"The Massachusetts Health Connector has published 2024 dollar limits on deductibles and other cost sharing for minimum creditable coverage (MCC) ... Providing MCC is not an employer mandate, but many employees use employment-based health coverage to satisfy the individual mandate. In addition, health plan reporting requirements compel plan sponsors (or their vendors) to determine whether their coverage meets MCC standards."   MORE >>

"[T]he court found that Sedgwick did not act in bad faith or intentionally misinterpret the disability plan.... The court found that there would be no deterrent value of a fee award since the error was unintentional, Plaintiff did not bring the lawsuit to benefit others, and ultimately Plaintiff did not prevail. Balancing the factors, the court was left with no 'definite conviction' that the district court made a clear error of judgment." [ Alves v. Hewlett-Packard Comprehensive Welfare Benefits Plan , No. 22-55621 (9th Cir. Sep. 14, 2023)]   MORE >>

"[T]he court explained that while COBRA requires the administrator to 'notify' qualified beneficiaries of their COBRA rights, it does not limit this notification to a single notice. As long as an administrator timely notifies a beneficiary of their COBRA rights, it has complied with the requirements of the statute. Moreover, since the address to which the former employees were required to send COBRA payments was included in the second COBRA notice, the court ruled that the employer had fulfilled its notice obligation." [ Bryant v. Walgreen Co. , No. 23-1294 (N.D. Ill. Aug. 29, 2023)]   MORE >>

"The median price of air ambulance transport by private equity or publicly-traded parent companies was $32,051 in 2016 (and has only increased). Those rates were 60% higher than the average amount for rides provided by hospitals, nonprofits, and independent companies. As a result of this ruling, an air ambulance bill will be significantly less as hospital-based air ambulance fees will continue be included (and single case agreements will continue to be excluded) in the calculation of the QPA." [ Association of Air Medical Services v. HHS , No. 21-3031 (D.D.C. Aug. 4, 2023)]   MORE >>

"The draft Model Bulletin encourages insurers to develop, implement and maintain a written program for the use of AI systems that is designed to mitigate the risk that the use of AI systems in making or supporting decisions affecting insurers' customers will result in decisions that are arbitrary or capricious, unfairly discriminatory or that otherwise violate unfair trade practice laws.... It remains to be seen whether and to what extent state insurance departments will adopt and distribute the Model Bulletin in its final form."   MORE >>

"[The authors] posit that [the] lack of compliance monitoring is not for lack of interest but rather because of the complexity of the landscape to which the regulation applies. As such, in this piece, we lay the groundwork for compliance studies by outlining the agencies responsible for enforcing compliance with the TiC rule, delineating the universe of entities that are required to comply with it, and discussing how compliance might be assessed."   MORE >>

10 pages. "Three House committees -- Energy and Commerce, Ways and Means and Education and the Workforce -- each approved legislation that would advance price transparency objectives. Generally, these bills seek to codify (and in some respects, modify) the requirements around hospital and health plan price transparency as previously implemented by [CMS].... This [article] compares the hospital and health plan transparency provisions of these primary pieces of legislation and compares them with current regulations. "   MORE >>

"For real competition to take hold, the big pharmacy benefit managers, or PBMs, the companies that negotiate prices and set the prescription drug menu for 80% of insured patients in the United States, would have to position the new drugs favorably in health plans. They haven't, though the logic for doing so seems plain."   MORE >>

"[If] the drug manufacturers are required to participate in these negotiations or withdraw their drugs from the Medicare and Medicaid market, it is logical to assume that the manufacturers will be financially impacted. Because drug research and development is costly, drug manufacturers will likely want to offset the revenue lost from other sources. As a result, the two types of plans that will not reap the benefits of lower costs from the Medicare Drug Price Negotiation Program -- individual and employer- sponsored health plans -- are likely to see further increases in prices"   MORE >>

"This data brief examines the financial burden of care that people age 65 and older with Medicare face, and how that burden differs for people with traditional Medicare and Medicare Advantage.... [The study examines] the extent to which beneficiaries [1] are underinsured with high out-of-pocket costs or deductibles relative to their income; [2] are experiencing cost-related barriers to receiving care; [3] have problems paying medical bills; and [4] have difficulty paying Medicare premiums."   MORE >>