18 pages. "The 2023 benefit year HHS-RADV error rates will be applied to 2023 benefit year plan liability risk scores and risk adjustment State transfers.... This memo contains an overview of the 2023 benefit year HHS-RADV error rate methodology, a summary of the 2023 benefit year HHS-RADV results, and information to assist issuers in understanding their result."
[Also available: Appendix A: National Program Benchmarks -- 2023 Benefit Year HHS-RADV (XLSX); Appendix B: 2023 Benefit Year RA State Market Risk Pool Weighted Average HHS-RADV Error Rates (XLSX); Appendix C: 2023 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)]  MORE >>

Jun. 10, 2025. "Instructions for Recipient: This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year. " [Also available: Draft of 2024 IRS Form 1094-B: Transmittal of Health Coverage Information Returns]  MORE >>

"The filing and payment to the IRS is due by July 31, 2025, and is required for policy and plan years that ended during the 2024 calendar year. For plan years ending before Oct. 1, 2024, the fee is $3.22 per covered life. For plan years ending on or after Oct. 1, 2024, and before Oct. 1, 2025, the fee is $3.47 per covered life."  MORE >>

"While POWER Act primarily focuses on harmonizing retaliation standards across multiple Philadelphia ordinances, secondarily it revises substantive provisions in those laws, including paid sick leave. Forthcoming rules and FAQs should clarify how changes impact standards concerning coverage, rate of pay, and notice to employees."  MORE >>

"New findings from Insurope's annual Global Employee Benefits and Multinational Pooling Market Report reveal that while 84% of HR leaders believe wellness solutions have a positive impact on retention, absenteeism and employee satisfaction, many programs are falling short. Poor alignment with company culture, lack of personalization and low engagement were some of the top reasons for the disconnect."  MORE >>

"Pharmacy closures are increasing in the U.S., with about 1 in 3 U.S. retail pharmacies closing since 2010.... [P]rimary drivers include reduced front-of-store sales, shrinking reimbursement rates from PBMs, pricing strategies and the structure of PBM network contracts, and staff shortages.... [It's] important for employers to assess the potential impacts on their workforce, explore opportunities to help plan members in affected areas maintain access to care, and proactively manage pharmacy benefit costs. "  MORE >>

"CMS indicated these audits will begin immediately and that CMS will review all eligible MA contracts for each payment year. CMS's goal is to expedite the completion of audits for payment years 2018 through 2024 by early 2026."  MORE >>

20 pages. "In March 2025, the SOA Research Institute convened a panel of industry experts to discuss the advancements and implications of generative AI (GenAI) in the insurance industry.... [T]he panelists discussed and covered the following key topics with respect to AI: [1] How GenAI is currently being used; [2] Using vendor tools or building tools in-house; [3] Privacy; [4] Compliance, governance and ethics; [5] Risk management; [6] Model validation; [7] Challenges; [8] The impact on actuaries."  MORE >>

"OCR found that the covered entity failed to: [1] Use or disclose PHI only as permitted by HIPAA; [2] Conduct a compliance risk analysis; [3] Establish preventative security measures; and [4] Provide notice of the breach to affected individuals, HHS, and the media within 60 days."  MORE >>

"Alternative pharmacy benefit manager and administrator Capital Rx is acquiring Amino Health, a care navigation company. The acquisition, the company said, will allow CapitalRx to offer a better member-facing experience to complement its unified claims platform on the back end.... [Amino Health CEO John Asalone said,] 'We've seen consolidation happen in the industry. Employers and customers are telling us, 'please give me a one-stop shop.'' "  MORE >>

"Drawing on five years of real-world data spanning pre- and post-Medicare enrollment periods, Inovalon's study disputes MedPAC's longstanding claims of favorable selection in MA and concludes the opposite: there is no favorable selection in MA. In fact, the analysis finds that FFS enrollees are healthier and less socially vulnerable than MA enrollees."  MORE >>

"[T]he US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect; the resulting increase would erase almost three-quarters of the decline in the uninsured rate since the ACA's main coverage provisions took effect at the start of 2014. [The author considers] the consequence of such a change, as well as how lawmakers could avoid this outcome if they wished to do so."  MORE >>

"[I]ndividuals and businesses in parts of Texas affected by severe storms and flooding that began on March 26, 2025 ... now have until Nov. 3, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Cameron, Hidalgo, Starr, and Willacy counties qualify for tax relief."  MORE >>

"The court reasoned that '[r]equiring courts to consider evidence of a breach of fiduciary duty related to a release of claims under ERISA aligns with the statute's purpose, structure, and underlying trust-law principles.' ... Because the district court 'found a genuine issue of fact material to the issue of a breach of fiduciary duty in obtaining the release of claims,' the Ninth Circuit noted that 'the final factor warrants serious consideration and may weigh particularly heavily against finding that the release was 'knowing' or 'voluntary' or both.' " [Schuman v. Microchip Technology Inc., Nos. 24-2624, 24-2978 (9th Cir. Jun. 5, 2025)]  MORE >>