COVID Vaccine Premium Incentives and Surcharges

"There are five main compliance issues for employers to address when considering a COVID-19 premium incentive or surcharge for the health plan: [1] No employer role in vaccine administration ... [2] HIPAA/ACA wellness program rules apply ... [3] Incentive/surcharge affects ACA affordability ... [4] Religious accommodations ... [5] President Biden's OSHA directive."  MORE >>

Newfront

Ninth Circuit Vacates Class Relief Against UnitedHealth for Alleged ERISA Claims-Processing Violations of Lactation Benefit Claims

"[The Ninth Circuit found that] the district court did not have Article III jurisdiction over [two participants'] full-and-fair review claims based on United's alleged failure to comply with ERISA's claims-processing rules ... Because the plaintiffs are not entitled to any reimbursement from United under the ACA, a ruling in their favor on their full-and-fair-review claim could not redress any concrete injury." [Condry v. UnitedHealth Group, Inc., No. 20-16823, (9th Cir. Sep. 16, 2021; unpub.)]  MORE >>

Roberts Disability Law

Price Transparency Tools Require Benefits Literacy

"Price transparency is essential to changing behavior and lowering costs, but if the consumer doesn't understand deductibles, networks, copays, coinsurance, etc., any extra data just adds to the confusion.... Thanks to innovation in the industry, there are a variety of tools available to fill those knowledge gaps and ease the stress."  MORE >>

Corporate Synergies

Hospital Groups Push Back Against Stiffer Penalties for Failing to Publish Prices

"The agency proposed back in July to keep the $300 a day penalty for smaller hospitals with 30 or fewer beds. However, it would also apply a penalty of $10 per bed a day for hospitals that have more than 30 beds, and the penalty cannot exceed $5,500 a day.... But hospitals charge that they are facing an unprecedented financial strain from the COVID-19 pandemic, and that has likely shifted facilities' attention."  MORE >>

FierceHealthcare

State Health Care Purchasers Can Push Hospitals to Comply with Federal Transparency Requirements

"State governments, as one of the largest purchasers of health care services, can leverage their negotiating power to help CMS fully enforce the requirements of the hospital price transparency rule."  MORE >>

Health Affairs Blog

CMS Suspends Part D Enrollment in 2022 for UnitedHealth, Anthem Medicare Advantage Plans

"The Biden administration has suspended Medicare Advantage Part D new customer enrollment for three United Healthcare Group plans and one Anthem plan for failing to meet medical loss ratio requirements.... The plans are prohibited from signing up any new customers for the 2022 coverage year, and suspensions occur before open enrollment starts Jan. 1."  MORE >>

FierceHealthcare

New North Carolina Law Increases Regulation of Pharmacy Benefit Managers

"Gov. Roy Cooper signed Senate Bill 257 ... [which] requires pharmacy benefit managers to get a license to do business in the state. It also protects consumers from surprise fees and overpayments."  MORE >>

Johnson City Press

[Guidance Overview]

Departments Propose Changes to Form 5500 and Schedules

"The proposed changes would be the first significant change to the Form 5500 series since the 2009 forms. The 2021 changes are intended to reflect the SECURE Act changes affecting annual reporting and improve oversight and transparency."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Agencies Propose Extensive Form 5500 Amendments

"The Proposed Rules are primarily intended to implement provisions of the [SECURE Act]. However, the agencies went much further, proposing changes affecting defined benefit plans, multiple employer plans (MEPs), pooled employer plans (PEPs), and multiple employer welfare arrangements (MEWAs)."  MORE >>

Groom Law Group

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AssetMark Launches Pooled Employer Plan (PEP)

AssetMark

NAGDCA Announces Winner of 2021 Art Caple President’s Award for Excellence

NAGDCA [National Association of Government Defined Contribution Administrators]

NAGDCA Celebrates 15 Years of Promoting Retirement Security

NAGDCA [National Association of Government Defined Contribution Administrators]

Vanguard and Retirement Clearinghouse to Offer Auto Portability Service to 401(k) Participants

Vanguard

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COVID Vaccination Accommodations Dos & Don’ts

September 28, 2021 WEBCAST

Fisher Phillips

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House Budget Reconciliation Text Includes Significant Health, Paid Leave, and Retirement Provisions

Groom Law Group

How Much Can the Health Plan Surcharge on Unvaccinated Employees Be?

Jackson Lewis P.C.

Cigna Sued Over Coverage Limitations on Mental Health Treatment

Law|Street