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Articles by Susie Bilbro
Tobacco Surcharge Claims Up in Smoke? DOL, HHS, and Treasury Issue FAQ 74: Addressing Questions Raised by Tobacco Surcharge Lawsuits
No retroactive refund required. FAQ Part 74 confirms that employers are not required to provide retroactive rewards or remove tobacco surcharges for the period before a participant completes a reasonable alternative standard, such as a tobacco cessation program. Prospective-only rewards satisfy the regulatory framework. Enforcement relief, not litigation immunity.
GLP-1 Coverage: Solutions for Managing Weight-Loss Drug Costs
Learn how Marsh McLennan successfully boosts staff well-being with digital tools, improving productivity and work satisfaction for more than 20,000 employees. The proliferation of artificial intelligence in the workplace, and the ensuing expected increase in productivity and efficiency, could help usher in the four-day workweek, some experts predict.
Emerging Alternatives for GLP-1 Prescription Drug Coverage: What Plan Sponsors Need to Know
As GLP-1 medications become an increasingly significant cost driver for employer-sponsored health plans, plan sponsors are seeking creative solutions beyond conventional pharmacy benefit manager (PBM) channels. Direct-to-consumer reimbursement models have emerged as a compelling alternative, enabling participants to obtain these medications at reduced prices while shifting claims processing outside traditional PBM frameworks.
Reminder: Group Health Plans Should Update HIPAA Notice of Privacy Practices by February 16
Many people see the start of a new year as a time to refresh and renew themselves. For covered entities under HIPAA, which include group health plans, it’s also time to refresh and renew your HIPAA Notice of Privacy Practices (Privacy Notice) to address the changes made to the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR part 2 (Part 2). The deadline for updating Privacy Notices to reflect these amendments is February 16, 2026.
Stuck in the Middle: Self-Funded Health Plans and Recent Challenges to State PBM Laws
In recent years, prescription drug prices have been top-of-mind for state legislators, who have responded by passing laws that seek to control that pricing in a variety of ways, including by regulating pharmacy benefit managers (PBMs).
In December 2024, Congress and President Biden passed two laws—the Paperwork Burden Reduction Act (PBRA) and the Employer Reporting Improvement Act (ERIA)—that made important changes to employers’ responsibilities regarding furnishing information to employees under the Affordable Care Act (ACA) information reporting provisions as well as the response deadlines and the statute of limitations for the employer shared responsibility penalty assessments.
BREAKING: DOL Expands the Voluntary Fiduciary Correction Program
Earlier today, the U.S. Department of Labor (DOL) published in the Federal Register an updated version of the Voluntary Fiduciary Correction Program (VFCP) under Title I of ERISA. Per the DOL, VFCP “is designed to encourage correction of fiduciary breaches and compliance with law by permitted persons to avoid potential [DOL] civil enforcement actions and civil penalties if they voluntarily correct” errors in accordance with the program.
New Reproductive Healthcare Privacy Final Rule: Key Compliance Steps And Dates
Highlights: The U.S. Department of Health and Human Services issued a Final Rule modifying the HIPAA Privacy Rule to support reproductive healthcare privacy. The Final Rule enhances protections by prohibiting the use of reproductive healthcare information for criminal or civil investigations. Covered entities must secure a signed attestation before disclosing reproductive healthcare-related protected health information for legal or oversight purposes.
Planning for Open Enrollment? Note the ACA Affordability Threshold Drop
This post was updated on February 6, 2024, to reflect the 2024 Federal Poverty Level announced in January 2024. On August 23, the Internal Revenue Service issued Rev. Proc. 2023-29, announcing that the Affordable Care Act (ACA) affordability threshold will be 8.39% for plan years beginning in 2024, a substantial decrease from the 9.12% affordability threshold set for plan year 2023. This marks the largest change yet in the affordability thresholds year-over-year.
Let the Plan Speak: First Gag Clause Attestation Due December 31, 2023
By December 31, 2023, group health plans and health insurance issuers must submit an attestation to certify compliance with the “gag clause prohibition” under the Consolidated Appropriations Act of 2021 (CAA).
Tenth Circuit Rules ERISA Preempts Oklahoma PBM-Reform Law
NOTE: This post was originally written August 29, 2023, and was updated on September 27, 2023. Breaking news: On September 19, 2023, the Oklahoma Attorney General filed a Petition for En Banc Rehearing, challenging the Tenth Circuit panel’s decision in this case and requesting a rehearing before the full Tenth Circuit bench.
Planning for Open Enrollment? Note the ACA Affordability Threshold Drop
On August 23, the Internal Revenue Service issued Rev. Proc. 2023-29, announcing that the Affordable Care Act (ACA) affordability threshold will be 8.39% for plan years beginning in 2024, a substantial decrease from the 9.12% affordability threshold set for plan year 2023. This marks the largest change yet in the affordability thresholds year-over-year.
Flexible Spending Accounts: Require Substantiation or Risk Disqualification
On April 28, 2023, the IRS Office of Chief Counsel issued Chief Counsel Advice Memorandum 202317020 (CCA Memo), with an important reminder to employers who provide health and dependent care flexible spending arrangements (FSAs) under an Internal Revenue Code (Code) Section 125 cafeteria plan: a failure to adequately substantiate FSA expenses before reimbursement may result in the loss of the tax-free status of all benefits provided under the Code Section 125 cafeteria plan.
Tenth Circuit Rules ERISA Preempts Oklahoma PBM-Reform Law
In a win for self-funded (i.e., self-insured) health plans subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA), the Tenth Circuit recently ruled that ERISA preempts provisions of an Oklahoma law regulating pharmacy benefit managers (PBMs) and pharmacy networks. The states in the Tenth Circuit are: Colorado, Kansas, New Mexico, Oklahoma, Utah, and Wyoming.
State Prescription Drug Legislation and ERISA Preemption
We recently authored an article for Washington Legal Foundation examining whether federal law preempts state prescription drug coverage laws that would apply to employer-sponsored group health plans. According to a provision in the Employee Retirement Income Security Act of 1974 (ERISA), state laws that “relate to” employee benefit plans are preempted by ERISA standards. Unfortunately, as we pointed out in the article, this “related to” statement is broad and vague.
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