12 pages. "This form may be used by the health care providers and facilities to inform uninsured (or self-pay) individuals of the expected charges for receiving certain health care items and services.... HHS considers use of the model notice to be good faith compliance with the good faith estimate requirements to inform an individual of expected charges. Use of this model notice is not required ... [A] good faith estimate that meets all of the requirements under 45 CFR 149.610 is necessary in order to begin the patient-provider dispute resolution process."   MORE >>

"Dependent care FSA expenses are not considered incurred until the services for the period are fully provided (e.g., the end of the month). This makes it difficult to pay for such expenses with a debit card when the provider requires advance payment (e.g., the start of the month) [which is] before the FSA can permit payment.... [T]he cafeteria plan rules permit a recurring daycare expense to be initially substantiated and used to load the FSA debit card to pay for each future service period at the same daycare provider."   MORE >>

"To encourage the use of telemedicine benefits, Congress amended established rules and regulations related [to] individual health savings account (HSA) eligibility, the [ACA], and HIPAA. With the Public Health Emergency, officially over as of May 11, 2023, various pieces of relief are sunsetting and employers that took advantage of the relief need to make changes.... Here is a wrap up of the provided relief and employer action steps."   MORE >>

"If an employee takes a full week of leave during a holiday week, it counts as one week of leave. According to the regulations, the fact that the employee would not have had to work on the holiday doesn't matter -- it was a week of leave. It doesn't exactly work the same way when an employee takes intermittent leave during a holiday week."   MORE >>

"A recent Tenth Circuit case highlights ERISA's requirement that benefit claim denial letters must contain reasoned explanations for the denial and address any supporting evidence provided by the claimant.... [T]he Tenth Circuit ruled that ... the third-party claims fiduciary for an employer-sponsored group health plan acted 'arbitrarily and capriciously' under ERISA by not adequately engaging with the opinions of a participant's physicians and in not providing its reasoning for the denial of medical benefits in its claim denial letters." [ D.K. v. United Behavioral Health , No. 21-4088 (10th Cir. May 15, 2023)]   MORE >>

"Aetna argued that the only 'action subject to complaint' was its miscalculation of benefits ... The court rejected this argument, noting that the behavior Ms. Morris complained about was not the miscalculation of benefits, but Aetna's conduct over the years that 'could have avoided any overpayment, much less the catastrophic amount that resulted.' " [ Morris v. Aetna Life Insurance Company , No. 21-56169 (9th Cir. Jun. 2, 2023; unpub.)]   MORE >>

"Because there are so many eyes trained on PBMs at this moment, Plan sponsors should ... [use] the scrutiny as leverage to ask for terms that, in the past, might have been non-starters.... Plan sponsors can argue in good faith that the PBM has a fiduciary obligation to provide data and transparency to all of its group health plan clients.... By articulating to the PBM the requirements incumbent upon a fiduciary, a Plan sponsor can address some of the more onerous provisions in its PBM Agreement, and with proper memorialization of the process will adhere to fiduciary standards, all while accruing savings to the Plan."   MORE >>

"[This brief discusses] what a facility fee is, why patients might receive a bill for a facility fee for non-hospital services, why there is controversy around these bills, and what policymakers are doing to address them.... [An] interactive tool [compares] prices for two common services, a physician visit and an ultrasound, with and without a facility bill."   MORE >>

"[This article discusses] the legal standards courts apply in deciding whether an employer's past practice of providing severance pay establishes an ERISA plan, and [offers] practical suggestions for employers considering layoffs to mitigate the risk of unexpected liability for severance."   MORE >>

"A lawsuit that accuses a major Pennsylvania highway contractor of stealing pension and welfare benefits of hourly employees assigned to prevailing wage projects is now a class action.... The complaint is related to the criminal charges filed by the state attorney general's office that alleged the illegal diversion of pension money and other workers' benefits." [ Packer v. Glenn O. Hawbaker, Inc. , No. 21-1747 (M.D. Penn. Jun. 6, 2023)]   MORE >>

19 pages. "With COVID-19 in the rearview, another -- but not new -- affliction affects Americans: inflation How does this influence health and wealth? And what can employers do to help their employees best navigate the impact higher prices have on their healthcare costs and savings?"   MORE >>