"The Ruling specifically avoids addressing the tax consequences and reporting requirements related to contributions to and benefits paid from a private plan established by an employer in lieu of a State's PFML program.... The IRS provides helpful transition relief for 2025 ... The Ruling does not address State tax consequences.... The Ruling describes facts related to a PFML program in the hypothetical 'State X' and then describes six scenarios."  MORE >>

"An employer with a group health plan that provides prescription drug coverage to Medicare-eligible individuals must make an annual disclosure to [CMS] ... no later than March 1, 2025 for calendar-year plans.... [Employer group health plans] must report small breaches occurring in 2024 no later than March 1, 2025."  MORE >>

"The [ACA] prohibits group health plans and insurers from discriminating with respect to plan participation or coverage against any health care provider acting within the scope of that provider's license or certification under applicable state law. However, the statute does not require group health plans and insurers to contract with any provider willing to abide by the terms and conditions for participation established by the plan or insurer, and it does not prevent ... establishing varying rates of reimbursement based on quality or performance measures. "  MORE >>

Chart details various Health & Welfare benefit limits and fees, 2018-2025.  MORE >>

"The Inflation Reduction Act redesigned the Part D benefit to lower out-of-pocket prescription drug costs. ... [CMS] announced a new Part D Premium Stabilization Demonstration in July 2024, intended to reduce premiums and plan sponsors' liability. This In Focus provides an overview of the demonstration, its impact on premiums, CMS's statutory authority to create the demonstration, and considerations for Congress." [IF12889 Jan. 30, 2025]  MORE >>

"Effective for plan years beginning on or after July 1, 2025, SB 729 will require fully insured large group health plans in California to cover infertility diagnosis and treatment. It will require small group health plans to offer coverage for fertility and infertility services, but does not require small group plans to cover infertility diagnosis or treatment.... The law does not apply to self-funded plans[.]"  MORE >>

"J&J 's dismissal was based on procedural litigation rules and stopped short of weighing in on the ERISA fiduciary breach allegations. This does not change employers' responsibility to fulfill their fiduciary duties and they should continue the course with a proper fiduciary governance plan." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. Jan. 24, 2025)]  MORE >>

"Cigna executives kicked off Thursday's earnings call with their response to pharmacy benefit manager critics. The health giant will implement a series of reforms to give Express Scripts customers 'improved predictability' with prescription drug prices, said David Cordani, chairman and CEO of The Cigna Group. Customers will pay less for drugs and 'will fully benefit from our lower net negotiated prices,' Cordani said."  MORE >>

"Confronting soaring health care costs compounded by widespread obstacles in accessing care, top insurance executives warned Thursday that the state's health care system is at a breaking point. New payment models could help alleviate the industry's financial woes, particularly in the primary care landscape, they said."  MORE >>

"[M]uch like rebates, broker offers of lower (sometimes even zero) fees are really just a subterfuge for hidden fees and higher plan costs. They are not in the best interest of the benefit plan or its members. One could even argue that receiving these incentives is counter to the obligations of a fiduciary."  MORE >>