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<< Older News  |  August 2, 2021

News

All News > Health Plan Administration

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Plan Cybersecurity Guidance: DOL Enforcement Warrants Plan Sponsor Action
Poyner Spruill LLP Link to more items from this source
[Guidance Overview]
Aug. 2, 2021

"Although the most detailed piece of the package -- the best practices summary -- is framed as applying to plan service providers (such as recordkeepers and administrators), enforcement actions already implemented suggest that these standards likely also apply to plan-related information maintained by the plan fiduciary.... [P]lan sponsors and fiduciaries should be aware that this cybersecurity guidance likely applies to all plans governed by ERISA, not just retirement plans."

Tags: Health Plan Administration  •  Retirement Plan Administration

Recordings of Phone Calls Made for Quality Assurance Purposes Must Be Disclosed to ERISA Benefit Claimants
Hodgson Russ LLP Link to more items from this source
[Guidance Overview]
Aug. 2, 2021

"Plan administrators should work with their carriers or third party administrators to ensure that such recordings are retained for the relevant limitations period, and are disclosed upon request, even if the recordings were not relied upon in denying the claim."

Tags: Health Plan Administration  •  Retirement Plan Administration

Greater Price Transparency, Advanced Explanation of Benefits Requirements Coming Soon
Hall Benefits Law Link to more items from this source
[Guidance Overview]
July 30, 2021

"The CAA requires that health plan participants receive an advance explanation of benefits (EOB) whenever they schedule a health care service at least three business days in advance. Participants are also able to request an advance EOB for a health care service whether or not the service has been scheduled."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration

CMS Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
July 30, 2021

17 pages; Jul. 30, 2021. "CMS issued this toolkit to help health insurance issuers and Medicare Advantage plans identify the issues that need to be considered and addressed in order to provide coverage and reimbursement for vaccine administration. Because COVID-19 vaccines will be federally purchased, this toolkit primarily focuses on vaccine administration.... This toolkit:

  • Provides a list of operational considerations for issuers and Medicare Advantage plans as they design their approach to promoting COVID-19 vaccinations, and information on how issuers and Medicare Advantage plans can communicate with providers and enrollees on vaccinations and coverage;
  • Outlines legislative and regulatory provisions applicable to issuers that ensure that enrollees can receive a COVID-19 vaccine in a convenient setting, with no out-of-pocket costs;
  • Encourages issuers and Medicare Advantage plans to implement streamlined processes to quickly administer COVID-19 vaccine coverage; and
  • Describes how issuers and Medicare Advantage plans can maximize the number of their enrollees who get vaccinated once a COVID-19 vaccine becomes available."

Tags: Health Plan Administration  •  Health Plan Design

How a Contemporary Benefits Administration Solution Can Elevate Your Employee Experience
bswift Link to more items from this source
July 30, 2021

"Nearly 70% of HR professionals surveyed felt a contemporary ben admin system can help employees better understand their benefit options.... 66% of HR professionals surveyed reported that a contemporary ben admin system improved the relationship between HR and the rest of the organization.... 63% of HR professionals feel a contemporary ben admin system can help employees feel better connected to their healthcare experience."

Tags: Health Plan Administration  •  Retirement Plan Administration

Proposed Regs Would Substantially Expand Mandatory Electronic Filing of Information Returns
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
July 29, 2021

"The requirement to aggregate returns when calculating electronic filing thresholds, combined with the lower thresholds themselves, will likely eliminate paper filings for all but the smallest employers. The regulations' impact would be especially acute for smaller applicable large employers (ALEs), who have been able to file Forms 1094-C and 1095-C on paper when reporting information for employer shared responsibility. Since ALEs by definition have at least 50 full-time-equivalent employees, they are likely to pass the 100-return threshold when taking into account Forms W-2 and 1095-C."

Tags: Health Plan Administration

Cybersecurity Best Practices for Employer-Sponsored Benefits
Gallagher Link to more items from this source
July 29, 2021

"Begin with a solid working knowledge of the current cybersecurity threat landscape.... Develop and document a formal cybersecurity program.... How does your service provider selection process investigate an entity's ability to adequately protect data it will create, receive, transmit, or maintain on behalf of your employee benefits program? ... What level of oversight do your service provider agreements allow so that you can ensure the providers' security policy and procedure compliance? ... Train (and retrain) your employees at least annually."

Tags: Cybersecurity  •  Health Plan Administration  •  Retirement Plan Administration

Editor's Pick Employer Responsibilities Upon Receipt of a National Medical Support Notice
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
July 28, 2021

"The [National Medical Support Notice (NMSN)] serves as legal notice that the employee is obligated by a court or administrative child support order to provide health coverage for the child(ren). Employers need to promptly respond and complete the enrollment to satisfy their obligations under the NMSN."

Tags: Health Plan Administration

Legislation Introduced to Fix Health Insurance 'Birthday Rule'
Kaiser Health News Link to more items from this source
July 28, 2021

"[The Empowering Parents' Healthcare Choices Act (HR 4636)] would do away with 'the birthday rule' and a 'coordination of benefits policy' that trips up first-time parents up when it's time to sign up a new baby for insurance.... For Charlie Kjelshus, the birthday rule meant her dad's plan -- with a $12,000 deductible, a high coinsurance obligation and a network focused in a different state -- was deemed her primary coverage. Her mom's more generous plan was secondary. Confusion over the two plans caused a tangle of red tape for the family that took almost two years and national media attention to resolve."

Tags: Health Plan Administration  •  Health Plan Design  •  Health Plan Policy

IRS Reiterates FSA Debit Card Substantiation Rules
Kushner & Company Link to more items from this source
[Guidance Overview]
July 27, 2021

"Under the IRS' FSA substantiation rules, a credit or debit card receipt is not sufficient. The substantiation from a third-party must include the name of the individual receiving eligible service; the date(s) the service was provided (start and end date); the description of the service or item purchased (prescription, copay, office visit, glasses, daycare); the name of the provider/merchant (where the service was provided or the item purchased); and the claim amount (dollar amount for the service or item)."

Tags: Health Plan Administration

DOL Says Audio Recording Is Relevant to Participant's Denied Claim
Morgan Lewis Link to more items from this source
July 27, 2021

"[DOL Information Letter 06-14-2021] emphasizes that information is relevant if it was generated in the course of making the benefit determination, regardless of whether it was relied upon in making the benefit determination. Thus, contrary to the plan's claim, whether the information was created, maintained, or relied upon for claim administrative purposes is immaterial."

Tags: Health Plan Administration  •  Retirement Plan Administration

Aon and Willis Towers Watson Mutually Agree to Terminate Combination Agreement
Aon Link to more items from this source
July 26, 2021

"Aon plc and Willis Towers Watson announced today that the firms have agreed to terminate their business combination agreement and end litigation with the U.S. Department of Justice (DOJ). The proposed combination was first announced on March 9, 2020.... In connection with the termination of the business combination agreement, Aon will pay the $1 billion termination fee to Willis Towers Watson, Willis Towers Watson's proposed scheme of arrangement has now lapsed, and both organizations will move forward independently."

Tags: Health Plan Administration  •  Retirement Plan Administration

DOL Plan Audits Updated to Include Several Questions About Compliance with Its Cybersecurity Guidelines
Jackson Lewis P.C. Link to more items from this source
[Guidance Overview]
July 26, 2021

"The DOL would like to see how plan fiduciaries are communicating with their service providers to assess service provider cybersecurity risk, as well as the documents and other materials from service providers concerning the processing of plan data. Importantly, the DOL is not just looking for cybersecurity related information. The agency apparently wants to know how service providers are permitted to use plan data."

Tags: Cybersecurity  •  Health Plan Administration  •  Retirement Plan Administration

Open Enrollment Guide and Resources
Society for Human Resource Management [SHRM]; membership may be required to view article Link to more items from this source
July 26, 2021

"How can HR professionals best communicate with employees about their choices, when many workers are unfamiliar with the language and concepts of benefits offerings? What's the best way to help employees through open enrollment season?" [Includes glossary and collection of webcasts and articles specific to 2021 open enrollment.]

Tags: Health Plan Administration

ERIC and Mercer Response to EBSA RFI: Reporting on Pharmacy Benefits and Prescription Drug Costs (PDF)
The ERISA Industry Committee [ERIC] and Mercer Link to more items from this source
[Opinion]
July 26, 2021

"ERIC and Mercer request that the Departments consider issuing a delay for the Final Rule, in order to give employers time to negotiate and execute new contracts that will ensure they receive the required reporting information from all third-party vendors.... Plans and issuers will need at least 12 months to prepare the required data for submission to the Departments and [OPM].... Collecting data can be a daunting task for self-insured employers if they have carved out their pharmacy benefit to a PBM."

Tags: Health Plan Administration  •  Prescription Drug Costs

IRS Proposes Electronic Filing Requirements for Certain Information Returns
Ascensus Link to more items from this source
[Guidance Overview]
July 23, 2021

"The new proposed regulations reduce the threshold by which filers must electronically file from 250 to 100 returns for the 2022 calendar year. For filings required after calendar year 2022, the threshold will be further reduced to 10 returns." [Includes a summary list of benefits-related forms included in the IRS proposal.]

Tags: Health Plan Administration  •  Retirement Plan Administration

The No Surprises Act: Key Provisions for Employers (PDF)
VCG Consultants Link to more items from this source
[Guidance Overview]
July 23, 2021

"[S]ome states have already taken action against these balance billing practices by implementing various forms of consumer protection laws over recent years.... For fully insured plans, the insurance carriers will need to update the plans they issue to incorporate the new regulations and maintain compliance with both state and federal laws."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration  •  Health Plan Design

CMS Proposes to Increase Penalties for Hospital Price Transparency Noncompliance
K&L Gates Link to more items from this source
[Guidance Overview]
July 23, 2021

"CMS noted that several early studies have indicated a high rate of hospital noncompliance with the Hospital Price Transparency Rule, which the agency said aligns with its sampling and reviews conducted to date as part of its enforcement efforts.... [The] Proposed Rule also proposes to update the list of activities that CMS deems to be access barriers to the machine-readable file and specifically to require that the machine-readable file is accessible to automated searches and direct downloads."

Tags: Health Plan Administration  •  Health Plan Costs

Surprise! Tri-Agencies Meet Deadline with First Set of Surprise Billing Rules, with More to Come
Groom Law Group Link to more items from this source
[Guidance Overview]
July 23, 2021

"The IFR is largely focused on how the surprise billing protections apply to group health plans and health insurance issuers, as well as how the Qualified Payment Amount (QPA) is calculated. There are some rules related to the initial payment for surprise billing claims from providers and notices of denial, as well as provider-focused rules. The IFR generally hews closely to the CAA's provisions and provides some clarity regarding the calculation of the QPA amount."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration  •  Health Plan Costs  •  Health Plan Design

Another Blow to Cross-Plan Offsetting: Employers Should Take Note
HUB International Link to more items from this source
July 22, 2021

"Plan sponsors should recognize that 'opting out' eliminates an overpayment recovery tool. As a result, your plan may have a tougher time recovering future overpayments. More importantly though, proactively squelching the practice should avoid a costly ERISA lawsuit down the road." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]

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

Health Plan Administrator's Cross-Plan Offsets Were ERISA Prohibited Transactions and Violated Fiduciary Duty of Loyalty
Thomson Reuters / EBIA Link to more items from this source
July 22, 2021

"The court explained that, in a pooled account, overpaying claims under Plan A decreases the funds available to pay claims under Plan B, making Plan A's interests adverse to Plan B's. Thus, when the administrator reduced payments under Plan B to recoup funds for Plan A, it engaged in a prohibited transaction ... The court also agreed that the administrator's use of cross-plan offsetting violated the duty of loyalty." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]

Tags: Health Plan Administration  •  Health Plan Design

Price Transparency Rules Are Quickly Approaching
HUB International Link to more items from this source
[Guidance Overview]
July 22, 2021

"While some conflicting details and implementation dates need to be harmonized, many of these rules are effective January 1, 2022, with some effective sooner.... The legal responsibility for [self-funded] plan compliance falls on the plan itself and its fiduciaries, including the employer ... [E]mployers that sponsor self-funded plans should confirm with their TPAs that they will be handling these requirements. Contractual amendments will likely be required."

Tags: Health Plan Administration

Initial No Surprises Act Regs Provide Some Clarity for Employer Plans
Ogletree Deakins Link to more items from this source
[Guidance Overview]
July 22, 2021

"Employers may want to note that the DOL will establish a process to administer complaints that health plans and insurers are violating the No Surprises Act rules. Though employees could file such complaints, it appears that providers would be more likely to use the new system. Options for the DOL under the new process include referring the plan or insurer for an investigation or for enforcement action."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration  •  Health Plan Costs  •  Health Plan Design

Administration Issues Part I of Surprise Billing Rule
Morgan Lewis Link to more items from this source
[Guidance Overview]
July 21, 2021

"Along with the IFR, the Departments released model notices that group health plans and issuers (as well as providers and facilities) must make publicly available, post on a website, and include on each explanation of benefits and other related materials.... The regulations apply to group health plans and insurance issuers offering group or individual coverage, including grandfathered plans. The regulations do not apply to retiree-only plans; excepted benefits; short-term, limited duration insurance; health reimbursement accounts (HRAs); and other account-based group health plans (e.g., healthcare flexible spending accounts)."

Tags: Consolidated Appropriations Act, 2021   •  Health Plan Administration  •  Health Plan Costs

PCORI Fee Deadline Fast Approaching
Graydon Link to more items from this source
July 21, 2021

"The fee and the related IRS Form 720 are due no later than July 31st (note that July 31 falls on a Saturday in 2021). The updated form can be found here, and the PCORI fee reporting can be found in Part II, Line 133."

Tags: Health Plan Administration


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