Consolidated Appropriations Act of 2021 (CAA) – Updated with additional FAQs and information on the Transparency in Coverage rules.

Dental Plan Overview – Updated with information on the Notice of Benefit and Payment Parameters for 2025 final rule clarifying that states will be allowed to update their EHB benchmark plans to include routine non-pediatric dental services beginning in 2025. 

ERISA – Updated with information on the EBSA final rule rescinding the 2018 Association Health Plan Rule that expanded the availability of AHPs.  Additional information related to the CAA and Transparency in Coverage Rule was added.

No Surprises Act – Updated with information on the final rules related to fees established by the NSA for the IDR process and additional FAQs.

Medicare - 2024 premiums, deductible and copayments were updated.  Information on new coverage of mental health intensive outpatient program services was added.  Clarification related to current employment status of persons aged 65 or older and receiving disability payments from an employer was added.  A Summary Chart for ESRD-MSP Rules and Dually Entitled Medicare Beneficiaries was added.

Affordable Care Act Overview – Updated with information on final rules amending regulations regarding requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets.  Additional FAQs released by EBSA were added.

Affordable Care Act and Lifetime/Annual Limits – Updated with the 2024 and 2025 cost sharing limits for non-grandfathered plans.  Information on the Notice of Benefit and Payment Parameters for 2025 final rule was added.

Affordable Care Act and Preventive Care – Updated with additional FAQs and information on the final recommendation statement on screening for breast cancer.

State Assessments on Health Related Claims - Updated with current assessment information by state.

Mental Health Parity Acts of 1996 and 2008 – Information on final rules implementing the MHPAEA was added.

Flexible Benefits Administration - Maximum HAS/HRA contribution amounts and HDHP minimum deductible and out of pocket limits for 2024 and 2025 were updated. 

Privacy and Confidentiality – Information on the final rule implementing the confidentiality provisions of the CARES Act to align with the HIPAA and HITECH rules was added.  Information of the final rule issued by the EBSA prohibiting the disclosure of PHI related to lawful reproductive health care was added.

Ambulance/Transportation Services – Updated with information interim final rules related to balance billing for nonparticipating providers of air ambulance services.

Eligibility Overview – Information added on the final rule entitled Safeguarding the Rights of Conscience as Protected by Federal Statues.

Substance Abuse/Chemical Dependency – Updated with information on the final rule issued by the HHS and SAMHSA modifying the confidentiality of substance use disorder patient records. 

Medical Plan Overview – Additional ACA FAQ addressing SBC notice requirements was added.

PROCEDURAL TOPICS

Coding & Billing - Updated with information the latest release of the CPT-4 and CDT-2024.  Information on the new place of service code 27 – Outreach Site/Street on the CMS-1500 was added. 

Prescription Drugs – Information on additional FDA-approved biosimilar drugs, information on the five most expensive specialty drugs/therapies was added along with the current status of Alzheimer’s therapy drugs.  Information added on pursuing rebate opportunities on drugs paid under the medical benefit.  

Occupational, Physical and Speech Therapy – Updated with 2024 threshold amounts for use with the KX modifier.

STD - Other Disability Income Sources - Disability benefits by state were updated.

STD Benefit Taxation - The Social Security taxable wage base was updated.

Dental Plan Overview – Procedures requiring submission of X-rays or periodontal charting were updated.  

Dental Topics –Coding was updated.  Additional covered and non-covered services were added. 

MEDICAL TOPICS

Botulism Toxin Injections – Updated with additional covered services and investigational usage indications.

Cochlear Implants and Auditory Brainstem Implants – Updated with additional investigational procedures.

Allergy Testing and Treatments - Updated with additional conditions for which allergy immunotherapy may be considered medically necessary.

Growth Hormone – Updated with additional FDA approved drugs.

Lithotripsy – Updated with additional covered services.

Lung Volume Reduction Surgery – Updated with additional investigational services.

Obesity – Tirzepatide was added to the list of drugs approved by the FDA for weight reduction.  Information of the FDA approval of a new indication for the use of Wegovy was added.

Physical Therapy – Updated with additional investigational services.

Psoriasis Treatment – Updated with additional covered services.

RSV Prophylactic Measures – Updated with additional covered services.

Spinal Surgery/Procedures – Updated with additional covered services.

Vaccines/Immunizations - Updated with current information on the CDC’s Recommended Immunizations Schedules.

Vision Therapy - Updated with additional investigational services.

OPERATIONAL TOPICS

Extra-Contractual Payments/Exception Requests – Updated with new information on the handling of exception requests.  

Organizational Security/Disaster Planning – Updated with information on the EBSA cybersecurity guidance and its Compliance Assistance Release for 2024.  

Vendor Selection & Monitoring – Updated with information on plan fiduciaries legal obligation to act prudently and in the best interest of plan participants under ERISA.   

LISTINGS AND DIRECTORIES

Internet Sites – Links were updated.

State Intoxication Levels – State legislation chart was updated.