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Health & Welfare Plans Newsletter

April 29, 2021

5 New Job Opportunities


[Guidance Overview]

Upcoming Deadline icon Ready or Not, Mental Health Parity Reporting Has Been Effective Since February 10

"The DOL expects to focus on the following NQTLs over the near term: [1] in-network and out-of-network prior authorization requirements for in-patient services; [2] concurrent review for in-network and out-of-network inpatient and outpatient services; [3] standards for provider admission to participate in a network, including reimbursement rates; and [4] out-of-network reimbursement rates (methods for determining usual, customary, and reasonable charges)."  MORE >>

Snell & Wilmer

[Guidance Overview]

Upcoming Deadline icon Will Federal Rules on Mental Health Parity Work This Time?

"Plans and issuers should currently be prepared to make their comparative analyses available to the Departments or applicable state authorities upon request. There is no delay from the February 10, 2021 date specified in the CAA.... [T]he analysis for each plan must be detailed and specific. The Departments have listed six specific practices and procedures that would not satisfy the CAA requirements."  MORE >>

The Wagner Law Group

[Guidance Overview]

Alert (High Risk Issue) icon Easier Access to Exchange-Based Premium Tax Credit Subsidies Means Employers Need to Consider Risk of ACA Penalties

"[If] more people are suddenly rushing to the exchanges to see if they might be eligible for cheaper coverage, employer liability risk might be going up.... So this year, more than ever, if you want to avoid the dreaded 227-J letter and a potential penalty assessment, make sure that you choose a safe harbor carefully, make employer contribution calculations accordingly, and ensure that your Forms 1094 and 1095-C are accurate.  "  MORE >>

MZQ Consulting, LLC

[Guidance Overview]

New COBRA Subsidies Create Urgency for Employers

"[U]nless an individual is no longer within his or her maximum 18-month COBRA period, the individual gets a second opportunity to elect COBRA coverage if he or she had a reduction in hours or involuntary termination prior to April 1, 2021, and either [1] did not elect COBRA coverage in conjunction with that event or [2] elected COBRA coverage before April 1, 2021, but discontinued it before that date."  MORE >>

Godfrey & Kahn S.C.

[Guidance Overview]

Laws and Tax Incentives Fill COVID-19 Paid Leave Void as Vaccinations Increase and More Employees Return to In-Person Work

"Philadelphia's latest Public Health Emergency Leave (PHEL) ordinance ... covers all employers with 50 or more employees and permits covered employees to take leave for various COVID-19 related reasons, including to receive the COVID-19 vaccine and to recover from injury or illness related to the vaccination.... On April 21, 2021, the Chicago City Council passed a COVID-19 Vaccination Rights Ordinance, which ... provides different time-off requirements for employers that mandate COVID-19 vaccinations for employees and those that do not."  MORE >>

Duane Morris LLP

White House Aims to Permanently Extend Government-Paid Healthcare for Many Under ACA

"A key part of the plan is to make permanent a two-year subsidy boost included in [ARPA]. The law makes it so that those making [between 150% and 400% of] the federal poverty level can get fully subsidized coverage. Previously they had to pay no more than 4.3% of their income on healthcare."  MORE >>


House Ways and Means Committee Chair Introduces Proposal to Require Universal Paid Family and Medical Leave

"[T]he Building an Economy for Families Act: [1] Provides universal paid family and medical leave for all U.S. workers; ... [2] Provides a new refundable payroll tax credit for child care providers to raise wages of essential child care workers; ... [3] Creates a new Worker Information Network (WIN) to assist workers in accessing paid leave, unemployment insurance benefits, and child care[.]" [Also available: (i) fact sheet on guaranteed access to child care, (ii) fact sheet on paid family and medical leave; (iii) one-page summary of the bill; (iv) section-by-section summary; and (v) text of the bill (labeled 'discussion draft')]  MORE >>

House Ways and Means Committee Chairman Richard E. Neal (D-MA)

CMS Alert Illustrates How to Identify the Responsible Reporting Entity for Prescription Drug Coverage

"Employers should not assume that the RRE is the entity that has direct responsibility for processing and paying the prescription drug claims. For example, where the employer contracts directly with the group health plan for hospital, medical, and prescription drug coverage, CMS advises that the plan is processing and paying the claims directly and will be considered the RRE responsible for reporting."  MORE >>

Thomson Reuters / EBIA

Lowering the Age of Medicare Eligibility Would Likely Reduce Health Spending for Employers

"[C]osts for employer plans could drop by as much as 30 percent if all people age 55 and over were no longer in employer-sponsored insurance, the analysis finds, and by up to 43 percent if everyone 50 and older chose to enroll in Medicare.... 60- to 64-year-olds who move from employer plans to Medicare could be covered more cheaply because Medicare payments to hospitals, physicians and other health care providers are generally lower than what private insurance pays."  MORE >>

Henry J. Kaiser Family Foundation


How Would Biden's Proposed Paid Leave Plan Affect Employers?

"Until this proposal has the support of 60 Senators, gridlock surely will ensue. It's one thing to pass a temporary FFCRA measure on a small number of employers during a pandemic. It's a far different story when you're considering permanent paid leave that presumably would cover the far majority of American businesses. At a minimum, we're far more likely to see a compromised plan than the President's proposal."  MORE >>

FMLA Insights

Employee Benefits Jobs

View job as Client Services Manager
for Newport Client Services Manager


Folsom CA / Chicago IL / Saint Petersburg FL / La Crosse WI / Charlotte NC / Overland Park KS / Mobile AL / West Des Moines IA / Pittsburgh PA

View job as Benefits  Compliance (Financial Control and Audit)
for Kaiser Permanente Benefits Compliance (Financial Control and Audit)

Kaiser Permanente

Oakland CA

View job as Client Relationship Manager
for Goldleaf Partners, part of FuturePlan by Ascensus Client Relationship Manager

Goldleaf Partners, part of FuturePlan by Ascensus

Telecommute / IA / MN / ND / SD / WI

View job as Defined Benefit Pension Administrator
for Actuaries Unlimited, Inc. Defined Benefit Pension Administrator

Actuaries Unlimited, Inc.


View job as Retirement Plan Administrator
for Turning Point Associates Retirement Plan Administrator

Turning Point Associates

Telecommute / Swedesboro NJ / DE / PA

Press Releases

iJoin Personalizes Automated Financial Education with EXPLORE


Anthem, Inc. Completes Acquisition of myNEXUS Home Health Benefits Manager

Anthem, Inc.

OneDigital Acquires Keystone Retirement & Insurance Advisors LLC

OneDigital Health and Benefits

Webcasts and Conferences
(Health & Welfare Plans)

Plan Sponsors: What Keeps You Up at Night?

May 20, 2021 in GA

Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

Employee Benefits Spring Update 2021, Part 4: Best Practices to Prepare for Litigation

June 9, 2021 WEBCAST

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

COBRA Subsidy: You've Got Questions ... We've Got Answers

Ogletree Deakins

You’ve Sent the COBRA Special Extended Election Period Notices – What’s Next?


Release of Claims Fails to Block ERISA Lawsuit

Hodgson Russ LLP

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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.

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