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Health & Welfare Plans Newsletter

August 5, 2021

4 New Job Opportunities


[Guidance Overview]

IRS Seems to be Holding Employers to a Higher Affordability Standard Than the ACA Allows

"Recently, the IRS sent out another round of employer mandate penalties for the 2018 tax year. Some of the latest round of penalties.... disallowed the employer from utilizing the affordability safe harbors. This article briefly discusses what is occurring and the issues evolving from the IRS penalizing an employer after it has fallen short of the affordability safe harbor."  MORE >>


[Guidance Overview]

Departments Issue Guidance on PrEP Preventive Care Coverage

"Plans may use reasonable medical management techniques to encourage individuals prescribed PrEP to use specific items and services, to the extent the frequency, method, treatment, or setting is not specified in the USPSTF recommendation. For example, since the branded version of PrEP is not specified in the USPSTF recommendation, plans may cover a generic version of PrEP without cost sharing and impose cost sharing on an equivalent branded version. However, plans must accommodate any individual for whom a particular PrEP medication (generic or brand name) would be medically inappropriate[.]"  MORE >>


[Guidance Overview]

Interim Final Rule Restricts Surprise Billing and Balance Billing

"In order to permit the provider or facility to bill at an out-of-network rate, providers and facilities must provide participants, enrollees, and beneficiaries with a one-page consumer notice explaining that patient consent is required to receive care on an out-of-network basis. The notice must also outline any applicable state balance-billing restrictions and how the individual can contact appropriate state and federal agencies if the individual believes the provider or facility has violated any of the requirements outlined in the notice."  MORE >>

Nixon Peabody LLP

Health, Fringe and Leave Benefit Compliance Issues for 2022

"This list highlights 10 top compliance-related priorities for planning 2022 health, leave, and fringe benefits and recommends general actions for each item."  MORE >>


Virtual Communications: Expert Tips for Open Enrollment

"Employers' plans to return to large, in-person benefits meetings this year may be stymied by the delta variant of COVID-19 ... But that's not the only reason why employers would be mistaken to abandon many of the virtual tools they adopted last year. Instead, they can combine live and virtual benefits education, such as online benefit fairs[.]"  MORE >>

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

2021 Health Price Transparency: Data Availability and Analysis (PDF)

"[E]ven when hospitals published negotiated rate data it was often incomplete, had quality issues, or was extremely difficult to access. For example, in some instances many of the 70 required CMS shoppable services were incomplete or completely missing. Other examples of poor data quality include fewer than 300 total services included, a large quantity of missing values, or the same rate being provided for all contracted payers."  MORE >>

Wakely Consulting Group

Senate Uses Murky Math as It Shelves Drug Pricing Rule to Fund Infrastructure

"Tossing Trump's reform under the steamroller to offset other costs offers a window into the convoluted process of congressional budgeting: Senators say the plan will provide billions of dollars of savings, even though the federal government has never spent a dime on the rebate rule. And it focuses attention on the intractable problem of bringing down drug prices: The rule would take money from drug industry brokers and provide refunds to consumers, which would suggest it was saving them and Medicare money. Yet budget analysts said the process would cost the government billions of dollars."  MORE >>

Kaiser Health News

Legislative Effort Underway to Provide Paid Leave for Miscarriage

"A new bill introduced in Congress that aims to boost research into pregnancy loss also proposes a minimum of three days' paid leave for workers who experience miscarriage. If passed, the bill would break new ground on required paid leave."  MORE >>

HR Daily Advisor

Benefits in General

[Official Guidance]

Text of EBSA Request for Nominations: Advisory Council on Employee Welfare and Pension Benefit Plans

"The terms of five Council members expire at the end of this year. The groups or fields they represent are as follows: [1] Employee organizations; [2] employers; [3] the general public; [4] actuarial counseling; and [5] investment counseling.... Nominations must be received on or before [45 days after publication of this notice in the Federal Register, scheduled for Aug. 6, 2021]."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Employee Benefits Jobs

View job as Senior Technical Advisor
for Employee Benefits Security Administration [EBSA] Senior Technical Advisor

Employee Benefits Security Administration [EBSA]


View job as Retirement Plan Consultant
for Leading Retirement Solutions Retirement Plan Consultant

Leading Retirement Solutions


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

Leading Retirement Solutions


View job as Legal Specialist - Employment & ERISA
for MassMutual Legal Specialist - Employment & ERISA


Springfield MA

Press Releases

MJ Insurance Acquires ProCourse Fiduciary Advisors

MJ Insurance

New ‘FORT’ Built to Protect Plan Sponsors

Center for Board Certified Fiduciaries

Last Issue's Most Popular Items

Road Contractor to Pay $20.7 Million for Stealing Prevailing Wage Fringe Benefit Contributions

Solutions Law Press

What Multiemployer Plan Trustees Need to Know About Form 5500

Withum Smith+Brown, PC

Maryland Public Health Emergency Paid Sick Leave


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

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