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Time for a Commercial Break: Financial Impact of Certain Health Plan Business Practices on Providers (PDF)
Crowe Link to more items from this source
June 2, 2023

16 pages. "Conventional wisdom has been that treating more patients with commercial, or private, health insurance was seen as a good thing from a net revenue point of view ... [D]ata shows that commercial payors reimburse providers at a higher amount on a per-case basis compared with Medicare ... In fact, commercial payors take the longest to pay, require providers to jump through more administrative hoops to get paid, and delay payments to providers via claim denials at a higher frequency than government payors."

Tags: Health Plan Costs  •  Health Plan Design

DOL Opinion Letter Sheds Light on Calculating FMLA Leave During a Holiday Week
FMLA Insights Link to more items from this source
[Guidance Overview]
June 2, 2023

"In a highly technical opinion letter ... the [DOL] clarified how to calculate FMLA leave usage when an employee takes intermittent leave during a holiday week.... [It is] critical to understand that the term 'workweek,' as defined under the FMLA, is the employee's normal schedule (hours/days per week) prior to the start of FMLA leave. "

Tags: FMLA and Other Leave

Using ERISA as a Sword, Not a Shield: Part 3
American Enterprise Institute Link to more items from this source
June 2, 2023

"[A] more vigorous assertion of ERISA fiduciary obligations, either by employee-backed litigation or more thoughtful federal regulation (not always an oxymoron) could provide an independent tool to bolster healthcare price transparency that matters and strengthen the combined force of pro-transparency pressure. At a minimum, it could motivate some employers to contract with intermediaries (including better-structured association health plans, independent coverage health reimbursement arrangements, stop-loss insurers, and pharmaceutical benefits managers) that are more accountable to the employee beneficiaries of self-insured plans."

Tags: Fiduciary Duties  •  Health Plan Costs  •  Health Plan Design

'Long Haul' COVID-19 Claims Under a Long-Term Disability Policy (PDF)
Stradley Ronon, via Employee Benefit Plan Review Link to more items from this source
June 2, 2023

"It is imperative that applications for long-term disability due to long-haul COVID-19 ... be scrutinized to determine if a claimant continues to be residually or totally disabled.... Engaging medical experts to review a claimant's medical records will be vital to ensuring that only legitimate claims are paid. It is expected that courts are likely to undertake a fact-based analysis, and as scientists begin better understand the effects of long-haul COVID-19, it is expected that there may be guidelines for diagnosis simi- lar to chronic fatigue."

Tags: Disability Plans

Text of Instructions for IRS Form 5307: Application for Determination for Adopters of Modified Nonstandardized Pre-Approved Plans (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
June 2, 2023

Rev. June 2023. "What's New: The form and instructions have been updated to be completed on as of July 1, 2023.... The form and the instructions have undergone major revisions in the format and information required."

Tags: Retirement Plan Administration

IRS Interim Guidance on Self-Correction Under SECURE 2.0
Segal Link to more items from this source
[Guidance Overview]
June 2, 2023

"[Notice 2023-43], which is in the form of questions and answers, covers: [1] Conditions for self-correction; [2] Eligible inadvertent failures that may not be self-corrected at this time; [3] Conditions that will not apply under the interim guidance ... Plan sponsors may rely on this guidance in determining whether self-correction is allowed until IRS updates [Rev. Proc. 2021-30]."

Tags: Retirement Plan Administration  •  SECURE 2.0

Four Key (and Surprising) Points for Navigating FMLA Leave
Ogletree Deakins Link to more items from this source
[Guidance Overview]
June 2, 2023

"[1] Employers' more generous leave policies do not relieve them of their FMLA leave obligations.... [2] Prior temporary employment may count toward FMLA eligibility.... [3] Employers may not rely on 'undue hardship' to deny FMLA leave.... [4] 'Maternity leave' is an ambiguous term."

Tags: FMLA and Other Leave

Be Careful When Calculating FMLA Leave for a Week That Includes a Holiday
Society for Human Resource Management [SHRM]; membership may be required to view article Link to more items from this source
[Guidance Overview]
June 2, 2023

"A new [DOL opinion letter] clarifies how ... to calculate [FMLA] leave ... when it's taken during a week that includes a holiday.... If a holiday falls during a week when an employee takes a full workweek of FMLA leave, then a full week is counted as FMLA leave. However, if a holiday falls during a week when an employee works some hours and takes some FMLA leave, the holiday is not counted as FMLA leave, unless the employee was normally scheduled and expected to work on that holiday."

Tags: FMLA and Other Leave

Senators Ask DOL to Prioritize Six SECURE 2.0 Provisions
Pensions & Investments Link to more items from this source
June 2, 2023

"[One] provision the senators highlight as a priority for the [DOL] is allowing employers to offer pension-linked emergency savings accounts to non-highly compensated employees.... The senators also asked the DOL to focus on requiring defined benefit plans to include more information on plan assets, liabilities and funding status in their annual funding notices.... The lawmakers also directed the DOL and Treasury Department to amend regulations so that defined contribution plans can consolidate certain required notices."

Tags: Retirement Plan Administration  •  Retirement Plan Design  •  SECURE 2.0

Employer Contributions Reach Record-High Levels
American Retirement Association [ARA] Link to more items from this source
June 2, 2023

"Total savings rate for the first quarter -- which reflects a combination of employer and employee 401(k) contributions -- improved to 14% (compared to 13.7% in Q4 2022 and 13.8% in Q3 2022... [T]he average 401(k) employer contribution, which includes profit sharing and matching contributions, reached a record 4.8% in Q1[.]"

Tags: 401(k) Plans  •  Retirement Plan Design

Tenth Circuit Addresses Insurer Accountability for Claim Denials
DeBofsky Law Link to more items from this source
June 2, 2023

"The message the Tenth Circuit's ruling sends to insurers ... clearly establishes that health benefit administrators are required to acknowledge and address the evidence submitted by claimants. A decision will not be upheld simply because it is supported by a doctor's opinion. Instead, insurers must engage with the opinions of the treating doctors and explain their basis for any disagreement." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023)]

Tags: Health Plan Administration

Seventh Circuit Affirms Plan Sponsor’s Discretion for Severance Benefits
Groom Law Group Link to more items from this source
June 2, 2023

"The decision affirms that, if the plan so provides, discretionary eligibility criteria for severance benefits is permissible under ERISA. However, plan sponsors should be aware that the exercise of discretion in certain ways can cause issues under other federal laws intended to protect against discrimination ... [and] in the context of a voluntary severance plan, the exercise of discretion with respect to eligibility could negate the voluntary nature of the plan." [Carlson v. Northrop Grumman Severance Plan & Northrop Grumman Corp., No. 22-1764 (7th Cir. May 8, 2023)]

Tags: Severance Pay

U.S. Corporate Pension Plans Funding Status, May 2023
Wilshire Associates Link to more items from this source
June 2, 2023

"The aggregate funded ratio for U.S. corporate pension plans increased by an estimated 0.8 percentage points in May and ended the month at 99.8% ... The monthly change in funded ratio resulted from a 2.9% decrease in liability value partially offset by a 2.0% decrease in asset value. The aggregate funded ratio is estimated to have increased by 2.3% and 2.4% year-to-date and over the trailing twelve months, respectively."

Tags: Funding of DB Plans  •  Retirement Plan Investments

SEC's New Expansive Rule for Clawback of Incentive-Based Compensation Is Now in Effect (PDF)
King & Spalding, via The Journal of Federal Agency Action Link to more items from this source
[Guidance Overview]
June 2, 2023

"Encouraging executive officers to reduce errors requiring restatements, the new rule targets compensation awarded to executive officers as a result of erroneously reported financial information that is received in the three-year period preceding the date when an issuer is required to prepare an accounting restatement due to material noncompliance with any financial reporting requirement under securities laws."

Tags: Executive comp

Eleventh Circuit Finds Florida Surprise Billing Law Subject to Jury's Interpretation
Miller & Chevalier Link to more items from this source
June 2, 2023

"Florida's surprise billing law ... requires insurers to pay the 'usual and customary provider charges for similar services in the community where the services were provided' for out-of-network emergency care. The hospitals ... asserted that Cigna underpaid them for out-of-network emergency services, when their own data showed they normally receive five times Cigna's allowance.... The district court agreed with Cigna, but ... the Eleventh Circuit remanded the case with instructions that a jury must decide the 'community' rates." [North Shore Med. Ctr., Inc. v. Cigna Health & Life Ins. Co., No. 22-10514 (11th Cir., May 25, 2023)]

Tags: Health Plan Administration  •  Health Plan Costs  •  Health Plan Policy

Maximize Employer-Sponsored Health Plan Savings with Reference-Based Pricing
OneDigital Link to more items from this source
June 2, 2023

"Transitioning to an RBP plan can be quite disruptive to plan members and administrators because it represents a significant departure from traditional PPO plans. Some key considerations for those considering an RBP plan are outlined [in this article]."

Tags: Health Plan Costs  •  Health Plan Design

FAQs on the SEC's Prescribed Clawback Policy
Dorsey & Whitney LLP Link to more items from this source
[Guidance Overview]
June 2, 2023

"While the SEC may further postpone this deadline, listed issuers would be advised to prepare their boards now to approve compliant clawback policies by August 8, 2023, ... assuming that the SEC approves the listing standards by June 9, 2023[.]"

Tags: Executive comp

Out-of-Pocket Spending Among ESI Enrollees Diagnosed with Cancer
Health Care Cost Institute Link to more items from this source
June 2, 2023

"[A]verage total medical spending increased in the quarter leading up to the cancer diagnosis, peaked in the quarter including and following diagnosis and then declined, though post-diagnosis spending remained higher than pre-diagnosis spending throughout the year."

Tags: Health Plan Costs

Spending Among Group Plan Enrollees With Multiple Health Conditions: A Look at High-Cost Claimants in 2021 (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
June 2, 2023

"An examination of the health care claims of 8.6 million group plan enrollees in 2021 revealed that over 80 percent of top spenders had at least 1 of 5 chronic health conditions -- heart disease, respiratory conditions, musculoskeletal conditions, skin disorders, and nervous system conditions. This Fast Fact reviews the spending of people with one or more of these chronic conditions."

Tags: Health Plan Costs

FAS87 ASC715 Discount Rates and Moody's Rates, May 31, 2023
BenefitsLink Message Boards Link to more items from this source
June 1, 2023

An unofficial monthly report of the Moody's Daily Long-term Corporate Bond Yield Averages and Moody's Daily Treasury Yield Averages (used as benchmarks by some corporate pension plans).

Tags: Funding of DB Plans

D.C. Circuit Rejects Freestanding Rule Against 'Fail-Safe' Classes
Mayer Brown, via Lexology; free registration required Link to more items from this source
June 1, 2023

"Instead of what it described as an 'extra-textual' limitation on class certification, the D.C. Circuit held that the existing requirements of Rule 23 (and a district court's discretion to alter proposed class definitions) should be used to prevent certification of fail-safe classes.... [T]he D.C. Circuit was faced with an ERISA class action, in which the plaintiff sought to certify a proposed class of current or former employees of the defendant (or their beneficiaries) who had 'been denied vested rights' to retirement benefits." [In re White, No. 22-8001 (D.C. Cir. Apr. 4, 2023)]

Tags: Retirement Plan Policy

Can the HIPAA Privacy and Security Official Position Be Held by a Third Party?
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
June 1, 2023

"Although there is language in the preamble to the privacy rule that seems to assume that the privacy official will be an employee of the covered entity, there is no explicit requirement to that effect. And because some covered entities (e.g., most group health plans) will not have employees, the privacy official's duties will have to be performed by a third party (for a group health plan, usually an employee of the plan sponsor)."


The Illinois Paid Leave for All Workers Act: Some Questions Remain, But Employers Should Start Considering Options
Michael Best Link to more items from this source
[Guidance Overview]
June 1, 2023

"[C]overed employers must allow all employees (full-time, part-time, and seasonal) to earn and use up to 40 hours of paid leave each year, which employees can use for any purpose.... [E]very employer will need [to] determine the best way for their organization to satisfy the Act's requirements, draft any new policies that are needed, carefully review and revise any existing paid time off policies to ensure compliance with the Act, post the required notice, and set up a system to comply with the Act's record-keeping requirements. Employees may begin using paid leave under the Act on March 31, 2024, or after the first 90 days of their employment (whichever is later)."

Tags: FMLA and Other Leave  •  Local Regulation

Fiduciary Breach Claim Stemming from Elimination of Retiree Health Benefits May Proceed
Thomson Reuters / EBIA Link to more items from this source
June 1, 2023

"The court concluded that the retirees' arguments, along with their claims that they had made specific decisions in reliance on the employer's statements, were enough to allow the case to proceed and for the retirees to pursue the equitable remedies of reformation or surcharge." [Baker v. Save Mart Supermarkets, No. 22-4645 (N.D. Cal. Apr. 7, 2023)]

Tags: Fiduciary Duties  •  Retiree Health Plans

Can Your Plan Clear Mental Health Parity Compliance Hurdles?
International Foundation of Employee Benefit Plans [IFEBP] Link to more items from this source
June 1, 2023

"Hidden Hurdle 1: Equality does not equal parity ... Hidden hurdle 2: When you don't (and can't) know how your plan is run ... Hidden hurdle 3: Didn't we exclude that?"

Tags: Health Plan Design

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