37 presentation slides. Topics include: [1] ERISA fiduciary governance basics; [2] Group health plan transparency obligations; [3] CAA 2021 transparency requirements: Gag clause prohibition, MHPAEA NQTL comparative analysis, RxDC reporting, and Section 408(b)(2) disclosures; [4] Fiduciary breach litigation; [5] TiC rule requirements; [6] Cost containment strategies and tools for plan fiduciaries; [7] Key takeaways.  MORE >>

"Changes to machine-readable files (MRFs) will place more responsibility on hospitals to provide the dollar amounts they charge for services.... Hospitals could face compliance challenges in instances when the standard charge is based on a percentage or algorithm."  MORE >>

"This In Focus provides an overview of the preventive services coverage requirement. It includes enrollee estimates and outlines considerations for potential legislative changes. It also provides context relevant to the Kennedy v. Braidwood challenge to this coverage requirement, currently before the Supreme Court." [IF 13010 May 23, 2025]  MORE >>

"[T]he court examined whether BCBSM exercised discretion over its [own] compensation. The ASC stipulated a 30% fee from savings, but BCBSM's control over claims processing -- specifically, its ability to inflate claims initially -- meant it could manipulate the pool of overpayments from which it profited. This discretion over its own compensation affirmed BCBSM's fiduciary role." [Tiara Yachts, Inc. v. Blue Cross Blue Shield of Mich., No. 24-1223 (6th Cir. May 21, 2025)]  MORE >>

"[The court found] that the air ambulance companies did have standing to bring claims under ERISA as assignees and that the NSA provides a private cause of action to enforce IDR awards. This decision adds to a growing split among lower courts on the issue of whether the NSA allows providers and insurers to sue to enforce its mandates." [Guardian Flight LLC v. Aetna Life Ins. Co. Inc., No. 24-0680 (D. Conn. May 14, 2025)]  MORE >>

"The percentage of adult patients prescribed any type of GLP-1 drug increased from 0.9 percent of patients in 2019 to 4.0 percent of patients in 2024, a relative increase of 363.7 percent ... Over two percent of adult patients now take a GLP-1 drug to treat overweight or obesity.... The percentage of younger adults (aged 18-39) prescribed a GLP-1 drug increased from 0.19 percent in 2019 to 1.33 percent in 2024, a relative increase of 587.8 percent.... The use of behavioral health services decreased dramatically for patients prescribed GLP-1 drugs during the study period."  MORE >>

"[E]mployers who neglect [mental health concerns] are likely to face higher levels of absenteeism, lower productivity, and increased turnover. Employers should consider the following: [1] Offering more than a basic benefits package that addresses specific mental health needs; [2] Providing regular education, training and communication about available benefits; [3] Ensuring that managers are trained on both legal requirements and internal benefits programs; and [4] Leading by example."  MORE >>

"ERISA requires that the disclosure method of plan materials to employees be 'reasonably calculated to ensure actual receipt.' The DOL has a 2002 safe harbor approach to meet that standard, which is based on whether employees have work-related computer access integral to their job duties. Nonetheless, many employers today are comfortable operating outside that dated safe harbor approach given the current widespread access to online materials by most employee populations."  MORE >>