"This blog highlights the new information in FAQ 69, including challenges with certain service provider agreements, examples of impermissible restrictions on claims reviews and clarifications on how plans that violate the gag clause prohibition should complete their attestation."  MORE >>

"No Applicable Large Employer (ALE) wants to receive the dreaded 226-J letter issued by the [IRS] informing them of a proposed ACA employer mandate penalty. But, the good news is that employers will now have significantly more time to prepare a response before they need to consider requesting an extension."  MORE >>

"In general, plans are permitted to terminate COBRA coverage for a qualified beneficiary whose premium payment is not made on a timely basis, and plans may treat significant premium underpayments the same as nonpayment ... IRS COBRA regulations contain special rules for any premium payment that constitutes an 'insignificant shortfall.' A shortfall is deemed 'insignificant' if it is less than or equal to the lesser of [1] $50 or [2] 10% of the amount of the premium that the plan requires to be paid."  MORE >>

"Generally, the ESTA requires that employers provide Michigan-based hourly employees with 1 hour of paid sick time for every 30 hours worked up to 72 paid hours per year (or for employers with fewer than 10 employees, up to 40 hours of sick time per year would be paid and up to 32 hours would be unpaid)."  MORE >>

"[T]he Patients Before Monopolies Act [HR 10362] ... would make it unlawful for any person to simultaneously own, operate, or control -- either directly or indirectly -- [1] a pharmacy; and [2] an insurance company or a PBM. For those persons whose current organizational structure is found to be in violation of this provision, a three-year grace period would be granted upon enactment to divest all pharmacy assets."  MORE >>

"One option gaining traction is the Individual Coverage Health Reimbursement Arrangement (ICHRA), which saw adoption surge by 29% among small employers and 84% among large employers from 2023 to 2024[.]"  MORE >>

"[O]nly 32% of U.S. companies offer paid paternity leave, and the process for establishing paternity leave varies by state.... [T]he federal Family and Medical Leave Act (FMLA) ... allows employees to take up to 12 weeks of unpaid leave. But even with FMLA provisions, only 5% of fathers take two weeks or more to bond with their newborns, adjust to the new family dynamic, and learn essential childcare skills -- all of which are vital for a strong, lifelong parent-child relationship."  MORE >>