Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits

Strafford

CAA Challenges, Removal of Gag Clauses, Compliance Attestations, Determining Reasonableness in Vendor Fees and Services

This CLE webinar will provide employee benefits counsel a comprehensive analysis of evolving compliance challenges for employer-sponsored health and welfare plans. The panel will discuss key areas of focus of Department of Labor (DOL) audits, significant compliance issues for health plan sponsors under the Consolidated Appropriations Act of 2021 (CAA), plan contracts and the removal of "gag clauses," vendor fees and services, and new compliance attestation requirements. The panel will also discuss other key items impacting health and welfare plan administration and compliance.

Description

The DOL has an active enforcement program focused on health and welfare plans in response to rules provided under the CAA. ERISA counsel, fiduciaries, and administrators must ensure strict compliance with current regulations and implement procedures to overcome administrative challenges.

The administrative challenges and compliance failures for health and welfare plans can lead to lawsuits and significant penalties. The enactment of the CAA significantly impacts the administration and fiduciary obligations for health plans. Recently, the DOL and the Department of Health and Human Services issued guidance for compliance with certain provisions of the CAA regarding (1) plan contracts and the removal of "gag clauses"; (2) determining "reasonableness" for vendor fees and services; (3) prescription drug reporting; and (4) parity between medical and mental health coverage.

The DOL's key areas of focus for audits and enforcement will encompass the aforementioned items in addition to other critical issues. ERISA counsel must identify potential compliance pitfalls and understand the required documentation and procedures, audit triggers, and plan provisions targeted by the DOL and IRS to minimize these plan administration issues.

Listen as the panel discusses significant compliance issues for health plan sponsors under the CAA and recent guidance for plan contracts and the removal of "gag clauses," vendor fees and services, and new compliance attestation requirements.

Outline

1. CAA compliance for health and welfare plans
2. Plan contracts and "gag clauses"
3. Vendor fees and services
4. Mental health parity rules
5. Fiduciary rules and liability
6. Recent DOL developments
7. Best practices for plan sponsors and administrators

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