"Although early implementation revealed major technical and logistical hurdles, the TiC initiative is a step toward price transparency. To expand utility, Congress may consider further reforms addressing data access, data usability, and data integrity and standardization. Ultimately, transparency policies aim to help consumers make informed decisions, foster competition, and support oversight; addressing access and integrity issues can help meet these goals." [R48570 Jun. 13, 2025]  MORE >>

24 pages. Topics include: Health benefits litigation update. [1] H.R.1 -- One Big Beautiful Bill Act ICHRA/HSA provisions; [2] MHPAEA enforcement developments; [3] PBM reporting and state issues; [4] Health benefits litigation update.  MORE >>

"On appeal, the Fifth Circuit agreed with the district court that the NSA did not create an express or implied right of action for out-of-network providers to enforce IDR awards.... The Fifth Circuit rejected the providers' argument that they merely sought judicial enforcement -- as opposed to judicial review. In the court's view, the term 'judicial review' encompassed court orders enforcing IDR awards.... In an accompanying case, the Fifth Circuit held that judicial review also includes the power to vacate IDR determinations " [Guardian Flight, L.L.C. v. Health Care Serv. Corp., No. 24-10561 (5th Cir. June 12, 2025); Guardian Flight, LLC v. Med. Evaluators of Tex. ASO, LLC, No. 24-20051 (5th Cir. June 12, 2025)).  MORE >>

"Unum delayed pursuing the motion to transfer for seven months, waiting until one week before the close discovery and three weeks before the deadline for dispositive motions to file it. The impetus for doing so was the discovery of medical records outside the administrative record that favor Plaintiff's case. These extra-record documents are admissible in the 11th Circuit (Florida) but not in the 10th Circuit (Utah). The court found this legal difference was relevant in illuminating the parties' motivations." [Williams v. Unum Life Ins. Co. of Am., No. 24-24113 (S.D. Fla. June 5, 2025)]  MORE >>

"This report includes three tables that provide an overview of the health coverage provisions in the OBBBA, along with the applicable current law for each provision ... Table 1 includes provisions that apply to the Medicaid program. Table 2 includes provisions that affect the private health insurance market, but excludes provisions amending the Internal Revenue Code. Table 3 includes provisions related to Medicare." [R48569 Jun. 13, 2025]  MORE >>

"[T]he One Big Beautiful Bill Act: [1] Renames ICHRAs as CHOICE arrangements, expanding eligibility classes and creating a new tax credit for certain employers that offer them. [2] Allows employees to use cafeteria plan salary reductions to purchase Exchange-based coverage through CHOICE arrangements. [3] Expands HSA eligibility and the definition of qualified medical expenses and increases contribution limits for lower-income individuals."  MORE >>

"The [DOL] has rolled out an initiative over the last two years to investigate insurance companies' practices surrounding Evidence of Insurability (EOI) for life insurance benefits. These investigations have resulted in several settlements, which provide guidance for other insurance companies and employers to avoid similar legal consequences."  MORE >>

45 pages. "PFL access is associated with a 5.7 percentage point increase in the likelihood that individuals with disabilities receive informal care from their children.... PFL access significantly increases the use of home care services and nursing home care. These effects are primarily concentrated among individuals with disabilities who have both a spouse and children, and are almost non-existent among those who have only children and no spouse."  MORE >>

"Health insurers issue millions of denials every year. And ... many patients find themselves stuck in a convoluted appeals process marked by long wait times, frustrating customer service encounters, and decisions by medical professionals they’ve never met who may lack relevant training. Recent federal and state efforts, as well as changes undertaken by insurance companies themselves, have attempted to improve a 50-year-old system that disproportionately burdens some of the sickest patients at the worst times. And yet many doctors complain that insurance denials are worse than ever as the use of prior authorization has ramped up in recent years[.]"  MORE >>

"If you're a freelancer, a 1099er, or just someone who refuses to shovel five figures a year into a rigged premium system, you can still opt out without going uninsured. You just have to build your own coverage.... [1] Lock in a direct primary care (DPC) doctor ... [2] Add a catastrophic backstop -- health share or marketplace plan ... [3] Add gap fillers (only if you have to)."  MORE >>

"Written comments should be received on or before August 15, 2025 ... [T]axpayers can request determination letters and private letter rulings from the from the Commissioner, Tax Exempt and Government Entities, Employee Plans Office on how the tax laws apply to them. Employee Plans requires information from taxpayers in order to process these requests. Form 15662 will simplify and standardize the application process for Private Letter Rulings issued under Rev. Proc. 2025-4 and its successors."  MORE >>

"Noteworthy in the responses are a number of requests seeking the withdrawal of a broad range of existing regulations and other guidance, triggering a material increase in the response rate to the annual PGP solicitation notice. The number of submissions in response to Notice 2025-19 reflects an increase of more than 30 percent relative to the submissions making recommendations for inclusion in the 2024-2025 PGP."  MORE >>

"[T]he Strengthening Benefit Plans Act of 2025 ... would allow for overfunded 401(h) retiree pension accounts to be transferred to help pay for active healthcare programs. A 401(h) plan is an employer-sponsored fund for post-retirement medical benefits. By funding these benefits with previously paid contributions, employers would avoid paying additional costs out of pocket."  MORE >>