"Use a separate Form 7206 for each trade or business under which an insurance plan is established."  MORE >>

"The Colorado Division of Insurance has commenced formal rulemaking to amend Regulation 10-1-1 (governance and risk management requirements for use of external consumer data and information sources, algorithms and predictive models) ... [expanding] the regulation's overall reach to ... health benefit plan insurers ... The requirements will likely involve a significant compliance lift under a relatively brief timeline."  MORE >>

48 pages; Dec. 2024. "Plan and claim administrators should have a duty to provide and receive documents through electronic means.... The Department should develop model language and model forms, including a model EOB, for use in the claims and appeals process.... The Department should revise existing regulations relating to urgent care claims and appeals to reduce the 72-hour timeframe wherever possible.... [T]he Department should require disclosure of whether AI was used to make a benefit determination."  MORE >>

"Coverage of GLP-1s for weight loss is more common in the public sector than in the private sector.... Some plans that limit coverage of GLP-1s to treat diabetes have adopted these strategies to prevent off-label use of the medication: [1] Tighter prior authorization, such as checking for biometrics, glucose test strips and continuous monitoring devices; [2] Rules specifying that coverage will only be provided when certain types of physicians (e.g., endocrinologists, cardiologists) write the prescriptions."  MORE >>

"State and federal policymakers have considered and enacted a number of policies to address the difference in price associated with where a service is provided.... This brief explains what a facility fee is and illustrates one way they operate in practice. It then walks through two examples of the kinds of facility fees of greatest concern to consumers and policymakers."  MORE >>

"[A recent LIMRA study found] more than half (51%) say they would rely on their personal savings should they lose the ability to earn an income, and ... more than a quarter (26%) would draw from their retirement savings accounts ... [J]ust 55% of employees can say definitively whether their employer even offers disability insurance, and less than half of workers say they have a strong understanding of these benefits."  MORE >>

"Unless Congress acts to renew them by the end of this year, enhanced premium subsidies for the [ACA's] Marketplaces will come to an end ... Marketplace enrollees will face large premium increases, with five million Americans expected to lose coverage by 2026, followed by two million more by 2027, many of whom will become uninsured.... To substantially reduce these coverage losses among lower-income Marketplace enrollees, states should consider an underused alternative: basic health plans (BHPs)."  MORE >>