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Health & Welfare Plans Newsletter

July 15, 2021

5 New Job Opportunities


[Guidance Overview]

New Surprise Billing Regs: How Cost Sharing Will Be Calculated

"The [qualifying payment amount (QPA)] will be used to cap a patient's cost-sharing responsibility for out-of-network care unless they have formally consented to be balance-billed ... Health plan payments then will be determined via either negotiations or an independent dispute resolution (IDR) process that will be spelled out in rulemaking later this year."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Neither Stop-Loss Coverage Nor Other Insured Benefits Caused Self-Insured Health Plan to Be Considered Insured

"[S]top-loss insurance does not pay participants' benefit claims and may not even reimburse the plan sponsor or plan for all catastrophic claims. Thus, even though stop-loss coverage is purchased from an insurer, it lacks the risk-shifting element essential to the concept of true insurance, and typically does not qualify as health insurance." [Hua v. Board of Trustees, No. 20-748 (D. N.J. May 28, 2021)]  MORE >>

Thomson Reuters / EBIA

Court Orders Payment for Residential Treatment Based on 'Wildly Inconsistent' Rationales for Denial

"The court concluded that even under ERISA's deferential 'arbitrary and capricious' standard of review, the administrators' 'wildly inconsistent' reasons for the decision were unacceptable. Rather than sending the claim back to the administrators for reevaluation (as is typical in such cases), the court ordered full payment for the child's residential treatment." [D.K. v. United Behavioral Health, No. 17-1328 (D. Utah Jun. 22, 2021)]  MORE >>

Thomson Reuters / EBIA

District Court Slams Unum for Disability Denial for Double Amputee

"[T]he court concluded that Unum 'attache[d] far too much significance to Plaintiff's prior success in coping with her limitations, and unrealistically minimizes the impact of her worsening condition.' Finally, the court gave weight to the fact that plaintiff's Social Security disability claim was approved, even though Unum had not considered the approval because the approval was received after Unum had denied plaintiff's claim." [Dwyer v. Unum Life Ins. Co. of America, No. 19-4751 (E.D. Pa. Jul. 8, 2021)]  MORE >>

Kantor & Kantor

Effects of Employer-Mandated Switches to High-Deductible Health Plans

"These findings suggested that after employer-mandated switch to an HDHP, fewer individuals sought care for nonspecific chest pain. The decline in seeking care was particularly prevalent among individuals with cardiovascular comorbidities, those living in high-poverty areas, and for those with higher increases in deductibles."  MORE >>

Cardiology Advisor

Employee Benefits Captives: Gain Long-Term Stability in a Volatile Healthcare Market

"Captives pool small to mid-size employers together to stabilize and cap the employers risk when self-funding.... Being part of a captive allows the experience of a standalone, self-funded plan but amplifies the benefits, as each employer benefits from the economies of scale and gains access to data analytics, manageable stop loss levels, and vendor pricing."  MORE >>

ABD Insurance & Financial Services

Hospital Price Transparency Roll-Out: The Good, the Bad and the Ugly (PDF)

"The good: Price information is available on many hospitals' websites and savvy consumers may be able to use this information to negotiate lower costs for their health care services.... The bad: Hospitals are still fighting to keep this information out of the public domain.... The ugly: Data is incomplete, messy, and difficult to use."  MORE >>

Cowden Associates, Inc.


Paid Family Leave Deserves a Debate, Not Histrionics

"In what should have been a measured, thoughtful policy debate about paid family leave for federal employees, a recent congressional hearing instead devolved into scurrilous attacks on the integrity and value of frontline federal workers around the country."  MORE >>

Tony Reardon, in Government Executive


How States Can Build on the ACA to Improve Affordability and Lower Health Care Costs

"This issue brief outlines ways in which states can use the ARP as a starting point for additional reforms, as well as how the changes made to the ACA give states additional flexibility and additional federal funding to help offset state costs in implementing these reforms. As a result, states are in an excellent position to adopt policies that increase coverage and improve affordability, both of which are critical steps that would improve health outcomes and reduce health disparities."  MORE >>

Center for American Progress

Benefits in General

The Top Employee Challenges in 2021

Infographic. "Preventing burnout ... Easier access to employee benefits ... Engaging with employers in a virtual world ... Getting employer support for mental health."  MORE >>


Employee Benefits Jobs

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

Actuaries Unlimited, Inc.


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

View job as Senior Level Client Services Manager, H&W Benefits
for TRI-AD Senior Level Client Services Manager, H&W Benefits


Telecommute / Burbank CA / AZ / CO / FL / IN / NC / NV / OK / OR / TX / UT

View job as Retirement Plan Transition Administrator
for Alerus Retirement Plan Transition Administrator


Telecommute / MN / ND

View job as Benefits Account Manager
for G&A Partners Benefits Account Manager

G&A Partners

South Jordan UT

View job as DC / DB Plan Administrator
for NPPG DC / DB Plan Administrator


Telecommute / Shrewsbury NJ / FL / TX

Press Releases

Alegeus Partners with CAPTRUST to Power Modern HSA Investment Solution


OneDigital Expands Its Midwest Operation With Illinois-Based Benefits Acquisition


Webcasts and Conferences
(Health & Welfare Plans)

Benefit Issues You Need to Know When Using Temp Agencies

July 21, 2021 WEBCAST

Miller Johnson

Don't Be Surprised by the 'No Surprises Act'

July 22, 2021 WEBCAST

McAfee & Taft

FMLA Intermittent Leave: How to Address Employees Who Take Advantage

August 11, 2021 WEBCAST

Business Watch Network

Last Issue's Most Popular Items

Mental Health Parity Remains a DOL Priority: MHPAEA Compliance in Response to the CAA

Groom Law Group

Drug Pricing and Other Healthcare Policy Changes Targeted in Executive Order on Promoting Competition

Sidley Austin LLP

ERISA, Post-Rutledge: State Bills Threaten Affordable Care for Employer Plans

CVS Health

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

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