"The HDHP deductible waiver and corresponding HSA safe harbor originated as part of a broad range of measures enacted in the [CARES Act] ... The waiver was further extended in subsequent legislation ... Now, without a further extension of the HSA exception, meeting the deductible will be required for HDHP members to remain eligible to make HSA contributions or to receive their employers' HSA contributions."  MORE >>

"2025 surprise billing independent dispute resolution fees applicable to health plans, health insurers and health care providers will remain are holding steady.... The 2025 IDR entity fees now published on the NSA website are effective for disputes initiated on or after January 1, 2025."  MORE >>

"Effective December 30, 2024, significant revisions to the Missouri Board of Pharmacy's Rule 20 CSR 2220-2.013 (Prescription Delivery Requirements) will kick in, introducing new patient safety measures for pharmacies that mail or ship prescriptions. The Missouri Board of Pharmacy issued formal guidance on this new requirement."  MORE >>

"Instead of bright lines like age at the time of incapacity or the formation of the caretaker relationship, the critical question for the Court was whether the sibling requesting accommodation had taken on more responsibility for providing care than one would ordinarily expect to provide to a sibling ... [T]he Court remanded the case to the trial court to determine whether Ms. Chapman had intended to form a quasi-parental relationship with her dying sister akin to those relationships held in the past to constitute in loco parentis relationships." [Chapman v. Brentlinger Enterprises, No. 23-3582/3613 (6th Cir. Dec. 13, 2024)]  MORE >>

"[F]or no value care, there are no circumstances under which a service or procedure would be clinically beneficial to patients, and, in some cases, such care could cause patient harm.... [The authors] build on previous work to identify 'no value care' among the employer-sponsored insurance population. [The analysis is limited] to three 'no value care' services ... Vitamin D tests, arthroscopic knee surgeries for osteoarthritis, and prostate specific antigen (PSA) tests."  MORE >>

"Though it has since been announced that the [Value-Based Insurance Design (VBID)] model will be sunsetting come Calendar Year 2026, lessons learned from this program and subsequent impacts of the implemented benefits will guide future priority interventions and member care going forward.... One benefit adopted by a majority of eligible plans was the option to waive low income cost share for certain individuals. This paper focuses on the adaptation of that benefit and the resulting alignment with CMMI VBID objectives."  MORE >>

"Aetna, ConnectiCare and Harvard Pilgrim have the highest denial rates among individual health insurance policies sold through Access Health Exchange. A review of 2023 data from the state's Insurance Department found the three companies deny claims at rates above the statewide average for both HMO and indemnity plans. Aetna had the highest denial rates for HMO plans, at 39.4%, followed closely by Harvard Pilgrim, at 38.8%, and Connecticare, at 33.6%."  MORE >>

"UnitedHealth and Amedisys have agreed to extend the deadline to close their $3.3 billion merger agreement to next year ... as the deal faces close scrutiny from the U.S. Department of Justice. The extension comes more than a month after the DOJ and three U.S. states filed a lawsuit to block the deal, citing concerns that it would reduce competition in the home health services market."  MORE >>

"The IRS, CMS and Social Security Administration have released 2025 inflation adjustments for several benefit-related provisions, including those impacting retirement plans, health savings accounts, health flexible spending accounts, Social Security and Medicare.... These limits potentially impact design, administration, communication and tax reporting for the related benefit plans."  MORE >>

"The 2025 appointees and their areas of expertise are as follows: [1] Actuarial Counseling: Christian Benjaminson is a vice president and principal consulting actuary at Cheiron Inc.... [2] Employee Organizations: Wendell Young is the President of United Food and Commercial Workers Local 1776 Keystone State as well as Vice President of the UFCW International Union.... [3] Employers: Jay Dorsch is the chair of the Employee Benefits and Executive Compensation practice of Cozen O'Connor ... [4] General Public: Elizabeth Hopkins is a senior partner at Kantor & Kantor LLP and head of the law firm's pension practice.... [5] Investment Counseling: Craig Wright is a founding partner at Strategic Financial[.]"  MORE >>