"The Consolidated Appropriations Act of 2021 (CAA) marks a major shift in the pharmacy benefits landscape, bringing increased transparency to key aspects of Plan design.... ERISA was amended to expressly prohibit gag clauses in PBM-Plan contracts.... Another significant CAA provision regulates PBM compensation under PBM-Plan agreements.... The CAA also requires disclosure of compensation that brokers receive."   MORE >>

"As coverage requirements change, [this article covers]: [1] Over-the-counter and in-office tests; [2] COVID-19 vaccines; [3] Standalone telehealth benefits; [4] Noncompliance relief for the Mental Health Parity and Addiction Equity Act; [5] Employee assistance programs; [6] Reinstatement of deadlines applicable to benefit plans and participants Communication and plan-related notices."   MORE >>

"[C]ollection of employees' and employers' contributions to the FAMLI fund has been pushed back a year and will begin October 1, 2024. Payout of benefits has also been delayed a year and will begin January 1, 2026.... [ [T]he new law also caps the total rate of contribution at 1.2% of an employee's covered wages."   MORE >>

"Employers with 15 or more employees must contribute at least 50% of the total rate of contribution. Employers can choose to pay all or a portion of the required employee contribution.... [The Act] expands the qualifying reasons for PFML leave ... [and] the definition of family members[.]"   MORE >>

"The New Orleans-based U.S. 5th Circuit Court of Appeals temporarily blocked U.S. District Court Judge Reed O'Connor's ruling that put in jeopardy coverage for certain cancer screenings, behavioral counseling, HIV prevention and other services recommended by the U.S. Preventive Services Task Force." [ Braidwood Management, Inc. v. Becerra , No. 20-0283 (N.D. Tex. Mar. 30, 2023); No. 23-10326 (5th Cir. motion for stay granted May 15, 2023]   MORE >>

The May 17 hearing will be open to the public and press and will be live streamed online  ... Legislation to be considered is listed with a link to the text of each bill.   MORE >>

"What are the recruitment criteria for the fertility companies' physicians and clinics networks? Do they rely on objective data related to health outcomes and cost? What are their rates of singletons vs. multiple births? ... What is their pricing and what is it based on? Is the employer-paid portion fixed or flexible/discretionary? Does the fertility vendor offer employers a range of subsidy options?"   MORE >>

"One survey shows saving money and time spent commuting are the most important factors for those who want to work remotely, sharing the top spot with childcare. What's an employer to do to attract talented workers who can't afford to live nearby? Help them afford it -- or, in some cases, build it for them."   MORE >>

"The concern for HIPAA-regulated entities is that the Metas of the world, these tracking technology vendors, often are not business associates to the hospitals or physician practices. They may not be permitted to receive the data as a hospital vendor.... Depending on the facts, it may be a little bit grey as to whether this is a permissible use of that data, and if it's not, healthcare organizations need to analyze whether there's a potential HIPAA breach involved."   MORE >>

"Responsible reporting entities (RREs) for group health plans, typically insurers or third-party administrators, must report certain information to CMS about individuals with Medicare and group health care plan coverage.... CMS cites delays resulting from the COVID-19 public health emergency as one reason for extending the deadline to February 18, 2024, for issuing the final regulations."   MORE >>

"The 24 participating companies reported $21.1 billion in combined STD and LTD in-force premium in 2021, an increase from $19.3 billion reported by the same companies in 2020.... The average LTD in-force PPL increased by 4.7% from 2020 to 2021, whereas the average STD in-force PPL increased by 18.7%."   MORE >>

"For plan sponsors with U.S. based operations and exclusively U.S. controlled groups, there is, generally, a healthy awareness of the rules as operations are typically centralized in the U.S. and frequently a single third-party administrator is used for all retirement plans of the controlled group. For foreign based corporations with U.S. subsidiaries ... each company in the U.S. controlled group may have their own retirement plan and cafeteria plan with completely different benefits and separate third-party administrators and none of the parties are aware that a controlled group exists.... The ownership thresholds triggering application of these rules are much lower for [affiliated service groups] than for controlled groups."   MORE >>

"Employers should revisit their existing benefits strategy and update it to reflect the current economic environment and meet their employees' needs.... Benefits can supplement salaries ... Set goals for your benefits program ... Benefits should promote overall well-being ... Make packages appealing to all ages ... Benefits go beyond insurance, retirement."   MORE >>