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[Official Guidance]

Text of CMS Draft 2022 Actuarial Value Calculator Methodology (PDF)

24 pages. "The AV Calculator represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation.... The draft 2022 AV Calculator is available [online].... [T]he 2022 AV Calculator does not affect any 2021 plans, and will only be applicable for 2022 plans.... [CMS] will accept comments on the draft 2022 AV Calculator, as well as the draft 2022 AV Calculator User Guide and the draft 2022 AV Calculator Methodology until ... December 24, 2020." Icon to read more

Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Health and Welfare Benefits: 2020 Year in Review (PDF)

35 presentation slides. Topics: [1] Legislative Developments; [2] Regulatory Developments -- Non-COVID: Final Health Plan Transparency Rules, ICHRA Final Rule and Follow-up Guidance on Pay-or-Play and Non-Discrimination Requirements, DOL Electronic Disclosure Rule (for qualified plans), New SBC requirement for 2021, 2021 NBPP (includes some important HSA guidance re: coupons), Direct Primary Care, and Grandfather Rule Relief; [3] Misc. Sub-Regulatory Developments: 2021 Cost-of-living Adjustments for Popular Benefits; [4] Health Plan Litigation Developments; [5] Recap of Coronavirus Impact on Employer H&W Benefits; [6] State Law Potpourri; [7] Cafeteria Plan, Grace Period, and Carry-Over Relief; and [8] COBRA, Claims and Appeals, and Special Enrollment Extensions. Icon to read more

Alston & Bird

[Guidance Overview]

HHS Issues Final Rule on Transparency in Coverage for Health Care Services

"The final Rule requires certain disclosures regarding prices and cost-sharing information for certain healthcare items and services provided by non-grandfathered group health plans and insurance issuers. The Rule generally applies to traditional health plan coverage, and does not apply to account-based group health plans (such as HRAs, including individual coverage HRAs, or health FSAs), excepted benefits, or short-term limited-duration insurance. The Rule requires two categories of disclosures: disclosures to the public, and disclosures to plan participants." Icon to read more

Seyfarth Shaw LLP

[Guidance Overview]

Healthcare Cost Transparency Rules Finalized

"The new rules require most employer-sponsored group health plans and health insurance issuers to disclose price and cost-sharing information up front, giving enrollees estimates of any out-of-pocket expense they will have to pay to meet their plan's cost-sharing requirements. Health plan sponsors and insurance issuers will also have to give patients and other stakeholders access to previously unavailable pricing information, using a standardized format that allows easy cost comparisons." Icon to read more


[Guidance Overview]

HHS Eliminates Safe Harbor Protections for PBM Drug Rebates; Creates New Safe Harbors for Point-of-Service Discounts and PBM Fixed-Fee Arrangements

"[T]he Final Rule amends the AKS discount safe harbor ... to eliminate safe harbor protection for drug discounts and rebates offered by pharmaceutical manufacturers to pharmacy benefit managers (PBMs), Medicare Part D prescription drug plan sponsors, and Medicaid managed care organizations.... [T]he Final Rule creates two new pharmaceutical-related safe harbors: [1] a safe harbor (the 'Point-of-Sale Safe Harbor') applicable to certain prescription drug point-of-sale discounts as offered to Medicare and Medicaid beneficiaries to reduce their direct out-of-pocket prescription drug costs and [2] a safe harbor (the 'PBM Service Fees Safe Harbor') applicable to flat fee arrangements paid by drug companies directly to PBMs for PBM services." Icon to read more

Sheppard Mullin

[Guidance Overview]

New York DOL Releases Paid Sick Leave Guidance

"New York's sick and safe leave law requires employers with five or more employees to provide paid sick and safe leave (SSL), and those with fewer than five employees and a net income of $1 million or less to provide unpaid SSL each calendar year. Eligible employees began accruing SSL on September 30, 2020, and may utilize earned SSL starting January 1, 2021." Icon to read more

Davis Wright Tremaine LLP

[Guidance Overview]

Final Transparency Rules Mean More Disclosures by Plan Sponsors

"For plan years beginning January 1, 2022, health plans and insurers must disclose three separate files on their websites that include detailed pricing information for all covered items and services under the applicable plan. The first file must show negotiated rates for all in-network covered items and services. The second file must show information regarding charges from, and payments to, out-of-network providers. The third file must provide historical information regarding in-network prescription drug pricing by pharmacy location." Icon to read more


[Guidance Overview]

IRS Explains 'Qualified Health Plan Expenses' for Purposes of FFCRA Tax Credit

"The IRS explains that the amount of qualified health plan expenses taken into account in determining the credits generally includes both the portion of the cost paid by the employer and the portion of the cost paid by the employee through pre-tax salary reduction contributions, but not amounts that the employee paid with after-tax contributions." Icon to read more

The Wagner Law Group

CMS Looks to Permanently Expand Telehealth Services

"The Trump administration added more than 60 telehealth services that will be reimbursable during the public health emergency caused by the COVID-19 pandemic. Those changes to telehealth coverage will also be allowed permanently in rural areas." Icon to read more


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COBRA Continuation Coverage for Spouse of Medicare-Eligible Retiree?

"If an employee who is 66 years old and on Medicare retires on January 1, but his spouse is not yet eligible for Medicare, how long could the spouse elect COBRA coverage?" Icon to read more

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Press Releases

Most Popular Items in the Previous Issue

Agencies Releases Advance Copies of Form 5500 Series Annual Return/Report for 2020 (PDF)
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; and Pension Benefit Guaranty Corporation [PBGC]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, 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, 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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