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Health & Welfare Plans Newsletter

July 1, 2021

4 New Job Opportunities


[Official Guidance]

Text of IRS Notice 2021-42: Treatment of Amounts Paid to Section 170(c) Organizations Under Employer Leave-Based Donation Programs to Aid Victims of the COVID-19 Pandemic (PDF)

"[T]his notice extends the federal income and employment tax treatment provided in Notice 2020-46 to cash payments made to section 170(c) organizations after December 31, 2020, and before January 1, 2022, that otherwise would be described in Notice 2020-46."  MORE >>

Internal Revenue Service [IRS]


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[Guidance Overview]

IRS Extends Tax Relief for Leave Donations Aiding COVID-19 Victims

"This extension arrives somewhat late in the game -- possibly too late for employers that have not already established a leave-based donation program. But for those with such a program, this extension will be a welcome affirmation that the favorable tax treatment of leave-based donations can continue, at least for cash payments made during 2021."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Agencies Request Information Regarding Reporting on Medical and Pharmacy Costs

"The Departments ask for comments for the following specific areas ... [1] general implementation concerns, [2] the definition of terms, [3] the entities that must report, [4] the information that is required to be reported, [5] coordination with other reporting requirements, [6] public report and privacy protections, and [7] regulatory impact analysis. The request contains 41 questions (some of which have multiple parts) divided into the seven areas[.]"  MORE >>


CMS Summary Report on Permanent Risk Adjustment Transfers for the 2020 Benefit Year (PDF)

40 pages. "Risk adjustment state transfers as a percent of premiums remained relatively steady compared to the 2019 benefit year.... The amount of paid claims remains strongly correlated with risk adjustment state payments and charges ... Risk scores decreased between 2019 and 2020.... The impact of the pandemic and how enrollees accessed healthcare was evident in the significant increase in telehealth usage, although there was only a slight increase in total paid claims costs when compared to the 2019 benefit year."

  • Appendix A: HHS Risk Adjustment Program State-Specific Data (XLSX)
  • Appendix B: HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
  • Appendix C: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)
  • Appendix D: Issuer-Specific Information for Merged Market Issuers (XLSX)
  • Appendix E: Default Risk Adjustment Charge (XLSX)
  • Appendix F: Default Risk Adjustment Charge Allocation (XLSX)


Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Fourth Circuit Largely Rules for Plaintiffs in Class Action Challenge to Aetna/Optum Billing Practices

"[T]he Fourth Circuit covered the whole shebang of ERISA: standing, fiduciary status, party in interest status, restitution, surcharge, disgorgement, and declaratory and injunctive relief for both an individual and a class. This opinion, which reads like an ERISA treatise, serves as a reminder of the many layers that exist within ERISA and its equity-based common law. What is not layered is the issue at the core of the suit: money." [Peters v. Aetna, No. 19-2085 (4th Cir. Jun. 22, 2021)]  MORE >>

Kantor & Kantor

Fifth Circuit Rules for ERISA Claimant Where Disability Claim Straddles Two Insurance Companies That Both Deny Coverage

"What happens when an employee becomes disabled during a period when his employer switches long-term disability carriers and both carriers disclaim coverage? ... MetLife argued that Talamantes' benefits never became payable under its policy and his merely becoming eligible for coverage did not relieve Standard of its obligation to cover the claim. The court disagreed, finding that this interpretation is dependent on the merits of the disability claim and a claimant would be 'in the dark' about whether he had coverage until he litigated his disability claim." [Talamantes v. Metropolitan Life Ins. Co., No. 20-50953 (5th Cir. Jun. 29, 2021)]  MORE >>

Roberts Disability Law

Plan Administrator Was Entitled to Abuse of Discretion Standard of Review Despite Absence of Word 'Discretion' in Plan Documents

"The Second Circuit panel held that Aetna was granted discretionary authority ... for the following reasons: [1] The plan document need not actually use the word 'discretion,' so long as the benefit plan gives authority to determine eligibility for benefits.... [2] The plan ... [stated] that Aetna would decide claims in accordance with 'reasonable' claims procedures. Because Aetna was permitted to apply its subjective judgment, the court held Aetna was delegated discretionary authority over claims.... [3] Aetna created the procedures to implement its review of eligibility determinations, thereby indicating it held discretionary authority." [Tyll v. Stanley Black & Decker Life Ins. Program, No. 20-1060 (2d Cir. May 4, 2021, unpub.)]  MORE >>

Hodgson Russ LLP

For Surprise Medical Bills, It's the Beginning of the End

"Among the more important and contested provisions is a detailed definition of the 'fair' price that arbiters should consider as a baseline for deciding how much the insurance plan typically owes the hospital or doctor. This will be a key figure because it will determine how much the patients owe -- they are still responsible for paying the out-of-network doctor their normal co-payment or deductible amount -- and what reimbursement the provider will net. Other thorny issues ... include how providers must inform patients that they do not participate in their insurance network, along with the framework for a new federal complaint system."  MORE >>

The New York Times; subscription may be required

Using Benefits Data to Create Voluntary Benefits

"Your first task is to understand who your people are and where they are at in their life and work journeys.... Utilize benchmarking to discover benefits opportunities and gaps.... Apply analytics to benefits usage (or other data sets) to add to your perspective on options.... Analytics should also guide your benefits communications."  MORE >>

HUB International

Employers Need an Inclusive Family-Building Benefits Package

"Growing social equity concerns are propelling many employers to re-evaluate their benefits strategy to meet the needs of a diverse and changing workforce. A comprehensive approach to family-building, regardless of gender identity or relationship status, can be critical to talent attraction and retention."  MORE >>


Estimating Impacts of Pandemic-Related Job Loss on Health Insurance Coverage Among Adults Ages 50 to 64

"Estimates show that a significant number of older workers likely lost employer-sponsored health insurance during the first several months of the pandemic. Some older adults losing employer coverage became newly uninsured, while others enrolled in nongroup coverage or Medicaid."  MORE >>


HHS Proposes to Amend and Repeal Various Benefit and Payment Parameters and Provisions for 2022 and Beyond

"Although largely aimed at insurers and Exchange regulators, some provisions may be of interest to employers and their advisors.... [1] Expanded exchange enrollment periods ... [2] Repealed exchange direct enrollment option.... [3] Amended state innovation waiver rules.... [4] Technical amendment for mental health parity."  MORE >>

Thomson Reuters / EBIA

Benefits in General

How Employers Can Help with Rising Healthcare Costs in Retirement

"Encourage discussions on alternatives to traditional retirement options ... Promote investing in health savings account plans ... Offer retirement workshops that help with problem-solving."  MORE >>


Improving Employee Engagement in the Hybrid Workforce

"Clear, consistent internal communication around your benefits programs can directly improve the employee experience.... Here are a few ideas to boost low employee engagement with your benefits programs ... [and] some real-life examples from [companies] that have cracked the code to benefits engagement."  MORE >>

Tango Health

Employee Benefits Jobs

View job as Plan Consultant
for Sentinel Benefits & Financial Group Plan Consultant

Sentinel Benefits & Financial Group

Telecommute / Wakefield MA

View job as ESOP Consultant
for Ascensus ESOP Consultant


Telecommute / GA

View job as Plan Administrator/ Consulting
for Associated Pension Consultants Plan Administrator/ Consulting

Associated Pension Consultants

Chico CA / Sacramento CA

View job as 401(k) Consultant
for Creative Retirement Systems 401(k) Consultant

Creative Retirement Systems

Telecommute / Cincinnati OH

Selected New Discussions

CARES Act's Effect on Verification of Dependents

"Could anyone cite some guidance on the 'relaxed deadlines' in the 'outbreak period' when an employee fails to verify their dependents? The dependent was removed from the plan in May. But they're now providing documentation and asking for reinstatement. Under normal circumstances we would not allow such a dependent to be re-enrolled until Open Enrollment."

BenefitsLink Message Boards

Press Releases

Ascensus Expands Employee Benefits Administration and Compliance Capabilities with Agreement to Acquire UnifyHR


The Cerrado Group Announces Nexus Administrators as Newest Member Firm

The Cerrado Group

Webcasts and Conferences
(Health & Welfare Plans)

Best Practices for Managing Intermittent Leave

July 21, 2021 WEBCAST

SHRM [Society for Human Resource Management]

An In-depth Look at Paid Family and Medical Leave Programs

July 21, 2021 WEBCAST


Helping Your Workforce Navigate the Medicare Maze

July 21, 2021 WEBCAST

Disability Management Employer Coalition [DMEC]

Return to the Workplace and ADA Considerations

July 27, 2021 WEBCAST

Disability Management Employer Coalition [DMEC]

Health Plan and PBM Cost Mitigation Strategies

August 18, 2021 WEBCAST

Conference of Consulting Actuaries

Last Issue's Most Popular Items

Action Items for Annual Open Enrollment


The Ninth Circuit's Jarvis Opinion: A Correct Application of Retrenched ERISA Preemption

Prof. Edward A. Zelinsky, via SSRN

Colorado Supreme Court Strikes Down Employer's Vacation Forfeiture Policies

Jackson Lewis P.C.

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

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