67 pages; Mar. 20, 2025. "Enclosed are the Technical Guidance and Instructions for preparing your benefit proposals for the contract term January 1, 2026, through December 31, 2026. Guidance applicable to Federal Employees Health Benefits (FEHB) Fee-For-Service (FFS) and Health Maintenance Organizations (HMOs): Community-Rated (CR), Experience-Rated (ER), Current HMO, and New HMO plans are noted throughout the document."  MORE >>

"[G]roup health plans and health issuers offering group health coverage must complete annual reporting on prescription drug and health care enrollment, premiums and spending. This guide is intended to inform group health plans of their obligations ... [A chart] reflects the most common types of group health plans that are subject to the RxDC reporting requirement or that are excluded from the reporting obligation."  MORE >>

"Missouri law will now require most private employers to allow all employees to accrue and use sick leave beginning May 1, 2025. While there are still a variety of legal challenges pending to the law, employers should begin preparing now in case the law goes into effect as written. The first sick leave deadline employers are facing is April 15, 2025."  MORE >>

"A California judge is giving plaintiffs until late April to file a fourth amended complaint alleging that Cigna used a computer algorithm to improperly deny claims.... Initially filed in July 2023, the federal lawsuit alleges that Cigna used a computer algorithm to automatically reject hundreds of thousands of patient claims without examining them individually as required by California law." [Kisting-Leung v. Cigna Corp., No. 23-1477 (E.D. Calif. Mar. 31, 2025)]  MORE >>

"When a plan sponsor decides to change the plan year for their health and welfare benefit programs, numerous compliance items should be considered, including but not limited to those issues identified in [this checklist]."  MORE >>

"Direct contracting ... provides the cost control of [reference based pricing (RBP)] without the associated member disruption. In this model, the employer negotiates a fixed price for care with the provider and pays the claim cost directly from health plan funds. Most direct contracts use a bundled arrangement, where the entire episode of care is billed as one cost, rather than multiple billing codes in the traditional fee-for-service model."  MORE >>

"Empowering employees with clinical navigation ... Enhancing access to specialty care ... Proactively managing chronic conditions ... Optimizing benefits for a more cost-efficient model."  MORE >>

"Many new and emerging solutions have made broadening mental health benefits easier. From virtual treatment options to 1:1 coaching, innovative employee support is available in all kinds of interesting models....[Examples include] ... [1] Flexible work schedules.... [2] Mental health days off.... [3] Virtual therapy.... [4] Financial coaching."  MORE >>

"[The authors] estimate the economic value of offering health coverage to farmworkers and their employers ... [and] find that farmworkers with employer-provided health coverage are significantly more productive than those without and, on average, generate an additional $0.85 in economic surplus for each hour worked. Employers who offer health coverage retain an additional $0.65 of economic surplus for each hour of work performed by their employees due to a health productivity premium, after accounting for the cost of offering insurance."  MORE >>

"When selecting an employee benefits consultant to be your partner, research the firm, assess the broker's reputation, understand their areas of expertise, analyze key metrics and otherwise gain comfort.... Once you have selected an employee benefits partner, you want to leverage the relationship to the fullest. For example, they can support you in defining a benefits strategy, developing plans to manage benefits-related costs and performing benefits-related 'block and tackle' activities."  MORE >>