News

Updated Sep. 12, 2024. "Beginning August 1, 2024, providers must submit Forms 4461 or 4461-B electronically ... Paper submissions postmarked after July 31, 2024, will not be processed. Also, beginning September 1, 2024, providers must submit Forms 4461-A or 4461-C electronically ... Paper submissions postmarked after August 31, 2024, will not be processed.... You must have a single PDF file (not exceeding 15MB) that you'll upload at the end of the application."

Topics: [1] Deadlines extended for updating plan documents for several major law changes affecting retirement plans; [2] Forms 4461-A and 4461-C electronic submission.

"[E]mployer-plan sponsors should consider including contract provisions requiring the carrier/TPA to administer the plan in accordance with MHPAEA requirements and provide a complete Comparative Analysis to include any NQTLs it imposes. They also should consider asking the service provider to assist in reviewing plan data and network information to show the plan operates in accordance with MHPAEA.... The significant rise in plans offering telehealth benefits with no participant cost-sharing ... creates potential challenges for plans in passing the 'substantially all' portion of the test (e.g., that the same type of cost-sharing must apply to at least 2/3 of claims in a classification in order to be applied to MH/SUD claims in that classification)."

"The Proposed Arrangement would implicate the Federal anti-kickback statute because Requestor, an organization that offers EGWPs,15 would offer remuneration to a Group in the form of sharing a percentage of its savings that could induce the Group to refer its enrollees to Requestor so that Requestor, via its EGWP, would arrange for the furnishing of items or services that are reimbursable by a Federal health care program. No safe harbor would apply."

11 pages. "The final rules represent a major overhaul of the existing parity regulations. Plans and insurers will need to conduct additional analysis to determine the rules' impact in general and for a particular plan.... Self-funded plan sponsors have more compliance obligations and will require assistance from one or more service providers to comply. The final rules' numerous examples illustrating how the parity requirements work should be reviewed carefully for insight into plan design, application and outcome red flags."

"Mercer projects that every key Internal Revenue Code (IRC) limit for qualified retirement plans will likely rise from 2024 to 2025. The 2024 limits will reflect increases in the Consumer Price Index for All Urban Consumers (CPI-U) from the third quarter of 2023 to the third quarter of 2024.... [A table] shows Mercer's projections of the 2025 limits compared with the actual 2024 amounts."

"[The] ERISA Advisory Council ... debated the complexities of integrating lifetime income options into retirement plans and the broader implications for plan sponsors and participants amid the changing retirement landscape.... [T]he council intends to further evaluate how lifetime income products can be integrated into QDIAs and how these decisions will impact plan sponsors' fiduciary responsibilities."

"At its heart, MHPAEA, as outlined in the Final Rule, imposes a burden of presumptive discrimination on all managed care functions and requires Health Plans to prepare and maintain parity compliance documentation that is ready to rebut that presumption at any time upon request."

"The agencies anticipate that the final rules will result in changes in network composition and medical management techniques related to MH/SUD care, more robust MH/SUD provider networks, and fewer and less restrictive prior authorization requirements for MH/SUD care. But opposition has already been registered by a Congressional committee, and legal challenges seem likely[.]"

"Oregon in 2017 ... implemented the first program. The success of this program encouraged other states to adopt similar initiatives.... The overarching goal was to provide a retirement savings option for small business employees who otherwise would not have access to such plans.... While a highly customized employer-sponsored retirement plan ... makes sense for many employers, for smaller employers with limited resources, a state-sponsored Auto-IRA program may prove a useful solution."

"Proponents of ERISA preemption point to the creation of a uniform and predictable regulatory environment for employers with respect to their ERISA-governed benefit offerings, while its detractors believe that state and local governments ought to have a greater role in pursuing health care reform beyond their current ability to regulate health insurance. To better understand the value of ERISA preemption to large employers, [EBRI] and American Benefits Council conducted roundtable discussions with over a dozen benefits executives at large companies."

"The IRS provides three optional affordability safe harbors that allow an ALE to calculate affordability of its health coverage without requiring information on an employee's household income: the federal poverty line (FPL), the W-2, or the rate of pay. There are advantages and disadvantages to each of these safe harbors."

"[T]he IRS announced the new [ACA] affordability percentage of 9.02% for 2025 employer health care plans. After three years of decreases, this percentage increase gives employers more flexibility in setting employee premiums without making their coverage unaffordable under the safe harbor."

"Some 54% of workers have access to employer-sponsored plans.... But the lack of required participation has a downside.... The report warned that the 'voluntary, employer-centric nature of the workplace system also leads to variation in the quality of workplace retirement plans.' "

"[T]he new SEC rule is the suitability standard with two modifications. It cynically co-opts the fiduciary industry's 'best-interest' phrasing and treats more misbehaviors as technical breaches.... But in practice, the breaches are allowable because Reg BI arms brokers with ways to disclose away almost anything in the small print. The SEC accomplished one objective of the fiduciary movement -- regulatory harmonization for all advisors. But at a steep price. It made sure advisors and brokers appear to be conflicted alike."

"The FAQs restate the IRS's prior guidance on educational assistance programs and, for the first time, provide guidance regarding the treatment of student loans.... Employers who offer, or intend to offer, an educational assistance program should: [1] maintain a written plan and provide reasonable notice of the availability of the program to employees; [2] if providing student loan assistance as part of the program, ensure the terms of the plan reflect that; [3] and review the IRS sample plan[.]"

"The IRS released final regulations dated April 3, 2024, and a related fact sheet, regarding short-term, limited-duration insurance and the consumer notice required for certain fixed indemnity coverage.... [T]he IRS reiterated its concern regarding fixed indemnity policies and other arrangements where premiums for the coverage are paid pretax and cash payments are made even though no medical expenses are incurred or the medical expenses are reimbursed through other coverage. It explained that these payments generally are taxable wages subject to FICA, FUTA and FITW."

"[1] HIPAA privacy extends special protections to reproductive health care: Employer action required by 12/23/24 ... [2] Gag clause attestation.... [3] NQTL compliance.... [4] Transparency requirements.... [5] Fiduciary obligations ... [6] Cybersecurity compliance.... [7] Prescription drug reporting."

"Though intended for the benefit of Medicare, the availability of a published net price point has other benefits, both for Medicare and for other stakeholders. In particular, it provides a window into the effectiveness of negotiations by Medicare Part D plans and other U.S. payers, and competition to lower the prices of prescription drugs."

"From its origins as the Pension and Welfare Benefits Program through its elevation to a sub-cabinet position and into the 21st century, EBSA has worked with many members across the employee benefits community ... Beginning with developing effective regulations, the input in the rulemaking process from voices across the employee benefits community has been critical to developing informed rules to implement the goals of ERISA."

"The [IRS] announced ... tax relief for individuals and businesses in the entire state of Louisiana, affected by Tropical Storm Francine that began on Sept. 10, 2024. These taxpayers now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments."

20 pages. "To stay relevant through these disruptive times, many recordkeepers will need to reinvent their business models at a fundamental level.... [T]his paper [explores] strategic recordkeeping models that will compete in the future landscape and those that may face extinction. [It also explores] the evolving revenue pools offering an opportunity for retirement recordkeepers to reinvent and expand their business models if they are to exist profitably in this space."

"The update to the QPAM exemption requires action on the part of investment managers (banks, etc.), for example, filing the QPAM notice with the DOL. More importantly, the update provides an opportunity ... to review and reevaluate ... practices and processes, which may have been adopted years ago, to assure they are consistent with their current business environment as well as the updated QPAM exemption."

"[T]he Final Rule will continue to pose significant compliance challenges for plans and issuers with new requirements related to the documentation and justification of NQTLs. Plans and issuers must continue to perform and document NQTL comparative analyses, and these new rules will require plans and issuers to update existing NQTL comparative analyses documentation to comply with these new requirements."

"[To] the extent that Plaintiff alleges that EBPC, as a Plan fiduciary, and Boeing, as a functional fiduciary, were performing fiduciary functions when they continued to charge and collect premiums after receiving Plaintiff's [QDRO] notice stating that he was divorced, Plaintiff plausibly alleged that they were acting as fiduciaries when they continued to collect premiums. The court also found that he plausibly alleged that Boeing and EBPC breached their fiduciary duties by failing to investigate Plaintiff's ex-wife's continued eligibility after they received the QDRO stating that they were divorced. The court reversed the dismissal of these claims." [McIver v. Metropolitan Life Ins. Co., No. 23-55306 (9th Cir. Sept. 11, 2024; unpub.)]