Health & Welfare Plans Newsletter

October 19, 2020

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View job as Defined Contribution Plan Administrator for The MandMarblestone Group, llc
View job as Defined Contribution Plan Administrator for The MandMarblestone Group, llc Defined Contribution Plan Administrator

The MandMarblestone Group, llc
Telecommute / Philadelphia PA

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Sunwest Pensions
Telecommute / Tempe AZ

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Goldberg, Swedelson & Associates
Telecommute / Encino CA

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Webcasts, Conferences

Oregon Employer Update: New OR-OSHA Rules, New Paid Leave, and More
October 23, 2020 WEBCAST
Littler

Plan Sponsor Year-End Virtual Seminar
October 29, 2020 WEBCAST
Groom Law Group

MA Paid Family & Medical Leave Communications - Help EEs Navigate Change
November 10, 2020 WEBCAST
New England Employee Benefits Council [NEEBC]

Election 2020 - The Impact of the Election on Benefit Plan Design and Regulation
November 12, 2020 WEBCAST
Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

HSAs and Medicare
November 12, 2020 WEBCAST
Ascensus

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[Guidance Overview]

Exceptional Usefulness and Quality and Usefulness icon2020 Instructions for Forms 1094-C and 1095-C Contain the Most Substantial Changes in Years

"For most employers the most significant change in the 2020 draft instructions compared to previous iteration is the plan start month box is now required.... Employers who decided to sponsor an ICHRA have a whole new set of rules to assist them in completing the Form 1095-C. Fortunately, most employers will not even need to concern themselves with all of the new ICHRA rules and reporting should be very similar to previous years." Icon to read more

Accord

Waiting on an End to the Extended ERISA Deadline Periods

"Early in the pandemic, the IRS and DOL issued a temporary rule (published May 4, 2020) extending certain deadlines applicable to retirement plans and health and welfare plans.... The examples in the temporary rule assumed an end date of April 30, 2020 for the National Emergency, which would have extended the Outbreak Period through June 29, 2020. As we all now know, this National Emergency did not end on April 30, and in fact it is still in place.... As the crisis has extended, the impact of the 'temporary rule' is becoming more of an issue." Icon to read more

Holland & Hart LLP

Built for Speed and Savings: How a Nimble PBM Can Help Health Plans Control Drug Spend

"Novel specialty medications hit the market. Costly prescribing trends emerge. New patterns of fraud, waste and abuse are hatched. A pharmacy benefit manager's (PBM) ability to detect such opportunities, then quickly act on them, can impact millions of dollars in pharmacy spend every year. Yet, one PBM might take days or weeks to act on an opportunity that another PBM takes months to identify, let alone respond to.... So how can you tell which PBMs are nimble and which are slower to move?" Icon to read more

Evolent Health

Benefits in General

DOL Amicus Brief Addressing Burden of Proof in Determining Eligibility for Specific Benefits (PDF)

35 pages. "When a participant presents a prima facie case for coverage and the plan seeks to limit her benefits based on plan language, the plan should bear the burden of proving the limitation.... The district court erred by rejecting burden shifting, holding instead that an ERISA plan participant has the burden to prove how a limitation does not bar her from eligibility for benefits. If necessary to reach this burden question, this Court should correct the lower court's error by requiring the plan to prove benefit limitations, which more appropriately aligns with the common law for insurance and conforms with general principles governing the allocation of burdens." [Ovist v. UNUM Life Ins. Co. of N. Amer., No. 17-40113 (D. Mass Mar. 27, 2020; on appeal to 6th Cir. No. 20-1464)] Icon to read more

U.S. Department of Labor [DOL]

Data Breaches and HIPAA Enforcement Remain Endemic Amidst the COVID-19 Pandemic

"[E]nterprise-wide risk analyses should account not only for PHI, but also for other personally identifiable information (PII). Nearly every organization will possess PII, ... with each bearing privacy and security obligations under a variety of federal laws and regulations specifically addressing cybersecurity practices. Organizations must also be mindful of state and local requirements concerning cybersecurity[.]" Icon to read more

Health Law Advisor, Epstein Becker Green

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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