EMPLOYEE BENEFITS BLOG
EMPLOYEE BENEFITS BLOG
Insights on Employee Benefits and Executive Compensation
EMPLOYEE BENEFITS BLOG
Insights on Employee Benefits and Executive Compensation
Employee Benefits
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Senate Committee Advances Bills to Tackle High Drug Prices, Enhance Market Competition

by | Apr 18, 2025 | ,

The US Senate Judiciary Committee has advanced six bills aimed at reducing pharmaceutical prices and improving market competitiveness. These bills address various issues, including limiting the number of patents a biologics license holder can assert in litigation, clarifying the boundaries of permissible settlements in “pay for delay” agreements, and preventing “product hopping” by branded drug manufacturers. Additionally, the bills seek to curb abuses of the US Food and Drug Administration’s citizen petition process, improve interagency coordination on patent information, and mandate the Federal Trade Commission publish a report analyzing pharmaceutical benefit manager pricing practices and the pharmaceutical supply chain.

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The Employee Retention Credit: How to Litigate and Resolve Claims

by , and | Apr 10, 2025 | ,

The Employee Retention Credit (ERC), introduced under the Coronavirus Aid, Relief, and Economic Security Act in March 2020, was designed to help employers retain employees during the COVID-19 pandemic by offering a refundable tax credit against certain employment taxes. However, the processing and payment of ERC claims have faced significant delays, with many claims remaining unprocessed or disallowed by the Internal Revenue Service (IRS).

In this Bloomberg Tax article, Shawn O’Brien, Samuel Hamer, and Michael Scarduzio summarize each ERC stage and outline a taxpayer’s path to payment by stage.

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Navigating the Shifting Fiduciary Landscape

by | Apr 8, 2025 | ,

Todd Solomon recently appeared on the 401(k) Roundtable™ podcast. Hosted by Rick Unser of Creative Planning Retirement Services, the podcast is designed to help plan sponsors, fiduciaries, and members of retirement plan committees stay up to date on recent developments in the benefits industry.

During the episode, Todd explored the changing fiduciary landscape, trends in Employee Retirement Income Security Act litigation, the influence of the Trump administration on the US Department of Labor, and the evolving expectations surrounding fiduciary duties. He delved into the balance between the duty of loyalty and prudence, the significance of participant demographics in making plan decisions, and the difficulties plan sponsors face when weighing cost against value, particularly when choosing investments like target-date funds. Todd and Rick also stressed the importance of thorough documentation, active committee involvement, and creative approaches to improving participant outcomes in today’s intricate regulatory climate.

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Reproductive Health Under Trump: What’s New and What’s Next

by , , and | Apr 1, 2025 | , ,

Over the past two months, the second Trump administration has shifted federal policies and priorities regarding abortion, in vitro fertilization (IVF), contraception, and other reproductive-health-related matters – and it is expected to continue to do so.

Meanwhile, new regulatory developments in this area at the state level are also ongoing. Many states now require that insurance plans provide some combination of fertility benefits, fertility preservation, and coverage for a number of IVF cycles. After July 1, 2025, all large employers in California must provide insurance coverage for fertility treatments, including coverage for unlimited embryo transfers and up to three retrievals.

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Breaking Down the New No Surprises Act FAQs Post-TMA III

by , , , and | Mar 25, 2025 | ,

On January 14, 2025, the US Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management, released Part 69 of a series of FAQs aimed at helping stakeholders understand and comply with the federal No Surprises Act.

This latest set of FAQs focuses on how health plans and issuers should determine the qualifying payment amount and includes updates to disclosure and patient cost-sharing requirements, reflecting the recent rulings by the US District Court for the Eastern District of Texas and the US Court of Appeals for the Fifth Circuit in the case of Texas Medical Association, et al. v. United States Department of Health and Human Services, et al.

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Price Transparency: A Trump Administration Regulatory Priority

by and | Mar 13, 2025 | ,

On February 25, 2025, the Trump administration highlighted one of its priorities in an executive order on price transparency. While the order primarily focuses on enforcing existing price transparency requirements, it also suggests potential changes or expansions, which would necessitate rulemaking. Potential impacts on health plans include the requirement to make detailed pricing information publicly available and to provide an online shopping tool. This tool will allow consumers to see the rates negotiated by their providers and plans, as well as an estimate of their out-of-pocket costs for 500 of the most shoppable items and services.

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How PPM Health Plans Can Solve the MEWA Problem

by , , , and | Mar 6, 2025 | ,

A physician practice management (PPM) structure can help ensure compliance with corporate practice of medicine laws and simplify administrative tasks. However, it can also unintentionally lead to health plan issues that need to be carefully managed to prevent compliance problems or complications when selling PPM entities.

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New York Assembly Passes Restrictive Health Information Privacy Act

by , , and | Mar 4, 2025 | , ,

On January 22, 2025, the New York Assembly passed Senate Bill S929, known as the New York Health Information Privacy Act. If enacted, it will impose strict requirements on entities that handle health or wellness-related consumer data.

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Examining Group Health Coverage Alternatives for Small Employers

by , , and | Feb 27, 2025 | ,

Small employers have long struggled to offer comprehensive major medical coverage to their workers and families, mainly due to underwriting hurdles. Groups with fewer than 50 employees are often confined to state small group market plans, which can be costly. Even slightly larger groups, underwritten based on their own claims history, still face a significant lack of transparency. As a result, many of these employers are exploring alternative solutions, such as association-style plans, group medical stop-loss arrangements, level-funded products, and individual coverage Health Reimbursement Arrangements.

This Special Report delves into the challenges small employers face and the various options they can consider to provide group health coverage.

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Trump Administration Places DOL’s ESOP Proposals in Regulatory Moratorium

by , , and | Feb 25, 2025 | , ,

On January 16, 2025, the US Department of Labor’s (DOL) Employee Benefits Security Administration released two proposed regulations related to employee stock ownership plans (ESOPs). One regulation aims to clarify the valuation process for non-publicly traded employer stock, while the other would provide a safe harbor for transactions involving newly established ESOPs.

However, on January 20, 2025, the Trump administration froze all pending proposals, including the DOL’s ESOP regulations. If finalized, these regulations would dramatically change the landscape for fiduciaries responsible for valuing stock in privately held corporations during transactions with ESOPs.

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