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Health & Welfare Plans Newsletter

July 22, 2021

4 New Job Opportunities


[Official Guidance]

Text of ASOP 28: Statements of Actuarial Opinion Regarding Health Insurance Assets and Liabilities

"Since the last update of this standard, changes have been made to ASOP No. 5, Incurred Health and Disability Claims, and ASOP No. 42, Health and Disability Actuarial Assets and Liabilities Other Than Liabilities for Incurred Claims, due in part to the changes imposed by the [ACA]. Some assets and liabilities that are included in the scope of the actuarial opinion have changed, and others have gained prominence. Therefore, this revision of ASOP No. 28 reflects these changes in actuarial practice."  MORE >>

Actuarial Standards Board

[Guidance Overview]

Alert (High Risk Issue) icon Price Transparency Rules Are Quickly Approaching

"While some conflicting details and implementation dates need to be harmonized, many of these rules are effective January 1, 2022, with some effective sooner.... The legal responsibility for [self-funded] plan compliance falls on the plan itself and its fiduciaries, including the employer ... [E]mployers that sponsor self-funded plans should confirm with their TPAs that they will be handling these requirements. Contractual amendments will likely be required."  MORE >>

HUB International

[Guidance Overview]

Initial No Surprises Act Regs Provide Some Clarity for Employer Plans

"Employers may want to note that the DOL will establish a process to administer complaints that health plans and insurers are violating the No Surprises Act rules. Though employees could file such complaints, it appears that providers would be more likely to use the new system. Options for the DOL under the new process include referring the plan or insurer for an investigation or for enforcement action."  MORE >>

Ogletree Deakins

[Guidance Overview]

Massachusetts Sets 2022 Individual-Mandate Coverage Dollar Limits

"The Massachusetts individual mandate ... requires state residents to maintain MCC or face a potential state tax penalty.... In addition, health plan reporting requirements compel plan sponsors (or their vendors) to determine whether the coverage they offer meets MCC standards.... the 2022 maximum MCC deductibles are $2,850 for individual coverage and $5,700 for family coverage. If the plan has a separate prescription drug deductible, those amounts for 2022 can't exceed $350 for individual coverage and $700 for family coverage."  MORE >>


[Guidance Overview]

New City of Chicago Ordinance Modifies Paid Sick Leave and Wage Theft Rules

"[T]he Ordinance expands the reasons that an employee may use paid sick leave to care for themselves or a family member.... Employers must continue to post a notice in a conspicuous place ... [E]mployers must issue the same notice directly to employees annually with a paycheck issued within 30 days of July 1."  MORE >>

Laner Muchin, via JDSupra

Health Plan Administrator's Cross-Plan Offsets Were ERISA Prohibited Transactions and Violated Fiduciary Duty of Loyalty

"The court explained that, in a pooled account, overpaying claims under Plan A decreases the funds available to pay claims under Plan B, making Plan A's interests adverse to Plan B's. Thus, when the administrator reduced payments under Plan B to recoup funds for Plan A, it engaged in a prohibited transaction ... The court also agreed that the administrator's use of cross-plan offsetting violated the duty of loyalty." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]  MORE >>

Thomson Reuters / EBIA

Alert (High Risk Issue) icon Another Blow to Cross-Plan Offsetting: Employers Should Take Note

"Plan sponsors should recognize that 'opting out' eliminates an overpayment recovery tool. As a result, your plan may have a tougher time recovering future overpayments. More importantly though, proactively squelching the practice should avoid a costly ERISA lawsuit down the road." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]  MORE >>

HUB International

Using the 'National Economy Standard' to Defeat Disability Claims

"What happens when the claimant is 'disabled' from performing her job with her current employer… but can perform that same job with another employer? This issue highlights the importance of the 'national economy' definition of disability as found in most long term disability policies.... (This decision also provides good defense responses to criticisms of benefit denials based solely on medical record reviews rather than independent medical exams.)" [Holden v. Unum Life Ins. Co. of America, No. 20-6318 (6th Cir. Jul. 8, 2021; unpub.)]  MORE >>

Lane Powell PC

ICHRAs: A Potential Health Coverage Alternative?

"There are no absolute guidelines determining if an organization should offer ICHRAs as an option or in lieu of traditional insurance. In many cases, an ICHRA may not be the best fit for an organization and its employees or may actually be more expensive than traditional health insurance. Here are key points to consider."  MORE >>

HUB International


The Sleeper Health Cost Policy

"Hospitals have been sitting on the sidelines happily watching policymakers go after drug costs. But drugs represent ten percent of health spending while hospitals represent thirty four percent. A more aggressive policy aimed at anti-competitive mergers and consolidation in the hospital industry would aim right at high hospital prices that drive up health spending."  MORE >>

Henry J. Kaiser Family Foundation

Benefits in General

District Court Narrows Focus of Antitrust Suit Over $30 Billion Aon-Willis Merger

"A federal judge has narrowed the scope of a [DOJ] lawsuit blocking the proposed $30 billion merger of insurance brokers Aon PLC and Willis Towers Watson PLC, allowing the companies to finalize remedies for three of five issues raised by the antitrust regulator. The impending trial on the remaining issues, set to start in November, will focus on whether large U.S. businesses would face diminished competition when seeking two categories of insurance: property, casualty and financial risk coverage; and health-and-benefit coverage for employees[.]" [U.S. v. Aon and Willis Towers Watson, No. 21-1633 (D.D.C. Jul. 20, 2021)]  MORE >>


Employee Benefits Jobs

View job as Senior Retirement Analyst
for Dunbar, Bender & Zapf, Inc. Senior Retirement Analyst

Dunbar, Bender & Zapf, Inc.

Remote / Pittsburgh PA

View job as Retirement Services Supervisor
for Alerus Financial Retirement Services Supervisor

Alerus Financial

Remote / MN / ND

View job as Retirement Implementation Coordinator
for Alerus Financial Retirement Implementation Coordinator

Alerus Financial

Remote / MI / MN / ND / NH

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

Creative Retirement Systems

Remote / Cincinnati OH

Press Releases

CAHC Joins US Chamber, Business Roundtable, National Association of Manufacturers, and Vermeer in Coalition to Expand Jobs-Based Health Insurance Coverage

Council for Affordable Health Coverage [CAHC]

New American Equity Fixed Index Annuity Offers Paths to Protected Lifetime Income and Legacy Benefits

American Equity Investment Life Insurance Company

Webcasts and Conferences
(Health & Welfare Plans)

2021 Retirement and Disability Research Consortium Annual Meeting

August 5, 2021 WEBCAST

Center for Retirement Research at Boston College

Navigating and Preparing for a DOL Audit: What Plan Sponsors Need to Know

August 24, 2021 WEBCAST

American Law Institute Continuing Legal Education Group [ALI CLE]

Last Issue's Most Popular Items

Administration Issues Part I of Surprise Billing Rule

Morgan Lewis

IRS Guidance on COBRA Premium Assistance: What We Know Now

Trucker Huss

IRS Form 5500 Reminders for Employers Maintaining Employee Benefit Plans

Hawley Troxell

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

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