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[Guidance Overview]

Fee Disclosures Will Soon Be Required for Group Health Plans

"Buried in the year-end Consolidated Appropriations Act (CAA) is a provision that requires group health plan brokers and consultants to make comprehensive fee disclosures ... [These] disclosures ... are limited to brokers and consultants that reasonably expect to receive $1,000 or more in direct or indirect compensation from plan assets for providing services to group health plans. Such services include selecting insurance products, recordkeeping, medical management vendors, benefits administration, stop-loss insurance and pharmacy benefit management services, and consulting on matters such as the development or implementation of plan design, insurance or insurance product selection, and benefits administration selection." Icon to read more

Faegre Drinker

[Guidance Overview]

2021 Federal Poverty Levels Can Impact ESR Affordability

"[E]mployers with calendar-year plans can't rely on the higher [federal poverty levels (FPLs)] for 2021 affordability testing. Instead, calendar-year plan sponsors must use the 2020 FPL amounts.... [T]he 2021 FPL safe-harbor monthly employee contribution limits for the lowest-cost, self-only [minimum essential coverage (MEC)] with minimum value [are]: Noncalendar-year plans beginning in 2021: $105.51 ... 2021 calendar-year plans: $104.53[.]" Icon to read more


[Guidance Overview]

Remember All That COVID-Related Leave Your Employees Took Last Year? It May Render Them Ineligible for FMLA Leave This Year

"Because the FMLA requires the employee to actually perform work to earn the hours necessary to be eligible for FMLA leave, it means that furloughed hours do not count toward eligibility. It also means the employee who was forced off work due to symptoms of COVID-19 was not actually working for the employer. The result remains the same even if you paid the employee for the time they took (or were forced) off work." Icon to read more

FMLA Insights

[Guidance Overview]

White House Fact Sheet: President Biden to Sign Executive Orders Strengthening Americans' Access to Quality, Affordable Health Care

"The Biden-Harris Administration will open a Special Enrollment Period for Americans to sign up for health coverage and roll back attacks on the [ACA], Medicaid, and access to reproductive health care." Icon to read more

The White House

[Guidance Overview]

Upcoming Deadline iconNew Year, New Deadlines: California and Other State Individual Mandate Reporting

"Beginning in 2021, employers sponsoring a group health plan with employees who are residents of California enrolled in the plan will be subject to the new California individual mandate reporting requirements. These employers must ... furnish Forms 1095-C to employees by February 1, 2021. The same IRS Form 1095-C provided to individuals under the [ACA] will satisfy California's requirement. While the IRS extended the federal deadline to March 2, 2021 ... California has not extended its deadline." Icon to read more

Miller Johnson

[Guidance Overview]

EEOC Reveals New Proposed Rules on Employer Wellness Programs

"While the proposed rules ultimately may be revised before being finalized, they provide insight into the EEOC's perspective on defining incentives under a participatory wellness program in order for those incentives to be considered voluntary." Icon to read more

Calfee, Halter & Griswold LLP

[Guidance Overview]

California COVID-19 Supplemental Paid Sick Leave in 2021

"Now that the leave requirements of the FFCRA (and by extension, California state required supplemental sick leave) have expired, many local agencies are reviewing the supplemental sick leave ordinances that were adopted in 2020. Some agencies have extended the date by which employees may use benefits so that the ordinances have survived beyond the expiration of the FFCRA. Others have expanded the scope of local ordinances to provide for leave for all employees who work in that jurisdiction, not just employees who were previously excluded from the FFCRA." Icon to read more

Jackson Lewis P.C.

Fifth Circuit Weakens HHS' Ability to Enforce HIPAA Safeguards

"[T]he court found that the Security Rule did not require M.D. Anderson to have a 'bulletproof' mechanism, nor was it required to enforce the mechanism 'rigorously.' ... Under the court's pained interpretation of the Privacy Rule, M.D. Anderson's loss of ePHI via theft and loss did not qualify as a disclosure.... [T]he court held that the regulation required OCR to prove that someone outside the covered entity actually received the ePHI, and that OCR had failed to do so here." [Univ. of Texas M.D. Anderson Cancer Center v. HHS, No. 19-60226 (5th Cir. Jan. 14, 2021)] Icon to read more


District Court Grants Catholic Church Permanent Injunction Regarding Coverage of Gender-Transition Procedures

"In these consolidated cases, a coalition of entities affiliated with the Catholic Church and the State of North Dakota challenged the implementation of Section 1557 of the [ACA] contending that the [HHS and the EEOC] interpreted Section 1557 and related antidiscrimination laws in a way that compelled them to perform and provide insurance coverage for gender transitions and abortions.... The court concluded that RFRA entitled the Catholic Plaintiffs to permanent injunctive relief from the provision or coverage of gender-transition procedures." [Religious Sisters of Mercy v. Azar, No. 16-0386 (D.N.D. Jan. 19, 2021)] Icon to read more

Kantor & Kantor

Fiduciary Traps for the Unwary: Participant Health Plan Contributions

"[T]he Court found that the employer had discretionary control over participant contributions since the contributions were deposited in an employer account. It found that the owner was a fiduciary because, at the time the health plan lapsed, he was the only one with authority over the company's bank accounts ... Instead of paying the health bill, the Court determined that the company's funds (including the participant contributions) were used to pay corporate expenses. The Court found this use of participant contributions was a breach of fiduciary duty by the company and the primary owner." [Hammer v. Johnson Senior Ctr., No. 19-027 (W.D. Va., Nov. 30, 2020)] Icon to read more

HUB International

Whiplash: Is a New FFCRA on the Horizon?

"On Thursday, January 14, 2021, President Biden's administration announced ... its proposed $1.9 trillion COVID-19 stimulus relief plan.... [which] proposes to require all employers of any size to provide paid leave and to significantly extend the required paid sick and family leave benefits to essentially all workers through September 30, 2021. The new administration estimates the Plan could provide emergency paid leave to an additional 106 million Americans. To implement coverage, the Plan will impose substantial new burdens on employers by removing prior exemptions under the FFCRA." Icon to read more

Husch Blackwell

International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies

"2018 drug prices in the United States were substantially higher than those in each of 32 comparison countries when considering all drugs together. Compared with all comparison countries combined, U.S. prices were 256 percent of those in other countries.... U.S. prices for most subsets of drugs, and particularly brand-name originator drugs, were higher than those in comparison countries. The one exception was unbranded generic drugs, for which U.S. prices were on average 84 percent of those in other countries." Icon to read more

RAND Corporation

Some New Jersey Small Businesses to See COVID Surcharge on Health Insurance

"New Jersey's struggling small businesses have prioritized paying for employee health insurance premiums as the country faced its biggest public health crisis in modern history. Now small employers who purchase insurance through Members Health Plan NJ are looking at a 5.5 percent monthly COVID surcharge -- and it has prompted Assemblyman Kevin J. Rooney to sound the alarm." Icon to read more



Addressing the Risk of Medicare Trust Fund Insolvency

"Given the magnitude of the Medicare HI Trust Fund shortfall, a combination of revenue increases and spending reductions may be necessary to avoid policies that would increase the financial burden on beneficiaries or have an adverse effect on financially fragile health care institutions such as rural hospitals." Icon to read more

JAMA Network

Press Releases

OneDigital Acquires Fulcrum Partners
OneDigital Health and Benefits

Most Popular Items in the Previous Issue

How Employers Are Combating Escalating Health Care Costs in 2021
International Foundation of Employee Benefit Plans [IFEBP]

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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2021, 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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