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Health & Welfare Plans Newsletter

October 8, 2021

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

IRS Provides COBRA Coverage Clarifications

"Notice 2021-58 clarifies that the disregarded period for an individual to elect COBRA continuation coverage runs concurrent to the disregarded period to make the premium payment.... The guidance also offers transition relief to those individuals who made an election outside of the initial 60-day period and whose payment is due before November 1, 2021."  MORE >>


[Guidance Overview]

More Vax Facts: The Agencies Weigh In

"What kind of wellness program is it? ... Can cost sharing be imposed on vaccines? ... Can group health plan eligibility or benefits be conditioned on vaccination status? ... How does a premium differential impact ACA affordability?"  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

HHS Clarifies Applicability of HIPAA Privacy Rule to COVID-19 Vaccination Status Requests

"Employers, schools, stores, restaurants, and many others may request that an individual disclose whether they have been vaccinated without violating the Privacy Rule.... The guidance describes certain situations when disclosure is permitted without authorization."  MORE >>

Ballard Spahr LLP

[Guidance Overview]

Asking Applicants for Vax Status? Not So Fast, Employers

"The ADA, as it has been consistently interpreted since the 1990s, says employers can't ask for medical information at the applicant stage of the hiring process.... The ADA has rules about medical information that employers can request, and the rules are different depending on whether the individual is a job applicant, someone who has received a conditional offer of employment, or a current employee."  MORE >>

Constangy, Brooks, Smith & Prophete LLP

SCOTUS to Hear ACA Discrimination Case That Could Have Far-Reaching Effects on Group Health Plans

"CVS Pharmacy v. Doe asks if Section 1557 of the ACA creates a private right of action for discrimination on the basis of race, sex, age, and disability in federally funded health programs and activities. In doing so, the case gets at both the structure of employer-provided group health plans, and the anti-discrimination provisions of the Rehabilitation Act of 1973 as extended by the ACA. Plus, it dances around prescription drug costs and access to specialty medications."  MORE >>

MZQ Consulting, LLC

Pharmacy Benefit Manager Agrees to Pay $15.2 Million to Settle Allegations of Arkansas Medicaid Overbilling

"Under the terms of the settlement, Centene will pay $15.2 million to the state. Centene also agreed to revise its business practices and to provide the state with full transparency related to all pharmacy benefit claims, including the exact amounts paid for each pharmaceutical claim, among other things."  MORE >>

Cozen O'Connor, via Lexology; free registration required

Applied Behavioral Analysis Therapy Coverage Exclusions Raise a Red Flag

"Many group health plans eliminated [applied behavioral analysis (ABA)] therapy exclusions at some point during the past decade -- whether in response to state insurance mandates, employee requests, participant lawsuits under the [MHPAEA], or a reassessment of the clinical evidence relating to ABA therapy. The 2021 Consolidated Appropriations Act (CAA) provides yet another compelling reason for group health plans excluding ABA therapy coverage to reevaluate that exclusion."  MORE >>



Reforms Are Needed to Rein in Health Spending, But Reference Pricing Isn't Worth the Risk

"Given that biopharmaceutical innovation has historically been a critical driver of improvements in patient health, it is essential to examine how enactment of international reference pricing policies may affect future innovation and patient outcomes. [The authors] explore the trade-offs and risks associated with international reference pricing and suggest alternative policy approaches to reduce prescription drug costs while maintaining incentives for innovation."  MORE >>

Health Affairs Blog

Employee Benefits Jobs

View job as Paralegal Specialist - ERISA
for Nationwide Insurance Paralegal Specialist - ERISA

Nationwide Insurance

Remote / Columbus OH

View job as 401k Documents Consultant
for Newport 401k Documents Consultant


Remote / Dallas TX / Charlotte NC / Mobile AL / Lake Mary FL / Chicago IL / AZ / CO / IA / MN

View job as Director, People & Culture
for Center for the Study of Social Policy Director, People & Culture

Center for the Study of Social Policy

Remote / Washington DC

View job as ERISA Compliance Specialist
for Qualified Plan Administrators, Inc. ERISA Compliance Specialist

Qualified Plan Administrators, Inc.

Remote / Greensboro NC

Selected New Discussions

Law Student Considers Thesis for a Paper on ERISA Fiduciary Duties

"I'm in law school writing a paper on ERISA. Possible thesis: Under ERISA, a plan administrator should have a fiduciary duty to mitigate damages to the plan when an employee files an EEOC charge alleging discriminatory practices by the employer that could result in a retroactive relief being awarded to the employee. I'm not sure if I have anything here, or if any of this is plausible or relevant. Any advice/comments?"

BenefitsLink Message Boards

Webcasts and Conferences
(Health & Welfare Plans)

Federal, Connecticut, Washington D.C., Oregon, and New Hampshire Paid Family Leave Developments

October 12, 2021 WEBCAST

Seyfarth Shaw LLP

Employer-Sponsored Health Plan Federal Regulation: ACA, COBRA, ADA, GINA, CAA, MHPAEA, Reporting Requirements

November 23, 2021 WEBCAST


Last Issue's Most Popular Items

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

Ogletree Deakins

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

Thomson Reuters / EBIA

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


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

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