Hayley Kelley

Pharmacy Benefit Managers (“PBMs”) influence drug pricing and access, but their opaque practices raise concerns about transparency and competition.

Maine has finalized its Paid Family and Medical Leave rules, requiring employers to prepare for new payroll taxes starting in 2025.

The Department of Labor’s new guidance on the Gag Clause Prohibition clarifies that no agreements can restrict plan sponsors or their business associates from accessing critical health claims data, ensuring greater transparency and compliance.

Group health plan sponsors offering prescription drug coverage must submit their annual creditable coverage disclosure to CMS by March 1, 2025, for calendar year plans to ensure compliance and avoid penalties.

Illinois employers are required to provide employees with a written comparison of their health plan’s benefits. An updated model disclosure forms was recently released for 2025.

Starting January 1, 2025, New York employers must provide 20 hours of paid prenatal leave, with clear guidelines outlined by the NYS Department of Labor.

SB 1090 increases SDI and PFL wage replacement to 70-90% and streamlines claim processing.

In 2024, employers must distribute MLR rebates tied to employee contributions. Learn about allocation, ERISA compliance, and tax implications.

ACA reporting can be complex, with different forms required depending on your organization’s size and type of health coverage. In this post, we break down the essentials of Forms 1094-C, 1095-C, 1094-B, and 1095-B, highlight common mistakes, and explain penalties for non-compliance.