"Dental plans and vision plans that are excepted benefits ... are not subject to PCORI fees. Similarly, health flexible spending accounts that are excepted benefits ... [are] not subject to PCORI fees.... For plans with plan years that ended on or after January 1, 2021, through September 31, 2021, the fee is $2.66 per covered life. For plans with plan years that ended on or after October 1, 2021, through December 31, 2021, the fee is $2.79 per covered life."   MORE >>

"If the health care provider certifies a serious medical condition, we arguably must approve the leave. It does not matter whether the procedure is elective or not.... If it's clear that the treatment involved will occur on Day X, then a court likely would find that the travel necessary to get to the destination by Day X is so intertwined with the need for leave that it should be considered part of the protected leave as well."   MORE >>

"Employers will naturally turn to their group health brokers and advisors for initial guidance. [This article provides] some talking points for brokers and advisors, including tips on when legal guidance from ERISA counsel may be required."   MORE >>

"[It] is increasingly apparent that uncertainty and inconsistency in state abortion laws will likely prevail for the months and even years ahead. This environment will create complex and novel challenges for employers and group health plan sponsors seeking to offer abortion and other reproductive health care services."   MORE >>

"Many of the parents who sue over wilderness therapy ... argue insurers are violating [the MHPAEA] in their refusals to cover it. The law requires plans to cover behavioral health treatments at the same level as comparable medical and surgical procedures. What makes that legal tactic tricky, though, is it’s hard to find a medical analogue to wilderness therapy[.]"   MORE >>

"The impact on premiums of expanding pre-deductible coverage to 116 drug classes related to chronic disease management medications in HSA-eligible health plans is relatively small (range 1.3-4.7 percent).... Premiums increased the least -- 1.3 percent -- when employers imposed coinsurance instead of a deductible and when increased use of prescription drugs led to reduced use of other medical services."   MORE >>

"[1] Select the right pharmacy benefit management partner.... [2] Build flexibility into the PBM contract.... [3] Identify the greatest potential savings.... [4] Try multiple international filling solutions.... [5] Try domestic filling, specialty copay and dosage optimization.... [6] Member engagement."   MORE >>

"UnitedHealth Group's second quarter 2022 revenues grew $9 billion or 13% to $80.3 billion year-over-year, reflecting double-digit growth at both Optum and UnitedHealthcare. Second quarter 2022 earnings from operations were $7.1 billion with well-diversified contributions from across the enterprise. Adjusted net earnings of $5.57 per share increased 19% year-over-year. The second quarter 2022 medical care ratio was 81.5% compared to 82.8% last year, due to COVID effects and business mix."   MORE >>

"Two high-profile defendants in a $53 million prescription-drug benefits scheme that involved Jersey Shore doctors, firefighters, police officers, teachers, and others with access to state health-care plans pleaded guilty Thursday in U.S. District Court in Camden."   MORE >>