"CMS has released the following 2024 parameters for the standard Medicare Part D prescription drug benefit: [1] Deductible: $545 (up from $505 in 2023); [2] Initial coverage limit: $5,030 (up from $4,660); [3] Out-of-pocket threshold: $8,000 (up from $7,400); [4] Total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are not eligible for the coverage gap discount program: $11,477.39 (up from $10,516.25 in 2023); and [5] Estimated total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are eligible for the coverage gap discount program: $12,447.11 (up from $11,206.28)."   MORE >>

"[E]mployers are no longer required to provide to non-exempt employees who have or are suspected of having COVID-19 the five-day special paid leave due to emergencies declared by the Government of Puerto Rico[.]"   MORE >>

"The insurer conceded that the plan documentation (including the plan document and the summary plan description) did not provide for any internal review or appeal procedures that a covered participant may or must exhaust following a denial of a claim for plan benefits. However, it argued that the ERISA lawsuit is nonetheless barred because the spouse failed to exhaust the administrative remedies described in the denial letter. The Court disagreed, stating that the spouse is not subject to the exhaustion requirement because the written plan documents do not provide for, or describe, any appeal or review procedures for her to exhaust. The Court noted that the denial letter was not part of the plan documentation." [ Yates v. Symetra Life Insurance Company , No. 22-1093 (8th Cir. Feb. 23, 2023)]   MORE >>

"Though 72% of employers [surveyed] said they expect to continue covering preventive services, 22% revealed they do not know whether they will provide coverage and 6% said they'll be more selective."   MORE >>

"While it is very possible this law will pass in the 2024 legislative session, it is still a good time to get a better understanding of what the current legislation is, what lawmakers are proposing, and how this interacts with other employee benefits. Here are the most frequently asked questions ... as well as ... background on this legislation and what it might mean for your business."   MORE >>

"[The authors] estimate the effect of universal health insurance at age 65 -- when most Americans become eligible for Medicare -- at the national, state, and local level. [They] find a 30 percent reduction in debt collections -- and a two-thirds reduction in the geographic variation in collections -- with limited effects on other financial outcomes."   MORE >>

"20% [of survey respondents] said they or their family have received an unexpected medical bill and 22% were charged over $1,000. The survey points to the complexity and weaknesses of the NSA ... Rising facility fees are not being accounted for and protected against under the federal NSA legislation.... The best response to the NSA is still an approach that is both strategic and compliance oriented."   MORE >>

"When plan participants and/or governmental agencies, such as the DOL or IRS, cannot easily locate the plan sponsor it can be a recipe for disaster.... Often, third party service providers will prepare the initial drafts of summary plan descriptions and Plan Filings. It is imperative that, in reviewing these drafts, plan sponsors focus on the addresses included -- not only to confirm that they are correct, but to ensure that they are as specific as they should be."   MORE >>