35 pages. "This document contains proposed regulations under section 36B of the Internal Revenue Code ... that would amend the existing regulations regarding eligibility for the premium tax credit (PTC) to provide that affordability of employer-sponsored minimum essential coverage (employer coverage) for family members of an employee is determined based on the employee's share of the cost of covering the employee and those family members, not the cost of covering only the employee. The proposed regulations also would add a minimum value rule for family members of employees based on the benefits provided to the family members ... This document also provides a notice of a public hearing on these proposed regulations."   MORE >>

Version 4.0, April 2022. 17 pages. "The purpose of this document is to provide the details on cost-sharing reduction (CSR) reconciliation files that issuers submit to the Multidimensional Insurance Data Analytics System (MIDAS). This specification document (version 4.0) is applicable to CSR reconciliation for the 2021 benefit year as well as restatements for benefit year 2020."   MORE >>

Version 4.0, April 2022. 8 pages. "The purpose of this document is to provide the details on cost-sharing reduction (CSR) attestation files that issuers submit to the Multidimensional Insurance Data Analytics System (MIDAS). The Attestation Forms will be in Excel format and users must select the correct Attestation Forms A or B, as applicable. Attestation Forms A or B must be sent in a zipped format for each Health Insurance Oversight System (HIOS) ID and benefit year."   MORE >>

"Current regulations define employer-based health insurance as 'affordable' if the coverage solely for the employee, and not for family members, is affordable, making family members ineligible for a premium tax credit even though they need it to afford high-quality coverage through the Marketplace.... The Treasury Department and the [IRS] are proposing to eliminate the 'family glitch.' Should today's proposed rule be finalized, family members of workers who are offered affordable self-only coverage but unaffordable family coverage may qualify for premium tax credits to buy ACA coverage. Should the proposed change be made, it's estimated that 200,000 uninsured people would gain coverage, and nearly 1 million Americans would see their coverage become more affordable."   MORE >>

"Since the onset of the pandemic, many states and localities have passed COVID-19 supplemental paid sick leave laws requiring employers to provide leave to employees for COVID-19-related reasons. California and Colorado have gone beyond many other states by adding to the required amount of sick time.... [S]ick leave developments in those states could foreshadow developments in other states."   MORE >>

"Appeals to the full Ninth Circuit and possibly to the Supreme Court are expected, as plaintiffs are likely to argue the appellate court improperly disregarded the district court's factual findings about the plan administrator's conflicts of interest and unreasonable plan interpretations, contrary to the weight of expert testimony on generally accepted standards of care and other evidence.... It seems clear that Congress will be required, and likely motivated, to address underlying issues with parity and equity for behavioral health coverage." [ Wit, et al. v. United Behavioral Health , Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]   MORE >>

"The Ninth Circuit's decision illustrates how claims for coverage, especially for mental health services, are inherently fact-specific because they require analysis of the patient's medical needs, medical necessity, and sufficiency of alternative treatments. Rather than address the merits of any particular claim, the Ninth Circuit simply concluded that in light of the discretion conferred to UBH to interpret the plans, it was not appropriate to send over 50,000 claims back to UBH for review en masse." [ Wit, et al. v. United Behavioral Health , Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]   MORE >>

"The judge rejected the claim of the plan beneficiaries that Aetna's denial of coverage for mental health and substance abuse treatment violated federal mental health parity laws.... The judge stated that the parity law claim was duplicative of the ERISA denial of benefits claim ... [and] granted partial summary judgment to Aetna on the claims under the parity law. The judge then remanded the remaining claims back to Aetna to determine the properly allowable amount of coverage[.]" [ R. v. Bank of America Group Benefits Program Aetna Life Ins. Co. , No. 20-0441 (W.D.N.C. Feb. 9, 2022)]   MORE >>

"Thanks to the 2022 National Defense Authorization Act, federal workers can take up to two weeks off following the death of a child.... The new leave category will be available to all Title 5 federal employees serving in permanent or term appointments of more than one year with at least one year of service. Employees with intermittent work schedules are not eligible, and seasonal employees cannot use leave during their off-season."   MORE >>