The IRS has announced that the annual PCORI fee, which is imposed on health insurance issuers and self-insured health plan sponsors to fund the work of the Patient-Centered Outcomes Research Institute, will increase from $3.22 per plan enrollee to $3.47 per plan enrollee for plans that end between October 1, 2024 and September 30, 2025. While…

Effective September 20, 2024, the State of Arkansas implemented Emergency Rule 128 requiring pharmacy benefit managers (PBMs) to apply “fair and reasonable rates” to their pharmacy reimbursements. While Arkansas state law requires PBMs to use National Average Drug Acquisition Cost (NADAC) pricing for product reimbursement, the law does not address professional dispensing fees. Failing to…

Employers with employees in Massachusetts are required to electronically submit the Massachusetts Health Insurance Responsibility Disclosure (HIRD) form each year. The form was newly launched in 2018, replacing and significantly streamlining the previous HIRD reporting process. Employers with six or more Massachusetts employees during the previous 12 months are required to complete the HIRD form.…

The Departments of Treasury, Labor, and Health and Human Services (Tri-Agencies) have released proposed regulations that, if adopted in their current form, would address a number of issues regarding preventive services as well as expanding over-the-counter (OTC) contraceptive coverage. Current preventive coverage requirements include the requirement to cover OTC contraception when prescribed by a medical…

Three states – Alaska, Missouri, and Nebraska – will have paid sick leave (PSL) initiatives on the ballot for the November 5, 2024 election. These PSL initiatives, if passed, would take effect on July 1, May 1, and October 1, 2025, respectively. The ballot measures include the following provisions: Alaska Alaska’s ballot measure does not…

The Michigan Department of Labor and Economic Opportunity released guidance, in the form of FAQs regarding the impending implementation of the state’s Earned Sick Time Act (ESTA), as well as a new model notice poster. ESTA, which provides generous paid sick leave (PSL) benefits to Michigan employees, will take effect on February 21, 2025 as…

The IRS issued guidance in the form of two notices (Notice-2024-71 and Notice-2024-75) expanding the items and services that are considered preventive care and can therefore be covered under a high deductible health plan (HDHP) on a pre-deductible basis. The guidance also clarifies several items that are considered health care expenses for the purpose of…

The IRS has announced spending account limits for 2025. The annual contribution limit for health and limited purpose flexible spending accounts (FSAs) will increase to $3,300, up from $3,200 in 2024. For plans that allow carryover of unused health FSA funds, the carryover limit will increase to $660, up from $640 in 2024. The annual…

On September 17, 2024, the House of Representatives voted to approve the Chronic Disease Flexible Coverage Act (HR3800). If signed into law, the bill, which has been referred to the Senate Committee on Finance, would codify guidance issued by the IRS in 2019 that allowed high deductible health plans (HDHPs) to provide first-dollar coverage for…

The IRS has issued Revenue Procedure 2024-35, which establishes the affordability benchmark for employer-sponsored health plans under the Affordable Care Act (ACA). The indexed contribution percentage for 2024 plan years has been set at 9.02% of household income, a significant increase from the 2023 percentage (8.39%). Background Under the Affordable Care Act (ACA), employers with…