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Health & Welfare Plans Newsletter

October 7, 2021

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

Health Plan Surcharge for Unvaccinated Employees: New Guidance Provides a Roadmap

"Both vaccination surcharges and incentives are permitted by HIPAA, provided that a plan complies with the requirements for 'activity-only' wellness programs under the HIPAA regulations. Importantly, that means limiting the amount of the health plan surcharge or incentive generally to 30 percent of the total cost of coverage under the health plan, and providing a reasonable alternative way to avoid the surcharge if it is medically inadvisable for an individual to get the COVID-19 vaccine."  MORE >>

Ogletree Deakins

[Guidance Overview]

Agency FAQs (Part 50) Address COVID-19 Vaccine Coverage and Incentives

"The DOL, IRS, and HHS have issued five new COVID-19-related FAQs -- two addressing group health plan coverage requirements for qualifying coronavirus preventive services and three addressing vaccine incentives under group health plans and wellness programs."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

What Are the Transparency Requirements for Handling Requests for Provider Directory Information?

"[A] plan must establish a protocol for responding to a request from an individual enrolled in the plan about whether a health care provider or facility has a contractual relationship to furnish items or services under the plan. The protocol must meet specified requirements.... Although the transparency requirements for provider directories apply to plan years beginning on or after January 1, 2022, the agencies have advised that they will not issue rules until after the effective date. Nevertheless, plans are expected to implement these provisions using a good faith, reasonable interpretation of the statute."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Healthcare Providers Get Unpleasant Surprise from Latest Regs Under the No Surprises Act

"Providers are concerned the Interim Rule will drive up the cost of healthcare instead of reducing it as the law intended.... [P]roviders and plans must put in place the necessary measures by the current effective date -- January 1, 2022.... [A chart details] negotiation and independent dispute resolution deadlines."  MORE >>


[Guidance Overview]

Surprise Billing Regs (Part II) Provide Guidance on IDR Process for Provider Payment Disputes; Amend External Review Rules

"The agencies are building out an IDR portal to be used for the IDR process. One possible piece of good news: The agencies reason that implementing the regulations' IDR process will encourage predictable outcomes, which should reduce the use of the IDR process over time."  MORE >>

Thomson Reuters / EBIA

Employers Expect a 4.7% Increase in Health Benefit Costs for 2022

"Last year, as disruptions in healthcare utilization held down cost growth, fewer employers than usual took cost-savings measures that shift healthcare expense to employees, such as raising deductibles or copays.... The percentage of employers making these types of cost-shifting changes to their plans has fallen again, with only 38% making changes to shift cost in their medical plans in 2022, down from 47% that chose not to shift cost in 2021."  MORE >>



'Build Back Better' Plan Would Put in Place a Government Option and Sets a Path to Single-Payer

"Instead of 'Medicare for All,' a congressional proposal to outlaw private insurance and put everyone on a government-run health plan, Build Back Better takes key steps in that direction. The proposal focuses on reinforcing and expanding the [ACA] footprint by removing the income limitations on subsidies, making the existing [ACA] subsidies more generous and creating a new, federal, Medicaid-like option."  MORE >>

The Heritage Foundation

Benefits in General

[Guidance Overview]

DOL Says Plan Administrators Must Provide Audio Recording or Transcript of Call Between Claimant and Plan Representative Upon Request

"The opinion came in the form of an Information Letter issued in response to an inquiry from a claimant's attorney who sought guidance after a plan administrator declined to produce an audio recording of a conversation on the grounds that a record of the call had been produced and the recording was for quality assurance purposes only. The DOL held that these justifications were inconsistent with ERISA's regulations."  MORE >>

Hinshaw & Culbertson LLP


Fifth Circuit Is Right To Question ERISA Review Norms

"The court maintained that under a deferential standard of review, none of the plaintiff's arguments proved that the determination was arbitrary and capricious. While the court's ruling was unanimous, U.S. Circuit Judge Andy Oldham wrote a concurrence addressing the scope of review applied by the court in this case and questioning its use in other ERISA cases. What Judge Oldham wrote was an indictment of the way federal judges decide ERISA cases and has the potential to dramatically change all future ERISA litigation involving benefit claim denials." [Michael J. P. v. Blue Cross and Blue Shield of Texas, No. 20-30361 (5th Cir. Sep. 22, 2021; unpub.)]  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Employee Benefits Jobs

View job as Human Resources Business Partner - North
for Air Products and Chemicals, Inc Human Resources Business Partner - North

Air Products and Chemicals, Inc

Allentown PA

View job as Human Resources Business Partner - Large Projects
for Air Products and Chemicals, Inc Human Resources Business Partner - Large Projects

Air Products and Chemicals, Inc

Houston TX

View job as 3(16) Account Manager
for Pentegra 3(16) Account Manager



View job as Entry Level Insurance Policy Administrator
for Newport Entry Level Insurance Policy Administrator


Lake Mary FL

View job as Sr. Manager, DC Compliance & Documentation
for Charles Schwab Sr. Manager, DC Compliance & Documentation

Charles Schwab

Austin TX / Richfield OH

Selected New Discussions

Convert Grantor Trust to VEBA?

"Client currently has a grantor trust and wants to convert it to a VEBA. Is there any IRS guidance or practical considerations on converting an existing grantor trust to a VEBA? Is conversion of the existing trust even possible or should a health plan deplete the existing grantor trust and then transition to the new VEBA? Or should the existing trust document just be amended to comply with the VEBA requirements on a go-forward basis?"

BenefitsLink Message Boards

Press Releases

Elevate Launches with $15M Funding to Modernize Consumer Directed Benefits Delivery


Webcasts and Conferences
(Health & Welfare Plans)

Actuarial Value Webinar

November 9, 2021 WEBCAST

EBRI [Employee Benefit Research Institute]

FMLA Intermittent Leave – Avoiding Abuse

November 10, 2021 WEBCAST

Business Watch Network

The Auditor Called -- 'What Did I Do Wrong Now?'

November 17, 2021 WEBCAST

Conference of Consulting Actuaries

Last Issue's Most Popular Items

Text of IRS Notice 2021-58: Extension of COBRA Election and Premium Payment Deadlines Under Section 7508A(b) (PDF)

Internal Revenue Service [IRS]

New Guidance on COVID-19 Vaccine-Related Premium Surcharges and Discounts

Groom Law Group

Vaccine Surcharges: Yes, You Can!

Jackson Lewis P.C.

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

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