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Health & Welfare Plans Newsletter

June 29, 2021

6 New Job Opportunities


[Official Guidance]

Text of Agency Proposed Regs: Updating Payment Parameters, Section 1332 Waiver Implementing Regs, and Improving Health Insurance Markets for 2022 and Beyond

198 pages. "This proposed rule sets forth proposed revised 2022 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs); proposes repeal of separate billing requirements related to the collection of separate payments for the portion of QHP premiums attributable to coverage for certain abortion services; proposes to expand the annual open enrollment period and Navigator duties; proposes a new monthly special enrollment period for qualified individuals or enrollees, or the dependents of a qualified individual or enrollee, who are eligible for advance payments of the premium tax credit (APTC) and whose household income does not exceed 150 percent of the federal poverty level (FPL); proposes to repeal the recent establishment of a Direct Enrollment option for Exchanges; and proposes to modify regulations and policies related to section 1332 waivers." [Also available: press release and fact sheet.]  MORE >>

U.S. Department of Health and Human Services [HHS] and U.S. Treasury Department

[Guidance Overview]

Los Angeles Mayor Revises Existing, and Issues New, Order Requiring Paid Sick Leave for Absences Related to COVID-19 Vaccines

"The new order requires all employers to provide covered employees with ... paid time off to receive a COVID-19 vaccine, including time an employee spends traveling to and from an appointment, and time to recover from vaccination-related side effects that prevent the employee from being able to work or telework.... [This] Order is retroactive to January 1, 2021."  MORE >>


Answers to Common 2021 COBRA Subsidy Questions

"What plans and individuals qualify for 2021 COBRA subsidies? ... What is considered an 'involuntary termination of employment'? ... What constitutes 'gross misconduct'? ... Are employees who accept 'buyout' packages eligible for a COBRA subsidy?"  MORE >>

Corporate Synergies

District Court Ruling Gives Providers Ammunition in Fights Over Health Insurer Clawbacks

"[A] recent ruling from a federal district court in New Jersey gives ammunition to providers fighting to stop insurers from engaging in this routine billing practice, known as cross-plan offsetting. The court ruled the practice violates [ERISA].... The court [also] held that provisions in health plan documents that prevent patients from allowing a provider to sue on their behalf over an unpaid benefit are enforceable." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]  MORE >>

Bloomberg Law

Walmart Launches Low-Priced Private Label Analog Insulin

"The world's largest retailer said its more than 3 million customers with diabetes could save between 58% and 75% off the cash price of branded analog insulin products, or up to $101 per branded vial or $251 per package of branded FlexPen."  MORE >>


FDA's Approval of New Alzheimer's Drug Has Multibillion Dollar Implications for Medicare

"In 2017, nearly 2 million Medicare beneficiaries used one or more of the currently-available Alzheimer's treatments covered under Part D ... If just one-quarter of these beneficiaries are prescribed Aduhelm, or 500,000 beneficiaries, and Medicare pays 103% of $56,000 in the near term, total spending for Aduhelm in one year alone would be nearly $29 billion ... [T]otal Medicare spending for all Part B drugs was $37 billion in 2019."  MORE >>

Henry J. Kaiser Family Foundation

Primer on Severance Plans Under ERISA and the Tax Code

"The [DOL] has created a safe harbor rule for severance plans under which an arrangement providing for the payment of severance benefits on account of termination of employment will be treated as a severance plan and not a pension plan, provided [certain critera are satisfied] ... Employers may have additional responsibilities when maintaining a severance program subject to ERISA but there are advantages.... Certain bona fide severance arrangements that provide separation pay upon an involuntary termination of employment or pursuant to a window program are excluded from Code Section 409A."  MORE >>

Verrill Dana LLP


The Last Existential Challenge to the ACA Goes Down Swinging in the Supreme Court

"The longer-serving Justices, particularly Chief Justice Roberts, have heard enough ACA cases to last any jurist a lifetime. This was not accidental. In exchange for fiscal-political palatability, the drafters of the ACA had accepted a very high risk of continuing litigation. Increasingly stringent and stylized budgetary rules adopted by Congress starting in the 1970s, accentuated by a deepening partisan divide since the 1990s, rendered it politically and procedurally impossible to implement major legislation, particularly health reform, through federal agencies and public financing mechanisms rather than by burdening private parties and relying on state partnerships. Various individuals, corporations, and states therefore found themselves unwilling participants in the ACA, and they often took their financial or ideological grievances to court."  MORE >>

William M. Sage, in Health Affairs Blog

Benefits in General

[Guidance Overview]

DOL Hears an ERISA Claimant on Access to Audio Recordings

"DOL's issuance of an information letter on this issue seems a dubious use of that mechanism given its subtext ... Over time, benefits claim fiduciaries ... may reconsider whether to record these calls and, if they do, whether the recordings should be part of the administrative record for the claim; and ... the customer service facility provided by plan administrators, insurance companies and third party administrators may become less responsive to claimants[.]"  MORE >>

Eversheds Sutherland

[Guidance Overview]

DOL Information Letter Regarding Production of Recording of Call Between Plan Representative and Claimant

"[Information Letter 06-14-2021] addressed a narrow question based on the specific representations made by the requesting attorney and the positions taken by the plan involved. It does not purport to address whether call recordings are required to be produced in all cases.... [T]he Letter is not binding on courts or technically even on the DOL itself.... Thus, the courts may take a different view of the particular circumstances addressed in the Letter, or of whether call recordings are subject to production pursuant to the claim regulation in different scenarios."  MORE >>

Groom Law Group

Employee Benefits Jobs

View job as Experienced DC Administrator
for Karel-Gordon & Associates Experienced DC Administrator

Karel-Gordon & Associates

Deerfield IL

View job as Experienced DC Administrator
for Karel-Gordon & Associates

View job as Membership Director
for Retirement Industry Trust Association Membership Director

Retirement Industry Trust Association

Telecommute / Sarasota FL

View job as Senior 401k Documents Specialist
for Newport Senior 401k Documents Specialist


Telecommute / CO

View job as Account Services Representative (Entry-Level)
for Newport Account Services Representative (Entry-Level)


Folsom CA

View job as Economist
for Centers for Medicare & Medicaid Services [CMS] Economist

Centers for Medicare & Medicaid Services [CMS]

Telecommute / Woodlawn MD

View job as 401(k) Senior DC Administrator/Consultant
for Malcolm Thompson & Associates 401(k) Senior DC Administrator/Consultant

Malcolm Thompson & Associates

Telecommute / Houston TX

Press Releases

NFP Launches Executive Benefits Initiative Focused on the Healthcare Industry

NFP Corp.

ArmadaCare Appoints Mike Ross as Chief Revenue Officer


OneAmerica® Names Mike Domingos as Head of Distribution


Last Issue's Most Popular Items

Fourth Circuit: HIPAA Does Not Create a Private Right of Action

Jackson Lewis P.C.

American Academy of Actuaries Comment Letter to HHS, DOL and Treasury on Possible Agency Actions Related to the No Surprises Act (PDF)

American Academy of Actuaries

Using Mandatory Arbitration to Avoid ERISA Class Actions, Part 3: Practical Considerations (PDF)

Cohen & Buckmann P.C., via Bloomberg Law

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

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