welfare Benefit Funds [1545-BL40]
• Guidance on Rules Applicable to IRAs Under Sections 408 and 408A [1545-BL98]
• Requirements for Employee Stock Ownership Plans [1545-BM32]
• Rules Relating to Employer-Provided Meals and Employer-Operated Eating Facilities [1545-BO29]
• Definition of Church Plan [1545-BO31]
• Safe Harbor Rules Relating to Required Distributions, Missing Participants, and Uncashed Checks [1545-BR34]
• Enhancing Coverage of Preventive Services under the Affordable Care Act [1545-BR35]
• Cost Sharing Under the Affordable Care Act [1545-BR38]

Moved from Proposed Rule stage to Final Rule stage:

• SECURE 2.0 Updates to Required Minimum Distribution Rules [1545-BQ66]

Added to Final Rule stage:

• Guidance on the Timing of the Use or Allocation of Forfeitures in Qualified Retirement Plans [1545-BO98]
• Application of the Employer Shared Responsibility & Certain Nondiscrimination Rules to HRAs and Other Account-Based Group Health Plans Integrated With Individual Health Insurance Coverage or Medicare [1545-BP17]

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"A recent federal case suggests that a covenant not to sue performs extra work, above and beyond a release, at least in the context of preventing unwanted ERISA class actions." [Esquivel v. Whataburger Restaurants LLC, No. 24-0310 (W.D. Tex. Nov. 8, 2024; notice of appeal filed Dec. 9, 2024)]  MORE >>