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Health & Welfare Plans Newsletter

August 27, 2021

2 New Job Opportunities

 

[Guidance Overview]

Legal Considerations for Premium Differentials Based on COVID-19 Vaccinations

"As employers shift their focus toward the cost of COVID hospitalizations (which studies show are a much greater risk for unvaccinated individuals), employers are increasingly considering imposing a premium differential between vaccinated and unvaccinated covered participants. Imposing such a premium differential is doable, but likely creates a group health plan wellness program, which implicates both HIPAA (under rules issued by HHS), and the ADA and GINA (governed by the EEOC) wellness program rules."  MORE >>

Seyfarth

[Guidance Overview]

Can an Employer Charge Unvaccinated Employees a Higher Health Plan Premium?

"[U]nder HIPAA regulations and the ACA, an employer can offer financial incentives under its health plan to individuals who participate in its wellness programs. A wellness program can include incentives for getting the COVID-19 vaccine, such as a premium surcharge for those individuals who are unvaccinated. A premium surcharge for unvaccinated individuals will have to comply with [certain] HIPAA/ACA rules."  MORE >>

Warner Norcross & Judd LLP

[Guidance Overview]

Extension of Group Health Plan Compliance Dates

"On August 20, 2021, the DOL published FAQs Part 49 announcing the extension of the compliance dates for a few -- but far from all -- of the new group health plan mandates under the Tri-Department transparency regulations and the Consolidated Appropriations Act (CAA)." [A chart lists the requirements with original and extended compliance dates.]  MORE >>

Vorys

As Delta Concerns Grow, Workforces Are Rethinking Open Enrollment

"[O]ne potential impact of COVID-19 on overall benefit selections could be an increase in the amount of insurance coverage purchased by employees.... 14% of employees said they plan to purchase more coverage this open enrollment season, compared with what they selected prior to the pandemic. Additionally, 13% of respondents are planning to purchase even more coverage in 2022 than what they did this past year."  MORE >>

PLANSPONSOR; free registration may be required

Large Business Survey Sees a Post-COVID Shift to Telehealth Services

"Roughly three-quarters of the nation's large businesses expanded their telehealth programs for employees during the pandemic, and many may use those channels in the future to address social determinants of health and improve access to mental health services."  MORE >>

mHealthIntelligence

2021 Prescription Drug Policy Trends

"Prescription drug access and affordability is one area legislators looked for common ground, and over 700 bills were introduced in 48 states and Puerto Rico. Of those, at least 104 laws have been enacted in 33 states. This number kept pace with 2020 where almost the same number of bills were proposed."  MORE >>

National Conference of State Legislatures [NCSL]

Implementing a Bicycle Commuter Program at Your Organization

"Bicycle commuter programs are typically set up as a type of post-tax lifestyle spending account. Employees use personal funds to pay for qualified bike commuting expenses, then file a claim for a reimbursement with an itemized receipt using their online account or in the mobile app.... [A] bicycle commuter program can operate on a rolling basis, meaning you can set it up whenever and employees can enroll anytime[.]"  MORE >>

Connect Your Care

CBO Simulation Model of New Drug Development

"This paper presents the Congressional Budget Office's simulation model for analyzing legislative proposals that may substantially affect new drug development. The model uses estimates of changes in expected future profits or development costs to estimate the percent change in the number of drug candidates entering the various stages of human clinical trials. Given changes in decisions to enter at each stage, the model estimates when and by how much the number of new drugs entering the market will change." [CBO Working Paper 2021-09]  MORE >>

Congressional Budget Office [CBO]

[Opinion]

Why U.S. Healthcare Prices Are All Over the Map

"We are still on a path toward some sort of socialized medicine by the end of the 2020s. We cannot sustain this present system much longer.... Taxpayers pay 70% of all healthcare costs in blue states and 65% in red states.... The impact of [the MLR] was to relax insurers' incentive to keep claim costs down. Why? Because the only way for an insurer to increase revenue is to glow the claims pie. 15% of a $4,000 MRI pays better than 15% of a $1,000 MRI."  MORE >>

Benefit Revolution

[Opinion]

The New York Times Shines a Bright Light on Healthcare Pricing -- What Should We All See?

"[P]rice transparency alone is not the cure for the disease plaguing U.S. healthcare. Rather, it is a symptom of a larger, far-reaching affliction -- acceptance of the status quo. Payers, particularly employers who provide the majority of coverage in this country, must REFUSE to continue to tolerate high costs overall, uneven quality, and providers whose higher comparative costs do not correlate to better health outcomes. Instead, self-funded employers should work with their advisors to find ways to incent and reward efficient, cost-conscious health systems and practitioners who provide better care at lower costs."  MORE >>

Centivo

Benefits in General

[Official Guidance]

IRS Announces Tax Relief for Victims of Severe Storms and Flooding in Tennessee

"Victims of Severe Storms and Flooding that occurred on August 21, 2021 now have until January 3, 2022, to file various individual and business tax returns and make tax payments ... Individuals and households affected by Severe Storms and Flooding that reside or have a business in Dickson, Hickman, Houston, and Humphreys counties qualify for tax relief." [TN-2021-01]  MORE >>

Internal Revenue Service [IRS]

[Official Guidance]

IRS Announces Tax Relief for Victims of Wildfires in California

"Victims of wildfires that began July 14, 2021 now have until November 15, 2021, to file various individual and business tax returns and make tax payments ... Individuals and households affected by wildfires that reside or have a business in Lassen, Nevada, Placer, and Plumas counties qualify for tax relief." [CA-2021-03]  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Retirement Plan Administrator
for Wells Thomas, LLC Retirement Plan Administrator

Wells Thomas, LLC

Branford CT / West Hartford CT

View job as ESOP Analyst
for Newport ESOP Analyst

Newport

Remote

Selected New Discussions

Delta Is Ready When You Are (for an Extra $200/Month) -- COVID Surcharge Permitted by HIPAA?

"Many news outlets are reporting the decision by Delta Airlines to impose a $200/month surcharge on employees who refuse the COVID vaccine.

My initial reaction is that COVID vaccination status is a 'health factor' under Treas. Reg. 54.9802-1(a)(1)(iv) (Receipt of health care) or (v) (Medical history). One could also argue that refusing the COVID vaccination a health factor because it is analogous to the dangerous activities listed under 'evidence of insurability' in Treas. Reg. 54.9802-1(a)(2)(ii).

It seems to me that the $200/month is a higher premium under 54.9802-1(c) for a similarly situated individual. It's a stretch to argue that COVID vaccinated employees/non-COVID vaccinated employees are not 'similarly situated' because vaccination status is a bona fide employment-based classification under 54.9802-1(d)(1).

That leaves the exception for nondiscriminatory wellness programs in 54.9802-1(f), and specifically the exception for 'activity only' wellness programs in 54.9802-1(f)(1)(iv), because the $200 is related to a health factor. The activity-only wellness program would need to complete with the frequency, size of reward, reasonable design, and uniform availability/reasonable alternative standards requirements of 54.9802-1(f)(3)(iv). It seems that the employee's personal physician can offer an alternative if he/she is willing to say that obtaining the COVID vaccine is not medically appropriate for that individual -- although it's unclear what the alternative would be in this circumstance. 54.9802-1(f)(3)(iv)(C)(4)"

BenefitsLink Message Boards

Press Releases

Franklin Templeton Partners with Stadion Technology to Power New Personalized Managed Account Solutions

Franklin Templeton

Webcasts and Conferences
(Health & Welfare Plans)

Ready, Set, Enroll! Navigate Passive and Active Open Enrollments

August 27, 2021 WEBCAST

OneDigital

Health and Welfare Benefit Plans National Institute 2021

October 12, 2021 WEBCAST

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

Delta's Extra $200 Insurance Fee Shows Vaccine Dilemma for Employers

The New York Times; subscription may be required

Agencies Issue FAQs to Explain Implementation Timing of Group Health Plan Reforms

Nixon Peabody LLP

New Guidance on Transparency Requirements, Advanced Explanations of Benefits, and More

Katie Keith, in Health Affairs Blog

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

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