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Health & Welfare Plans Newsletter

October 4, 2021

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

Text of Agency FAQs, Part 50: Rapid Coverage of Preventive Services for Coronavirus; HIPAA Nondiscrimination and Wellness Programs (PDF)

"Q1: How does the December 12, 2020 ACIP recommendation impact when plans and issuers must provide coverage without cost sharing for COVID-19 vaccines under section 3203 of the CARES Act and its implementing regulations ? ... Q2: Does FAQs Part 44, Q8, continue to apply? ... Q3: May a group health plan (or health insurance issuer offering coverage in connection with a group health plan) offer participants in the plan a premium discount for receiving a COVID-19 vaccination? ... Q4: May a group health plan or health insurance issuer condition eligibility for benefits or coverage for otherwise covered items or services to treat COVID-19 on participants, beneficiaries, or enrollees being vaccinated? ... Q5: How are premium discounts and surcharges for receiving or not receiving the COVID-19 vaccination, respectively, treated for purposes of determining affordability of coverage with respect to the employer shared responsibility payment under section 4980H(b) of the Code?"  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Banning Surprise Bills, Part 1: A New Rule on Independent Dispute Resolution

"IDR entities must select the offer that is closest to the qualifying payment amount (i.e., the median in-network rate that payers pay to providers) and only deviate if there is credible information for the need to do so. This will help ensure that IDR outcomes are predictable and that stakeholders are not incentivized to use the federal IDR process to obtain higher out-of-network payments when doing so is not warranted based on the circumstances."  MORE >>

Health Affairs Blog

[Guidance Overview]

October Brings Changes to D.C. Universal Paid Leave Law and D.C. Family and Medical Leave Act

"The District of Columbia has enacted emergency legislation expanding the District's Universal Paid Leave Act (UPLA). The legislation takes effect on October 1, 2021, and lasts for no more than 90 days. In addition, the D.C. Mayor signed legislation to make these changes permanent. That legislation is in its 30-day Congressional review period. The legislation also expands eligibility for leave under the District's Family and Medical Leave Act."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

Effective January 1, Connecticut Employees Entitled to Only 12 Weeks of State FMLA Leave -- Even If Leave Starts in 2021

"According to the CTDOL, as of January 1, 2022, eligible employees are entitled to 12 weeks of unpaid job-protected leave in a 12-month period -- including leave that began in 2021, prior to the effective date of the amendments. This is in contrast to the 16 weeks of leave under the CTFMLA currently available to employees during a 24-month period[.]"  MORE >>

Ogletree Deakins

Providers Cry Foul Over New Surprise Billing Rule's Arbitration Process

"[P]roviders took umbrage with a key direction the rule gave to the arbiter. The final rule states that when deciding between the amounts, the arbiter should pick whichever amount is closest to the qualified payment amount (QPA), which is an insurance plan's median contract rate for the same or similar service in a geographic area.... The rule means providers will have to prepare a game plan to show that their amount needs to be different from the QPA."  MORE >>


The Importance of Hospital Price Transparency, and What It Means for Employers (PDF)

"Employers need high-quality, transparent pricing information to create innovative benefit plan designs and negotiate more favorable prices with insurers. Access to pricing information can allow employers to become better informed health care-purchasing consumers. The National Hospital Price Transparency Study (RAND 3.0) found that employers pay two-and-a-half times more than Medicare for health care services, and there is no link between hospital prices and quality or safety. Employers can help lower prices by identifying and helping employees and their families navigate toward lower cost, high-quality health care providers."  MORE >>

Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS]

Congress Considers 'Commonsense Reporting Act' to Streamline ACA Filings

"The Commonsense Reporting Act would allow reporting to be done prospectively before the beginning of a new coverage year, based on employee coverage during the current plan year."  MORE >>

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

California Court Rules That CFRA Covered Employee's Leave to Care for Adult Sister Prior to Expanded Law

"The employee was entitled to take family leave because he stood 'in loco parentis' to his sister, the court said. In 2014, the CFRA did not cover an employee's leave of absence to care for a sibling. At that time, however, an employee was entitled to take leave to care for an adult dependent, including one to whom the employee stood in loco parentis." [Vincent v. Dept. of the Cal. Highway Patrol, No. B302026 (Cal. Ct. App. Aug. 31, 2021)]  MORE >>

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

Whither Massachusetts Health Reform?

"What has emerged is a set of oligopolies on both the provider and the payer sides: Two major health plans and two major hospital systems dominate Eastern Massachusetts (three-fourths of the state's population). The battle between lower-cost community hospitals and the big AMCs is now mostly over, and the largest 'systems' must generate substantial revenue growth to pay for their expansion plans."  MORE >>

Health Affairs Blog

Benefits in General

[Guidance Overview]

Upcoming Deadline icon 2021 Plan Amendment Deadlines and Other Looming Fourth Quarter Considerations

"[1] Cafeteria plan and FSA plan amendments for COVID-19 election change and other relief.... [2] Health FSA changes: qualified medical expenses.... [3] Health FSA change: $550 carryover.... [4] Group medical plan changes: COVID-19 testing, vaccines, telemedicine.... [5] Retirement plans: hardship distribution amendment deadline.... [6] Pre-approved 401(k) and other defined contribution plans: restatement deadline.... [7] Retirement plans: cybersecurity compliance.... [8] Mental Health Parity and Addition Equity Act (MHPAEA): comparative analysis, compliance.... [9] No Surprises Act: group health plan surprise billing, transparency.... [10] Tax law compliance: remote and hybrid workers."  MORE >>

Jackson Lewis P.C.

Employee Benefits Jobs

View job as DC Administrator
for MGKS DC Administrator


Remote / Phoenix AZ

View job as DC Administrator
for MGKS

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

Employee Benefits Security Administration [EBSA]

Remote / Washington DC

View job as Client Services Specialist
for IJOIN Client Services Specialist


Remote / Scottsdale AZ

View job as Employee Benefits Associate Or Counsel
for Morris, Manning & Martin, LLP Employee Benefits Associate Or Counsel

Morris, Manning & Martin, LLP

Atlanta GA

Press Releases

Signify Health and HealthComp Collaborate to Develop Value-Based Health Benefits

Signify Health

IRI Announces Results of 2021 Board of Directors Elections

Insured Retirement Institute [IRI]

Webcasts and Conferences
(Health & Welfare Plans)

DOL ERISA Enforcement 2021 Update

October 6, 2021 WEBCAST

Morgan Lewis

Hot Topics in Employee Benefits: What We’re Seeing – October 2021

October 14, 2021 WEBCAST

Morgan Lewis

Last Issue's Most Popular Items

Text of HHS OCR FAQs: HIPAA, COVID-19 Vaccination, and the Workplace

Office of Civil Rights [OCR], U.S. Department of Health and Human Services [HHS]

HHS Addresses HIPAA Privacy and COVID-19 Vaccinations in the Workplace

Thomson Reuters Practical Law

Form 5500 Proposal Reflects SECURE Act Changes and More


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

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