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Health & Welfare Plans Newsletter

September 15, 2021

3 New Job Opportunities


[Guidance Overview]

New Federal Transparency Rules for Employers as Health Plan Sponsors

"This article [provides] a guide and timeline employers can use to follow along with the federal rules, their responsibilities as plan sponsors, and key dates for implementation."  MORE >>

The Alliance

[Guidance Overview]

Proposed Rules Address Air Ambulance Services Under the No Surprises Act, Health Insurer Compensation Disclosures, and More

"To avoid duplicative compliance efforts, the proposed regulations would view an insured health plan as satisfying its reporting requirements if the plan requires its insurer to furnish the necessary disclosures for air ambulance services (that is, under an agreement between the plan and insurer). For large self-funded plans, the plans' TPAs likely will end up submitting required information to the government -- with those costs then passed back to the plan. However, the self-funded plan itself is ultimately liable for ensuring compliance with the reporting rules and will need to monitor its TPA accordingly."  MORE >>

Thomson Reuters Practical Law

Mental Health Parity: DOL and NY AG Actions Highlight Ongoing Scrutiny of NQTLs

"On August 11, 2021, United Healthcare and its affiliates were served with separate enforcement lawsuits by the [DOL] and the New York Attorney General involving mental health parity ... The same day the complaints were filed, the parties also filed two different stipulations of settlement resolving these investigations, the related complaints and two additional private class actions pending in the same court. This article summarizes the overlapping claims in these cases, the terms of the settlements and the implications of the cases for various stakeholders." [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)]  MORE >>

Manatt, Phelps & Phillips, LLP

Ninth Circuit Revives Fiduciary Breach Claim for Alleged Company Misrepresentation of Lifetime Health Benefits

"The court rejected Warmenhoven's argument that the promises contained in the PowerPoints created an ERISA plan. Informal commitments to provide benefits could create an ERISA plan where there are no written instruments but that is not the case here.... On the ERISA Section 502(a)(3) claim, the court found that Warmenhoven did allege a remediable wrong[.]" [Warmenhoven v. NetApp, Inc., No. 19-16960 (9th Cir. Sept. 13, 2021)]  MORE >>

Roberts Disability Law

District Court Highlights Importance of Complying with ERISA's 'Other Instruments Rule' for Document Disclosures

"[T]he court found that the Defendants did not comply with ERISA's Other Instruments Rule when they provided the participant only the criteria related to mental health and substance use disorder benefits and also failed to provide the criteria related to medical/surgical benefits.... [T]he court observed the ASA was required to be disclosed to the participant because it evidenced the divided administration of the plan between the plan administrator and the TPA, and that organizational structure affected the participant's rights under the plan." [M. S. v. Premera Blue Cross, No. 19-0199 (D. Utah Aug. 10, 2021)]  MORE >>

The Wagner Law Group

ACA Litigation Still on the Docket After California v. Texas

"Referred to as 'the most challenged statute in American history' by some commentators, the [ACA] has been the subject of numerous lawsuits since its enactment in 2010 ... This Legal Sidebar provides relevant background on private health insurance requirements in Title I of the ACA, discusses several notable past or pending ACA cases, and concludes with select legal considerations for Congress." [LSB10641, Sep. 14, 2021]  MORE >>

Congressional Research Service [CRS]

New Health Care Transparency Requirements: Recommendations for Optimizing Pricing Data to Reduce System Costs

"Researchers found that hospital price transparency rules could be strengthened to measure price variation, empower employers to make better purchasing decisions and enable more accurate oversight of insurers by: [1] Expanding the number of hospitals publishing pricing data by increasing the maximum penalty from $300 per day to $5,500 per day. [2] Requiring hospitals to present data uniformly, through a 'machine readable' template that complies with [CMS] regulations. [3] Asking hospitals to display their commercial and Medicare rates side-by-side."  MORE >>

Robert Wood Johnson Foundation

Insured Population Holds Steady, with a Slight Shift from Private to Public Coverage

"Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%.... Private insurance coverage decreased by 0.8 percentage points from 2018. Public coverage rose by 0.4 percentage points from 2018. That shift was likely driven partly by older Americans becoming eligible for Medicare[.]"  MORE >>

Kaiser Health News

Retailers Stepping Up Tuition Benefits in Order to Attract and Retain Employees

"Amazon announced ... that they'll cover 100% of the tuition costs for its frontline employees.... Part-time employees who work as little as 20 hours a week are also eligible, though Amazon will only cover 50% of their costs,... The company ... [is] willing to invest some money in exchange for a more stable workforce -- even if tuition recipients leave for other companies. It's also a competitive move, as other large retail employers have recently announced 100% education benefits for their employees."  MORE >>


Benefits in General

AICPA FAQs with Illustrative Auditor's Reports for Initial Year of Implementation of SAS No. 136 (PDF)

31 pages. "[These] frequently asked question (FAQ) and illustrative auditor's reports have been developed to aid practitioners as they apply AICPA Statement on Auditing Standards (SAS) No. 136, Forming an Opinion and Reporting on Financial Statements of Employee Benefit Plans Subject to ERISA ... in their audits of financial statements of employee benefit plans subject to [ERISA] in the initial year of implementation."  MORE >>

American Institute of Certified Public Accountants [AICPA]

Maximizing Health Span: A Literature Review on the Impact of a Healthy Lifestyle in Retirement (PDF)

65 pages. "Though there are a plethora of innovations being explored to extend longevity ... it is not yet clear how many of these research endeavors will materialize as practical interventions in the foreseeable future and whether they will lead to meaningful improvements in health, rather than solely extensions of life. However, the existing literature contains evidence of the material impacts that stem from healthy lifestyle behaviors and chronic condition management. The primary purpose of this report is to review this literature to provide a resource for actuaries and others on relevant issues, and secondarily to call out areas of emerging evidence that could be further researched."  MORE >>

Society of Actuaries

Employee Benefits Jobs

View job as DC Plan Administrator
for Farmer & Betts, Inc. DC Plan Administrator

Farmer & Betts, Inc.

Remote / Tacoma WA / CO / OR

View job as DC Plan Administrator
for Farmer & Betts, Inc.

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 Distribution Processor, Senior
for Alerus Retirement Distribution Processor, Senior



Press Releases

Institutional Retirement Income Council Appoints Michelle Richter as Executive Director

Institutional Retirement Income Council

PBI Launches CertiCensus – The First Single Source Pension Plan Population Management Solution

PBI Research Services

Ascensus Unveils Retirement Website and Mobile Enhancements That Offer Simple, Seamless, and Supportive User Experiences


Last Issue's Most Popular Items

Non-Federal Governmental Plans and MHPAEA Comparative Analysis Reviews (PDF)

Center for Consumer Information and Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Text of DOL, IRS and PBGC Proposed Revisions to Form 5500 Annual Information Return/Reports and Form M-1

U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; and Pension Benefit Guaranty Corporation [PBGC]

No Surprises Act: Latest Proposed Regs Focus on Data Collection and Enforcement

Health Affairs Blog

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

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