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Health & Welfare Plans Newsletter

July 6, 2021

4 New Job Opportunities


[Official Guidance]

Text of HHS Final Rule: Basic Health Program: Federal Funding Methodology for Program Year 2022

53 pages. "This document finalizes the methodology and data sources necessary to determine federal payment amounts to be made for program year 2022 to states that elect to establish a Basic Health Program under the Patient Protection and [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Health Insurance Exchanges, and incorporates the effects on such payment amounts the American Rescue Plan Act of 2021 (ARP)."  MORE >>

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

[Guidance Overview]

HHS Proposed Rule Would Reverse Prior Guidance on ACA Marketplaces, Health Insurance Markets

"Perhaps the most controversial changes affect the ACA's section 1332 waiver program.... States would have to demonstrate that their proposed waivers would result in coverage as comprehensive and protective against excessive premiums and cost sharing as ACA coverage, and for at least as many people.... [The] proposed rule would also prohibit states from using private entities like web brokers, insurers, or agents instead of public marketplaces to enroll individuals in ACA coverage."  MORE >>

The Commonwealth Fund

[Guidance Overview]

Banning Surprise Bills: Agencies Release First Set of Regs for the 'No Surprises Act'

"Topics in [the interim final rules released on July 1] include patient cost-sharing protections, notice and consent standards for waivers, rules for calculating the qualifying payment amount (QPA), disclosure requirements, and complaints processes, among other standards.... The IFR includes additional clarity on how emergency services must be covered -- and the restrictions that plans and insurers cannot place on emergency care."  MORE >>

Katie Keith, Jack Hoadley, and Kevin Lucia, in Health Affairs Blog

Employers, Insurers Get Upper Hand in Surprise Billing Rule

"[T]he qualifying payment amount under the rule would be set based on provider contracts rather than every single provider ... [which] will likely keep payments down.... [T]he interim final rule specifies that emergency room rates won't be averaged with freestanding emergency rooms, which are more expensive ... The rule favors hospitals in the way it requires insurers to cover emergency services[.]"  MORE >>

Bloomberg Law

Surprise Billing Rule Also Strikes Down Insurer Emergency Department Policies

"[HHS] released an interim final rule ... that prohibits balance billing and includes several provisions requiring providers to notify patients of new consumer protections. But tucked into the 411-page regulation, the first in a series, is a provision that targets a controversial practice where insurers deny an [emergency department] claim if the diagnosis isn't considered an emergency."  MORE >>


Fifth Circuit Holds Medical Provider Tort Claim Against NFL Is Preempted by ERISA

"The court explained that the essence of Advanced's claim is that the NFL facilitated a coverage denial. To prevail on its state-law claim, Advanced has to show that its patients were covered by the ERISA plan, that they assigned their right to plan benefits to Advanced, and that the claims would not be excluded under the terms of the plan. Because plan interpretation is essential to Advanced's tort claim, it is completely preempted." [Advanced Physicians, S.C. v. National Football League, No. 20-10998 (5th Cir. Jul. 1, 2021; unpub.)]  MORE >>

Roberts Disability Law

Going Virtual Gives Weight Loss and Fitness Programs Broader Reach

"When pharmaceutical company Amgen began offering virtual classes and resources to help its approximately 25,000 employees lose weight and increase their fitness during the COVID-19 pandemic, it discovered it was able to extend the reach of these benefits. While onsite fitness programs had been offered to U.S. employees, going virtual made these programs available to the company's non-U.S. employees for the first time."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

Should I Mediate My Insurance Claim?

"When a party elects to pursue mediation, they are hiring a neutral who will work with the parties to help facilitate a resolution of a dispute. However, the mediator does not issue rulings or judgments, and merely makes suggestions and recommendations. A huge advantage of mediation is that since it is non-binding and can end in an impasse, the parties are free to continue to pursue a litigated outcome if the other side's proposals are unacceptable."  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Rhode Island Health Insurance Carriers Request 2022 Rate Hikes

"[T]he average increases sought range from 2.9% to 17.5% in the small group market and 5.3% to 14.1% in the large group.... [K]ey factors influencing the rate requests for 2022 are expected increases in the cost of health care services."  MORE >>



Billions for Controversial Alzheimer's Drug Could Buy This Instead

"Make Medicare more affordable.... Pay for vision, hearing and dental care.... Support family caregivers.... Strengthen long-term care.... Help people age in place.... Find out what older adults need.... Focus on prevention.... Invest in social determinants of health."  MORE >>

Kaiser Health News

Benefits in General

Tech Firms Take Greater Interest in Plan Design Features

"While fewer than half (45%) of the respondents reported that they offer 401(k) matching to employees (up from 36% in 2018), 13% of companies plan to add or increase their match in the next 12 months.... 72% of tech companies have implemented immediate vesting, compared to 67% of non-tech companies.... [The] findings also suggest a trend toward greater value in family-planning options, mental health solutions and additional paid holidays"  MORE >>

American Retirement Association [ARA]

Employee Benefits Jobs

View job as Fiduciary Service Administrator
for Definiti Fiduciary Service Administrator


Telecommute / The Woodlands TX / FL / PA / WA

View job as Fiduciary Service Administrator
for Definiti

View job as Retirement Plan Administrator
for Retirement Solutions Specialists Retirement Plan Administrator

Retirement Solutions Specialists

Telecommute / Jacksonville FL

View job as Junior Retirement Plan Administrator
for Integrity Pension Services, LLC Junior Retirement Plan Administrator

Integrity Pension Services, LLC

Telecommute / Las Vegas NV

View job as Quality Assurance Manager
for Nova 401(k) Associates Quality Assurance Manager

Nova 401(k) Associates

Telecommute / Houston TX / Dallas TX / Scottsdale AZ

Press Releases

Hub International Acquires the Assets of Tennessee-Based Aegis Retirement Group, LLC

HUB International

Last Issue's Most Popular Items

Interim Final Regs Issued on Surprise Medical Bills


Agencies Issue First Set of Regs Restricting Surprise Billing

Healthcare Financial Management Association [HFMA]; free registration required

District Court: Health Insurer Must Comply with ACA Section 1557 Nondiscrimination Rules for Entire Portfolio

Thomson Reuters Practical Law

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

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