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Health & Welfare Plans Newsletter

July 27, 2021

4 New Job Opportunities


[Guidance Overview]

IRS Reiterates FSA Debit Card Substantiation Rules

"Under the IRS' FSA substantiation rules, a credit or debit card receipt is not sufficient. The substantiation from a third-party must include the name of the individual receiving eligible service; the date(s) the service was provided (start and end date); the description of the service or item purchased (prescription, copay, office visit, glasses, daycare); the name of the provider/merchant (where the service was provided or the item purchased); and the claim amount (dollar amount for the service or item)."  MORE >>

Kushner & Company

[Guidance Overview]

Surprise Billing Regs: Impact on Out-of-Network Providers

"Intended to provide patients protection against unanticipated medical expenses, the IFR will remove the predominant methodology used by health plans to pay out-of-network providers under the [ACA]. For out-of-network providers, the IFR creates administrative complexity and can result in reduced reimbursement."  MORE >>

K&L Gates

[Guidance Overview]

Illinois Enacts Telehealth Parity Bill

"HB 3308 (Public Act 102-0104) will require individual and group accident or health insurance policies to cover clinically appropriate and medically necessary telehealth services, e-visits, and virtual check-ins in the same manner as any other covered benefits."  MORE >>

McDonald Hopkins

[Guidance Overview]

Exceptional Usefulness and Quality icon CRS Report on Surprise Billing in Private Health Insurance: Overview of Federal Consumer Protections and Payment for Out-of-Network Services

50 pages. "This report provides an overview of private health insurance billing and describes federal requirements related to surprise billing. Table A-1 summarizes all deadlines and deliverables required in the No Surprises Act. Appendix B summarizes additional provisions of the No Surprises Act not explicitly summarized or referenced elsewhere in the report. Table C-1 summarizes the applicability of federal surprise billing requirements to different surprise billing situations." [R46856, Jul. 26, 2021]  MORE >>

Congressional Research Service [CRS]

Alert (High Risk Issue) icon Offering a Worksite Clinic? It's Not Just HIPAA You Need to Worry About

"It may come as a surprise to many employers that a worksite clinic offering more than limited first aid or providing benefits to 1099 workers or family members of employees is in most cases a group health plan subject to ERISA. This means that the worksite clinic is subject to plan documentation, fiduciary and reporting and disclosure requirements such as annual filing of a Form 5500 and distributing a summary plan description to employees describing the benefits offered at the clinic."  MORE >>

Corporate Wellness Magazine

Research Suggests Urgent Care Centers Reduce Health Care Costs

"Across the six states studied, researchers found that the existence of an urgent care center in a zip code reduced the number of [emergency department] visits by about 17 percent.... [T]he authors estimate that urgent care centers save about $3.3 billion annually.... [T]his number does not consider other ways in which urgent care centers might offset those savings by, for example, encouraging new health care use or acting as a substitute for lower-cost primary care clinics."  MORE >>



How Drug Pricing Legislative Proposals Would Lower Costs for Consumers and Businesses

"[1] Seniors would have lower out-of-pocket prescription drug costs ... [2] Americans with private insurance would have lower premiums and out-of-pocket costs ... [3] Businesses would benefit from lower drug costs ... [4] People living with diabetes would have access to affordable insulin ... [5] Disabled people would see lower costs for critical treatments ... [6] People of color could see more equitable health outcomes ... [7] Women would benefit from lower prices on some of the most expensive drugs."  MORE >>

Center for American Progress


HR 3 Could Save Patients Thousands of Dollars on Prescription Drugs

"HR 3 would allow the secretary of [HHS] to negotiate lower prices on many of the highest-priced drugs -- plus all insulin -- directly with pharmaceutical companies. These lower prices would also be available to private insurers and employers, allowing tens of millions additional people to benefit from the negotiation process."  MORE >>

Center for American Progress


U.S. FMLA Rules Show Wide Inequalities

"FMLA's eligibility requirement of twelve months in the position puts self-identified multiracial and Black workers at a particularly high risk for exclusion ... The authors also found that because smaller employers are excluded from FMLA, Latinx workers, who were less likely to be employed in larger companies, faced greater exclusion. The US is one of just 11 countries globally lacking permanent paid sick leave and is the sole country to only guarantee unpaid leave."  MORE >>

Health Affairs Blog

Benefits in General

DOL Says Audio Recording Is Relevant to Participant's Denied Claim

"[DOL Information Letter 06-14-2021] emphasizes that information is relevant if it was generated in the course of making the benefit determination, regardless of whether it was relied upon in making the benefit determination. Thus, contrary to the plan's claim, whether the information was created, maintained, or relied upon for claim administrative purposes is immaterial."  MORE >>

Morgan Lewis

What’s the Secret to Employee Benefits for Nonprofits?

"Most organizations use their employee benefits to help attract and retain top talent. For nonprofits, this is even more important -- while salaries at nonprofits will usually benchmark below average, their benefits will usually be in the top quartile.... This places more weight on the benefits offering and more importance on employee satisfaction with their benefits package."  MORE >>

Corporate Synergies

Employee Benefits Jobs

View job as Senior Actuary
for Texas Pension Review Board Senior Actuary

Texas Pension Review Board


View job as Account Manager
for MAP Retirement Account Manager

MAP Retirement

Remote / Appleton WI

View job as Health Insurance Specialist (Compliance and Enforcement)
for Centers for Medicare & Medicaid Services [CMS] Health Insurance Specialist (Compliance and Enforcement)

Centers for Medicare & Medicaid Services [CMS]

Remote / Woodlawn MD / Bethesda MD

View job as Defined Contribution Consultant
for Aon Defined Contribution Consultant


CT / FL / GA / MN / NY / PA

Press Releases

HealthComp Appoints Bill Leahy to Vice President of Sales


Retirement Clearinghouse Completes $10B+ in Retirement Account Consolidations

Retirement Clearinghouse

Last Issue's Most Popular Items

Text of IRS Notice 2021-46: Premium Assistance for COBRA Benefits, Part 2 (PDF)

Internal Revenue Service [IRS]

Aon and Willis Towers Watson Mutually Agree to Terminate Combination Agreement


ERIC and Mercer Response to EBSA RFI: Reporting on Pharmacy Benefits and Prescription Drug Costs (PDF)

The ERISA Industry Committee [ERIC] and Mercer

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

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