If you live in one of the States listed in this notice, you may be eligible for assistance paying your employer health plan premiums. The list of States is current as of March 17, 2025.  MORE >>

Updated Apr. 9, 2025. "This document provides instructions for the HHS risk adjustment models for the 2024 benefit year, with revisions from the previous 2024 benefit year software instructions posted on the CCIIO website on Jan. 7, 2025[.]" [Also available: Technical Details (XLSX) and 2024 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

"[CHIPRA] implemented an annual notice requirement for any employers that maintain a group health plan that covers participants who reside in a state that provides any type of premium assistance subsidies under a CHIP or Medicaid plan. The notice obligation does not depend on the employer's physical location(s) and is based instead on where the plan's eligible individuals reside. The DOL makes annual updates to the CHIP Notice for states offering premium assistance subsidies[.]"  MORE >>

"[The Maryland] General Assembly ... passed House Bill 102, which ... would delay when employers and employees must begin submitting contributions for the funding of the program and when eligible employees may begin receiving leave and benefits from the program.... An unspoken cause for delay ... was the department had not finalized regulations for the rollout of the FAMLI program."  MORE >>

"According to Judge O'Connor, the Fifth Circuit told the trial court when it remanded the case in August 2022 to interpret how the terms 'working owner' and 'bona fide partners' applied to the plan. However, the companies and the DOL haven't provided enough information to determine if the particular working owners participating in the plan qualify as employees under [ERISA], as the parties previously told the court that discovery was unnecessary." [Data Marketing Partnership, LP v. DOL, No. 19-800 (N.D. Tex. Apr. 8, 2025)]  MORE >>

"In support of their fiduciary breach claims, the participants pointed out that the administrator's policies indicated that medical necessity determinations would be made by a 'medical director' but that such determinations were in fact made by the automated algorithm. The administrator argued that it was acting within its discretionary authority in interpreting plan terms to permit use of the algorithm, but the court concluded that this interpretation was an abuse of discretion." [Kisting-Leung v. Cigna Corp., No. 23-1477 (E.D. Calif. Mar. 31, 2025)]  MORE >>

"The [2024 EBSA 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 >>

"This toolkit is designed as a five-week mental health awareness campaign for May, National Mental Health Awareness Month: [1] Suggested communications schedule, plus national year-round observances. [2] Ready-to-use weekly email templates for consistent outreach. [3] Curated selection of mental wellness tools and resources. [4] Mental health fast facts overview with some surprising statistics."  MORE >>

"Nearly one-third of small businesses dropped health insurance coverage from one year to the next, with rising health insurance burdens as a contributing factor. Most small businesses that stopped paying health insurance premiums continued to operate in the following years. Nonemployer firms with the highest health insurance burdens experienced the largest premium increases, even though the typical firm across industries saw mixed growth rates. For employer firms across all industries, payroll expense increases explained the decrease in health insurance payroll burden over time."  MORE >>

"If you don't want to hand your employee an FMLA freebie, you've got some work to do. A critical factor in identifying the employee's work site is determining the location from which the employee receives assignments and the location to which they report.... If we hope to tag the supervisor's location as the employee's 'worksite,' then it's critical that we show the supervisor is more than a 'conduit'. Rather, we need to show that the supervisor: [1] plays a meaningful role in the assignment of work; and [2] actually reviews the work."  MORE >>

57 pages. "[T]here is no evidence to suggest that employers engage in the type of rigorous analysis or performance monitoring of insurers and administrators that is expected of a fiduciary.... [The authors] make the case that the [DOL] should capitalize on its authority under ERISA to promulgate regulations detailing the contours of health plan fiduciary duties. If it were to do so as it has for retirement plans, it could require employers to consider factors such as cost, quality, and value in selecting a health plan administrator and spending healthcare dollars on their employees' behalf. "  MORE >>

"In 2022, only 16% of hospitals were in full compliance with the federal mandate. That number has crept up, but not by much. More than 30% of hospitals still haven't posted anything at all. And among those that have, a majority are posting nonsense: contradictory, outdated, or flat-out fabricated price files."  MORE >>

"Lisa Gomez, the former head of EBSA, says that these staff cuts, focused on 'people who are far along in their careers will no doubt drain EBSA of the incredible wealth of institutional knowledge that is held by long-term employees. This leads to not only a brain drain but also works against efforts to build the bench when more experienced staff educates and mentors newer staff.' "  MORE >>