"Fully insured plans must follow applicable state mandates, while self-funded plans generally have more flexibility in plan design. However, employers will struggle with certain state laws related to travel for the purpose of gender-affirming care, irrespective of plan funding. The issues they encounter are similar to the questions concerning reproductive health that have followed the Dobbs decision."   MORE >>

"[HHS, DOL] and Treasury recently proposed a rule aimed at addressing some of the most significant problems with the IDR process. The proposed rule would tackle reimbursement delays, align the law's regulations more closely with its intent, and ensure providers are reimbursed in a timely manner so they can continue caring for patients in need."   MORE >>

"[T]he increased need to address employees' mental and physical health conditions is expected to expand EAP services by 11% or more in each of the three successive years, 2024-2027. The continued expansion of assistance services means employers with these programs must maintain ongoing compliance.... [1] How to comply with ERISA  ... [2] COBRA election notices  ... [3] HIPAA considerations for EAP compliance."   MORE >>

"The outcome of this suit -- and the extent to which the allegations around the prices paid by participants in the J&J plans are substantiated or explained in discovery -- could indicate that a plan fiduciary's selection of a PBM will be subject to closer scrutiny for compliance with ERISA's fiduciary duties going forward. In light of the litigation, plan sponsors may consider taking additional measures to review and document their processes related to the selection and monitoring of PBMs." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]   MORE >>

"Claiming that insurers consistently block access to this data, employers are saying it is increasingly difficult or even impossible to understand what they are being charged in their health plans. Despite a federal mandate that restricts health plans from limiting access to this valuable data, employers are still struggling to obtain it from insurers, turning to lawsuits as a last resort."   MORE >>

"A growing list of telehealth services are aiming to make it easier for potential patients to access weight loss drugs and look well-positioned to further interest: 73% of consumers who are interested in GLP-1 drugs for weight loss say they're interested in obtaining the medications via a telehealth service. Still, concerns about the price of GLP-1 drugs, potential side effects and worries that the weight will return after cycling off of the drugs remain obstacles to broader adoption."   MORE >>

"Researchers estimate that approximately 3 in 10 working adults are classified as obese and one-third meet the criteria for being overweight. Excess body weight is strongly linked to a heightened risk of chronic disease, including heart disease, type 2 diabetes, hypertension, certain cancers and other health conditions."   MORE >>

"Abusive practices by PBMs received sustained, bipartisan focus in Congress throughout the year, which resulted in the House's passage of the Lower Costs, More Transparency Act ( HR 5378 ) ... On the Senate side, three bills targeting PBM reform await Floor consideration. Meanwhile, the Biden Administration quietly continued its investigation of alleged anticompetitive behavior by the major PBMs."   MORE >>

"While employers have made significant investments to address the ongoing health challenge compounded by workforce shortages, more action is needed by policymakers to provide the support that millions of people need right now. By further expanding access with telehealth, strengthening the provider workforce, and better integrating care, we can improve mental health."   MORE >>

"[An] acquisition target's qualified retirement plans, health plans, executive compensation arrangements, and benefit programs can all be a source of significant liabilities.... In order to avoid any complications and liabilities, the parties need to understand the best deal structure based on the benefit programs requirements and perform due diligence to carefully address any issues under both [ERISA] and the Internal Revenue Code early in the transaction."   MORE >>

"[1] What are 'Plan Documents'? ... [2] Which plan documents should be kept? ... [3] How long should plan documents be retained? ... [4] Can the plan documents be retained in electronic form? ... [5] What should a plan sponsor do to be in plan document retention compliance?"   MORE >>

"Legislation introduced in the California Assembly would require the Occupational Safety and Health Standards Board to adopt a standard requiring employers to continue pay and benefits for workers who are excluded from the workplace for COVID-19 -- related reasons. The bill would require the Standards Board to adopt regulations by February 3, 2025. The bill appears to be based on outdated state and federal health agency advice that has since been updated."   MORE >>