"[1] A group health plan may provide longer periods of COBRA coverage than the law requires.... [2] In some circumstances, terminating employees can pay for their COBRA premiums from their severance payments on a pre-tax basis.... [3] When providing COBRA subsidies, ... [employer] options often depend on whether their group health plan is insured or self-insured.... [4] [T]erminating COBRA coverage just because their subsidy ended does not create a special enrollment right allowing [the employee] to enroll in other coverage.... [5] IRC Section 409A ... applies to the reimbursement or payment of subsidized COBRA payments unless an exception applies."   MORE >>

"Due to the expanded eligibility for the premium tax credits, there could be increased penalty exposure for ALEs that do not offer affordable, minimum-value coverage to all full-time employees.... The IRA made several cost-reduction reforms for enrollees in Medicare Part D prescription coverage ... [which] may make it difficult for some plans to demonstrate that the prescription drug benefit they offer under the group health plan is 'creditable.' "   MORE >>

"Eligible employees would still be able to take protected, unpaid leave under the Oregon Family Leave Act (OFLA) for employee health conditions related to pregnancy and for qualifying reasons that are not covered under Paid Leave Oregon, such as bereavement leave and sick child leave. Employees also would be able to take up to two weeks of OFLA leave to effectuate the legal process required for fostering or adopting a child until January 2025, when this reason for leave will become available only under Paid Leave Oregon. Most changes are scheduled to take effect July 1, 2024."   MORE >>

"HHS's investigation of the target company, a business associate (BA) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), will focus on whether the target company and its corporate parent (a major health insurer) complied with HIPAA's privacy, security, and breach notification rules."   MORE >>

"The appellate court noted that had Congress intended to apply a 'motivating factor' legal standard to FMLA retaliation claims, it would have included that provision in the law. However, since Congress did not include that provision, the court concluded that Congress intended the default 'but for' standard to apply in reviewing these legal claims." [ Lapham v. Walgreen Co. , No. 21-10491 (11th Cir. Dec. 13, 2023)]   MORE >>

"The Sixth Circuit found that Unum's decision to terminate Plaintiff's LTD benefits was not arbitrary and capricious where Unum relied on its in-house file-reviewing physician, interpreted Plaintiff's doctor's opinion as supporting Plaintiff's ability to work, and conducted a vocational analysis looking at the jobs available in the area of Plaintiff's new residence." [ Harmon v. Unum Life Ins. Co. of Am. , No. 23-5619 (6th Cir. Mar. 12, 2024; unpub.)]   MORE >>

"On February 21, Change disconnected its technology systems after reporting it was the victim of a cyberattack. Weeks later, health care providers continue to grapple with the operational, financial, and legal implications arising from the incident."   MORE >>

"Among the key reasons that employers adopt high-deductible health plans (HDHPs) is the hope that such cost sharing will lead to more cost-conscious health care behavior.... [P]articipants in such plans generally were more cost conscious than participants in traditional health care plans in past years ... That was no longer the case in 2023."   MORE >>

12 pages. "[R]isk score differences ... comparing interim 2023 and final 2022 data submission are not directly comparable due to data completeness, model changes, and other differences by year.... [CMS has] seen an increase in enrollment, including billable member months, and total premiums in the interim 2023 benefit year individual market data when compared to final 2022 benefit year data. These changes may also impact the relationship between interim and final risk adjustment data for the 2023 benefit year relative to past years." [Also available: Appendix A: Interim 2023 Benefit Year Risk Adjustment State Averages with State Billable Member Months ( XLSX ) and Appendix B: Interim 2023 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) ( XLSX )]   MORE >>

"Patients can change insurance only during end-of-year enrollment periods or at the time of 'qualifying life events' ... But insurers' contracts with doctors, hospitals and pharmaceutical companies (or their arbiters, so-called pharmacy benefit managers) can change abruptly at any time.... [W]hether obtaining insurance through an employer or buying it on the marketplace, [patients] generally choose a policy based on whether it covers their desired doctors and hospital or an expensive drug they need."   MORE >>

"The Change cyberattack has precipitated financial crises for care providers large and small and for patients, as well as for Change's immense owner, the $371 billion UnitedHealth Group. It has graphically demonstrated the vulnerability of a bewilderingly complex proprietary medical payment system. It is a 'Deepwater Horizon' moment in American health care finance."   MORE >>

"Preemption is fundamental to ERISA working as intended.... [T]he Council recommends to the committee that additional detail be added to ERISA's prohibited transaction rules as they pertain to health plans ... to require plan service providers ... to disclose to the plan and the plan fiduciary in advance of services being provided both the affiliate status of the party/provider and ... the cost that will be charged with respect to any services being provided by the affiliate."   MORE >>

"ERIC continues to support congressional efforts to designate that vendors involved in critical plan design and administration decisions, including an entity providing pharmacy benefit management services, are fiduciaries within the meaning of section 3(21) of ERISA with respect to a group health plan or group health insurance coverage.... Transparency is needed regarding PBM compensation sources.... There are multiple frameworks and standards that health plan sponsors and ERISA fiduciaries already comply with and use to protect sensitive plan and participant data.... The introduction of new or broadened requirements under ERISA would be redundant and would contribute to further complexity and administrative costs."   MORE >>

"[B]est practice items committees should consider annually: [1] Review the committee charter.... [2] Schedule fiduciary training.... [3] Consider establishing a committee for your health and welfare programs.... [4] Schedule regular committee meetings and document the process.... [5] Review the fiduciary liability insurance policy."   MORE >>

23 pages. "Notwithstanding the absence of an express statutory mandate, federal courts have created and uniformly apply a 'very important' judicially created exhaustion requirement under ERISA, ... a requirement that 'finds its genesis' in ERISA Section 503. Consistent with that genesis, exhaustion of administrative remedies does not extend to the seeking of external review."   MORE >>