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Health & Welfare Plans Newsletter

October 26, 2021

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

Exceptional Usefulness and Quality icon Implementation of Certain Provisions of the No Surprises Act and Title II (Transparency) of the Consolidated Appropriations Act 2021 (PDF)

9-page chart provides a summary of specific provisions, along with their effective dates, affected parties (plans, providers, etc.) and status of current regulatory guidance.  MORE >>

Society of Professional Benefit Administrators [SPBA]

[Guidance Overview]

D.C. Expands Universal Paid Leave Benefits

"Effective October 1, 2021, many workers in the District of Columbia now have available to them expanded paid medical, parental, and family leave benefits under the District's Paid Family Leave (PFL) program ... The expansion, currently enacted as emergency legislation, is ... set to expire on November 21, 2021 ... But the D.C. City Council is aiming to make the enhanced benefits permanent by including nearly identical provisions in the Fiscal Year 2022 Budget Support Act, which is currently under review by Congress."  MORE >>

Venable LLP

DOL Settles Unprecedented Lawsuit Against United Healthcare for Alleged Violations of MHPAEA (PDF)

"The enforcement actions reflect the first instance in which DOL has initiated litigation to enforce MHPAEA against a health insurance issuer, health plan, or administrative service provider in the 13 years since the initial passage of the statute.... [I]ssuers and health plans should carefully review both the consistency of the factors they use to determine which benefits should be subject to a given [non-quantitative treatment limitations (NQTL)] type as well as the ratio of mental health/substance use disorder benefits subject to an NQTL type compared to the application of the same NQTL to medical-surgical benefits in the same classification." [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 >>

Epstein Becker Green, via Employee Benefit Plan Review

Best Practices for Employers: Mitigating Health Care Fraud

"COVID-19-related claims significantly increased the likelihood of payment integrity risks.... How can you identify fraud, waste, and abuse in health care? ... What is the impact of health care claims processing mistakes? ... Claims audit best practices ... Emerging fraud and waste risks."  MORE >>

Moss Adams LLP

Exceptional Usefulness and Quality icon How COVID-19 Coding and Billing Errors Impact Employers

"[P]ayers modified benefits, such as testing and expanded coverage.... [D]ifferent methods of testing and treatment at a medical provider made it harder to process claims and determine how much of the cost a member would actually have to share ... [The CDC] issued a new diagnosis code and the American Medical Association issued new procedure codes for testing and vaccines.... [I]npatient claims for an individual diagnosed with COVID-19 have a 20% increase in their [Medicare] reimbursement ... [and] many commercial hospital contracts [are based] on Medicare rules."  MORE >>

Moss Adams LLP

Employer Group Launches Its Own PBM

"The Purchaser Business Group on Health said its EmsanaRx unit would address 'the lack of accountability of the PBM industry to its employer clients, who largely lack access to information about drug costs, true discounts and administrative fees that contribute to huge profits.' ... Nearly 80% of U.S. prescriptions are managed by three PBMS -- CVS Caremark, Express Scripts, and OptumRx."  MORE >>


Preparing to Improve Your Company's Health Benefits for 2022

"[K]ey partnership questions to ask as you go into meetings with your broker that can guide your decisions on everything from funding models to the benefits themselves: [1] What type of partner do you want to have? ... [2] What do your employees want out of their health benefits? ... [3] How are your current benefits partners doing? ... [4] What type of investment are you willing to make? ... [5] What type of funding model is the best fit for your company?"  MORE >>

Financial Executives International Daily

Worksite Health Clinics: 2021 Survey Report (PDF)

29 pages. "Nearly a third of all organizations with at least 5,000 employees offer a primary care clinic to their employees. This rises to 38% for employers with 20,000 or more employees.... Only 1% of respondents say they will decrease the number of clinic locations as a result of the pandemic. Clinic utilization rates -- the percentage of eligible individuals accessing clinic services at least once during the year -- averaged 52% for employees and 32% for dependents in 2020, essentially unchanged from 53% and 31% in 2019."  MORE >>


Benefits in General

Financial Wellness Meets Behavioral Economics: Helping Participants See the Big Picture and Act On It (PDF)

12 pages. "[M]any people exhibit a behavioral tendency known as narrow framing, which can lead people ... to allocate their savings to the wrong accounts, choose the wrong health insurance plans and fail to prepare for unexpected financial shocks. This paper outlines a new approach, informed by behavioral economics, that minimizes the problem of narrow framing. For instance, it explains how workers can be nudged to save for emergencies, thus helping them avoid cashing out their retirement savings during a financial shock. It also outlines sample interventions that can be used to help people reduce health care costs."  MORE >>

VOYA Financial

Employee Benefits Jobs

View job as Attorney Advisor
for Department of Justice, Offices, Boards and Divisions, Criminal Division Attorney Advisor

Department of Justice, Offices, Boards and Divisions, Criminal Division

Remote / Washington DC

View job as Supervisory Actuary - DH
for Pension Benefit Guaranty Corporation [PBGC] Supervisory Actuary - DH

Pension Benefit Guaranty Corporation [PBGC]

Remote / Washington DC

Selected New Discussions

Offering FSAs to Ex-Pat Employees

"We have a handful of ex-pats (US citizens working abroad). Anything to look out for, if we offer them FSA accounts?"

BenefitsLink Message Boards

Press Releases

Securian Financial Teams Up with iGrad to Offer the Enrich Financial Wellness Platform to Retirement Plan Clients

Securian Financial Group

Webcasts and Conferences
(Health & Welfare Plans)

Hot Topics and Trends in Employee Benefits: What Employers Need to Know

November 3, 2021 WEBCAST

Epstein Becker & Green

Last Issue's Most Popular Items

Employers with Illinois Employees Must Provide a Comparison of their Health Plan with State-Required Essential Health Benefits

HUB International

CMS Look-up Table: ICHRA Employer Lowest Cost Silver Plan Premium

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

Employer Group and Mark Cuban-Owned Company Launch Pharmacy Benefit Managers

The Wall Street Journal; subscription may be required

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

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