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Health & Welfare Plans Newsletter

July 23, 2021

4 New Job Opportunities


[Guidance Overview]

Alert (High Risk Issue) icon Guidance Reminds Health Plans to Check Up on Preventive Care Compliance

"Employer-sponsored group health plans ... need to check with their group health plan's insurer or third-party administrator on how all elements of PrEP are being handled. Employers should also verify that the contents of their group health plan's summary plan description, plan document, and other employee communication materials accurately reflect the coverage of PrEP and are compliant with the requirements by September 17, 2021."  MORE >>

Jackson Walker

[Guidance Overview]

The No Surprises Act: Key Provisions for Employers (PDF)

"[S]ome states have already taken action against these balance billing practices by implementing various forms of consumer protection laws over recent years.... For fully insured plans, the insurance carriers will need to update the plans they issue to incorporate the new regulations and maintain compliance with both state and federal laws."  MORE >>

VCG Consultants

[Guidance Overview]

Surprise! Tri-Agencies Meet Deadline with First Set of Surprise Billing Rules, with More to Come

"The IFR is largely focused on how the surprise billing protections apply to group health plans and health insurance issuers, as well as how the Qualified Payment Amount (QPA) is calculated. There are some rules related to the initial payment for surprise billing claims from providers and notices of denial, as well as provider-focused rules. The IFR generally hews closely to the CAA's provisions and provides some clarity regarding the calculation of the QPA amount."  MORE >>

Groom Law Group

[Guidance Overview]

Medicare Proposes New Changes for Telehealth Services in 2022

"This article discusses: [1] the current state of Medicare telehealth services; [2] requests for new telehealth services; [3] extending the timeframe for Category 3 temporary codes; [4] a new permanent code for virtual check-ins longer than 10 minutes; and [5] whether CMS should continue allowing direct supervision via telemedicine."  MORE >>

Foley & Lardner LLP

[Guidance Overview]

Hospital Price Transparency: CMS Issues Proposed Rule to Increase Penalties for Larger Hospitals Violating Disclosure Requirements

"While the CMP for the smallest hospitals would remain unchanged, the annual penalty for noncompliance by the largest hospitals throughout a year would be $2,007,500.... CMS also has had reports that publicly available standard charge listing have not been as accessible as CMS intended or desired.... As a consequence, CMS proposes in the Rule that each hospital must ensure 'that the standard charge information is easily accessible, without barriers, including, but not limited to, ensuring information is accessible to automated searches and direct file downloads through a link posted on a publicly available website.' "  MORE >>

Foley & Lardner LLP

[Guidance Overview]

CMS Proposes to Increase Penalties for Hospital Price Transparency Noncompliance

"CMS noted that several early studies have indicated a high rate of hospital noncompliance with the Hospital Price Transparency Rule, which the agency said aligns with its sampling and reviews conducted to date as part of its enforcement efforts.... [The] Proposed Rule also proposes to update the list of activities that CMS deems to be access barriers to the machine-readable file and specifically to require that the machine-readable file is accessible to automated searches and direct downloads."  MORE >>

K&L Gates

[Guidance Overview]

Massachusetts Now Requires Paid COVID-19 Leave for All Employees

"Effective May 28, 2021, the law requires employers to provide all employees up to 40 hours (pro-rated for part-time employees) of paid leave. Employers are required to provide leave until the earlier of September 30, 2021, or when Massachusetts announces that the $75 million fund to reimburse employers is expected to be depleted."  MORE >>

Verrill Dana LLP


PBMs: 21st Century Robber Barons

"[PBMs] produce some of the same anti-consumer, anti-small business, anti-competition results as the robber barons from more than a century ago. For many years, the FTC has allowed PBMs to grow bigger and exert their market leverage to the benefit of Wall Street shareholders and at the expense of small businesses and consumers. But lately there have been some signs of changing attitudes."  MORE >>

National Community Pharmacists Association [NCPA]

Benefits in General

[Guidance Overview]

IRS Proposes Electronic Filing Requirements for Certain Information Returns

"The new proposed regulations reduce the threshold by which filers must electronically file from 250 to 100 returns for the 2022 calendar year. For filings required after calendar year 2022, the threshold will be further reduced to 10 returns." [Includes a summary list of benefits-related forms included in the IRS proposal.]  MORE >>


Employee Benefits Jobs

View job as DC/DB Retirement Plan Administrator
for Steidle Pension Solutions, LLC DC/DB Retirement Plan Administrator

Steidle Pension Solutions, LLC

Remote / NJ / PA

View job as DC/DB Retirement Plan Administrator
for Steidle Pension Solutions, LLC

View job as Actuary (Pathways Recent Graduate)
for Pension Benefit Guaranty Corporation [PBGC] Actuary (Pathways Recent Graduate)

Pension Benefit Guaranty Corporation [PBGC]

Remote / Washington DC

View job as Associate Attorney / Attorney - Asset Management Retirement Plans
for The Standard Associate Attorney / Attorney - Asset Management Retirement Plans

The Standard


View job as TPA Development Manager
for Transamerica TPA Development Manager


Remote / CA

Selected New Discussions

Who Pays the PCORI for an ICHRA Program?

"There seems to be confusion as to whether the insurance carrier pays the PCORI or the employer (plan sponsor) pays it. I believe it's the sponsor's responsibility. Correct?"

BenefitsLink Message Boards

Webcasts and Conferences
(Health & Welfare Plans)

Tri-Agencies Meet Deadline with First Set of Surprise Billing Rules, With More to Come

July 29, 2021 WEBCAST

Groom Law Group

California Leaves of Absence Update and Tips for Preventing Leave Related Employee Benefit Chaos

August 19, 2021 WEBCAST


Employee Benefits and Technology: Adapting Employee Benefits and Health Solutions to Meet the Needs of an Evolving Workforce

August 19, 2021 in GA

Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

Last Issue's Most Popular Items

Price Transparency Rules Are Quickly Approaching

HUB International

Initial No Surprises Act Regs Provide Some Clarity for Employer Plans

Ogletree Deakins

ICHRAs: A Potential Health Coverage Alternative?

HUB International

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

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