"The Internal Revenue Code generally does not provide employees with an exclusion from income for domestic partner health coverage. Employers must therefore (in most situations) take the employee contribution for domestic partner coverage on an after-tax basis, and treat the fair market value of the employer payment for the domestic partner's coverage as taxable imputed income to the employee."  MORE >>

"Plan administrators must automatically furnish summary plan descriptions (SPDs) to all participants covered under ERISA health and welfare plans. The term 'participant' is not limited to current employees.... [1] Employees or former employees covered under the plan.... [2] COBRA qualified beneficiaries.... [3] Alternate recipients under Qualified Medical Child Support Orders (QMCSOs).... [4] Spouses or other dependents of deceased participants.... [5] Representatives or guardians of incapacitated persons."  MORE >>

"Without providing any specifics as to the results of its ongoing analysis of the affected programs, CMS announced its decisions to terminate four models early: [1] Maryland Total Cost of Care (original performance period 2019-2026); [2] Primary Care First (original performance period 2021-2026); [3] ESRD Treatment Choices (original performance period 2021-2027 ... and [4] Making Care Primary (original performance period 2024-2034)."  MORE >>

"As of January 1, 2025, 12 states and the District of Columbia have enacted a mandatory Paid Family Leave (PFL) program.... The latest focus (from a regulatory perspective) has been on updates issued for Colorado and Maine, adjustments to existing laws in California and Washington D.C. and pending legislation within the Maryland Senate that could once again delay Maryland's PFL provisions."  MORE >>

"If the Trump administration decides to draft new QPA regulations, it could make additional changes to the QPA methodology beyond those that have been the subject of litigation. While the courts have provided direction on what is permissible under the NSA and what aspects of previous regulations can and cannot stand, the rulings do not prevent the Trump administration from making other permissible regulatory changes as it deems appropriate, especially as stakeholders have challenged implementation of the law under the previous administration."  MORE >>

"Integrating a wellness program into a compliant group health plan can satisfy some key requirements of ERISA and the ACA, as well as the HIPAA privacy and security requirements. There are, however, some specific non-discrimination rules that apply expressly to wellness programs."  MORE >>

"[T]he lawsuit accuses central Ohio's largest private employer of failing its employees by agreeing to overcharges in prescription drugs by the company's pharmacy benefit manager (PBM), CVS Caremark. As a PBM, Caremark sets the drug prices for JPMorgan Chase's employee health plans." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. complaint filed Mar. 13, 2025)]  MORE >>

"Many plans [1] do not wish to cover GLP-1 medications or [2] seek to curb overprescribing due to the cost of the medication and uncertainty regarding the side effects associated with long-term use.... After summarizing potential litigation risks for group health plans that seek to control costs by excluding or limiting GLP-1 coverage for weight loss, this post identifies and discusses medical management techniques that a group health plan could consider using to manage costs should it decide to provide GLP-1 coverage for weight loss."  MORE >>

"In New York, state officials, advocates, and the health care provider community have been engaged in a policy tug-of-war over efforts to protect consumers.... At the center is a state law that took effect last fall to prohibit requiring patients to sign such consent-to-pay forms before they’ve received treatment and discussed the costs."  MORE >>

"In most cases, your health insurance must cover a list of certain services such as cancer screenings even if you get it from your employer. The proposed Texas House Bill 139 could remove that requirement and let a company provide an 'Employer Choice of Benefits Plan' that does not provide all those state-mandated services.... The employer choice of benefits plan still would have to follow federal rules set by the [ACA], which does include preventative cancer screenings, newborn screenings and vaccines[.]"  MORE >>

"ACA plans have never lived up to the promise that consumers would get access to low-cost plans. Premiums and deductibles have risen much more rapidly than its creators projected, and throwing more money at the program has not done much to improve options for enrollees.... Congress could fix this with a straightforward legislative change: grant an exception for ACA marketplace plans that would otherwise qualify as HSA-eligible if not for their MOOP limits. This would maintain other HSA requirements in the employer-sponsored insurance market while eliminating an unintended barrier that serves no clear policy purpose."  MORE >>

"[T]he chairman of the House Education and Workforce Committee called for the Secretary to 'rescind or withdraw' the fiduciary rule finalized under the Biden administration.... Chairman Walberg's letter to Secretary Chavez-DeRemer also urged her [to] rescind or withdraw the requirements under the Mental Health Parity and Addiction Equity Act ... He said the Committee also strongly supports the creation of association health plans (AHPs) through the enactment of the Association Health Plans Act and DOL's rulemaking on AHPs."  MORE >>

"The New York State Senate passed the No Severance Ultimatums Act on March 4, 2025. If enacted, the Act would amend New York Labor Law to prohibit 'coercive ultimatums' in employment severance agreements and would require employers to give all New York employees time to review and revoke severance agreements."  MORE >>