"Accommodating a late enrollment request could pose a problem if the plan intends to reimburse employees for medical expenses on a nontaxable basis under Section 105 of the federal tax code. It also could raise issues if it allows employees to pay for certain medical, disability, or accidental insurance coverage (among other benefits) on a pre-tax basis under Section 125."  MORE >>

"[DOL's 2024 MHPAEA report to Congress] included a settlement agreement resulting from an EBSA investigation of the NQTL 'standards for provider admission to participate in a network including reimbursement rates, for in-network inpatient and in-network outpatient services.' The settlement agreement exemplifies how plans, through their insurance network administrators, can monitor network adequacy standards and address network gaps. Data lists provide examples of how a plan can show that it uses the same or comparable standards to evaluate the adequacy of M/S and MH/SUD networks."  MORE >>

"What health coverage must be offered depends on the type of penalty the IRS assesses. Note that the IRS can only assess each penalty if a full-time employee purchases coverage on the Exchange and receives premium tax credits. Only an applicable large employer (ALE) may be subject to penalties."  MORE >>

"[T]he Proposed Rule contains a variety of key changes to the regulations governing health insurance subject to the ACA that will impact those seeking to obtain health coverage through state and federal insurance marketplaces (the “Marketplace”)."  MORE >>

"Benefit claim denial notices must meet detailed regulatory requirements. An employer that is the responsible fiduciary under a group health plan is responsible, and potentially liable, for a deficient claim denial communication – even if the communication is issued by a TPA." [Doe v. Deloitte LLP Grp. Ins. Plan, No. 23-4743 (S.D.N.Y. Feb. 24, 2025)]   MORE >>

"Lawsuits over what ERISA group health plans pay for prescription drugs continue full speed ahead, with plaintiffs in Lewandowski v. Johnson & Johnson filing an amended complaint to try to shore up standing, a dismissal in the lawsuit against Wells Fargo, and a new case filed against JPMorgan landing in court just this month."  MORE >>

"Broker compensation can impact everything from your plan costs to the level of support you receive, making transparency a key factor in your decision-making process. In this guide, we'll break down the common ways benefits brokers earn their income, the potential impact of their compensation on your benefits strategy, and what to look for so you get the best value for your investment."  MORE >>

"Employees have difficulty recognizing how the health and wealth solutions available to them contribute to their overall compensation and financial security. Confusion about coverage and usage prevents them from fully leveraging their benefits....  By integrating multiple information sources—such as claims, health and wealth information, and employee preferences—organizations can: [1] Help employees assess their medical and financial needs; [2] Guide them toward the options that best fit their situation; [3] Communicate benefits effectively, ensuring employees understand and engage."  MORE >>

"Employers can take proactive steps to create a healthier work environment. Below are some effective strategies: Promote mental health resources ... Encourage work-life balance ... Foster a positive work culture ... Offer stress-relief programs ... Evaluate workload and expectations."  MORE >>