Health & Welfare Plans Newsletter

November 3, 2020

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[Guidance Overview]

Tri-Agency Rules Expound on Vaccine Coverage Mandate

"Consistent with the legislation, the new regulations require group health plans to provide coverage of a coronavirus immunization within 15 business days after the vaccine is added to the list of preventive services recommended by the United States Preventive Services Task Force (USPSTF) or the Advisory Committee on Immunization Practices (ACIP) of the [CDC]. A vaccine is embraced by the mandate even it is not listed for routine use on the immunization schedules of the CDC." Icon to read more

Lockton

[Guidance Overview]

2020 ACA Reporting Forms and Instructions Include Changes

"While there are several changes, the most substantive apply to ALEs offering ICHRAs. ALEs must familiarize themselves with the new fields to ensure they have the required information to report appropriately and timely." Icon to read more

OneDigital Health and Benefits

[Guidance Overview]

COVID-19 Extension Guidance Makes the Interplay Between COBRA and Medicare (A Bit) Trickier

"Because the deadline for a qualified beneficiary to make a COBRA election typically occurs close in time to the date his or her coverage terminates, some employers have incorrectly assumed that COBRA continuation coverage must be offered only if the qualified beneficiary was entitled to Medicare before the qualified beneficiary's loss of coverage or qualifying event.... Because, under the Joint Notice, a qualified beneficiary's COBRA election could take place months after his or her qualifying event or loss of coverage date, employers must be sure to provide COBRA election notices to, and credit the COBRA elections of, qualified beneficiaries who enroll in Medicare after their qualifying event or loss of coverage date." Icon to read more

Verrill Dana LLP

[Guidance Overview]

IRS Releases Final ABLE Account Regs

"The [IRS] has issued final regulations for Achieving a Better Life Experience (ABLE) accounts. These accounts can help eligible individuals (known as designated beneficiaries) save for qualified disability expenses without ruining their eligibility for governmental aid.... Corporations and employers can make ABLE account contributions (including payroll deductions) to employees or employees' family members. But any employer contributions are subject to the rules governing federal taxation of compensation" Icon to read more

Ascensus

Massive Healthcare Fraud Takedown Focused on Fraudulent Telemedicine Schemes

"[T]he Department of Justice (DOJ), along with the [FBI], [HHS] Office of Inspector General, and the Drug Enforcement Administration (DEA) announced enforcement actions involving 345 individuals across 51 districts in what the U.S. government described as the 'largest healthcare fraud takedown in the agency's history.' Collectively, the cases announced in this nationwide enforcement operation alleged more than $6 billion in false and fraudulent claims to private insurers and federal healthcare programs." Icon to read more

Goodwin Procter

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U.S. Supreme Court Hears Argument on State’s Ability to Regulate PBMs

"Like Arkansas, a majority of states have enacted laws to address not only 'below-cost' reimbursements, but other PBM practices such as erecting artificial barriers to the PBMs' networks, improper termination of pharmacies and other providers from their networks, and unlawful auditing of prescription drug claims. PBMs routinely rely on the doctrine of ERISA preemption to avoid state regulation of their conduct. Consequently, the Eighth Circuit's broad ruling on ERISA preemption which invalidated Act 900 interferes with the states' ability to regulate PBM conduct and, in turn, directly interferes with patient-provider relationships." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., Nos. 17-1609 and 17-1629 (8th Cir. Jun. 8, 2018; oral arg. Oct. 6, 2020)] Icon to read more

Drug Topics

Benefits in General

Supporting Caregivers Can Help Create Competitive Advantage for Employers

"[1] Offer a financial wellness program with specialized retirement planning solutions that can help caregivers and people with special needs find a balance between living for today and planning for tomorrow. [2] Incorporate access to ... paid family care leave, disability/long term care insurance, [and] HSA/FSA ... [3] Initiate Employee Resource Groups (ERGs) for people with special needs, disabilities and caregivers to harness the power of peer-to-peer support ... [4] Provide access to an Employee Assistance Programs (EAP) with services specific to caregivers and people with special needs ... [5] Offer child care and caregiving support for parents and health care workers who are impacted by COVID-19." Icon to read more

Voya

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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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