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Health & Welfare Plans Newsletter

October 27, 2021

7 New Job Opportunities 7 New Job Opportunities


[Official Guidance]

HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes (PDF)

84 pages, Oct. 26, 2021. "This paper provides additional detail and analyses on the model updates proposed in the 2022 Payment Notice. It also includes information on HHS' ongoing evaluation of the state payment transfer formula's current cost-sharing reduction induced demand factors (CSR IDFs)."  MORE >>

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

[Official Guidance]

Text of 2021 IRS Form 1095-B and Instructions: Health Coverage Report (PDF)

"This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year.... [If] individuals in your tax family are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit." [Also available: 2021 IRS Form 1094-B, Transmittal of Health Coverage Information Returns]  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

2021 ACA Reporting: Preparing Forms 1094 and 1095

"[In] Notice 2020-76, the IRS announced that it would no longer provide relief for good faith efforts ... [M]any past years saw automatic extensions to furnish statements to individuals and, in some years, extensions to filing deadlines. But such transitional relief will not be available for the 2021 reporting year.... For reporting years 2019 and 2020, the IRS granted relief from penalties for failure to furnish Forms 1095-B to individuals if certain conditions were met.... That relief has been removed from the 2021 draft Form 1095-B Instructions."  MORE >>


[Guidance Overview]

Upcoming Deadline icon December 31 Deadline for COVID-19-Related Cafeteria Plan Amendments

"Employers who took advantage of the COVID-19 relief measures when operating their cafeteria plans have until Dec. 31, 2021 to ensure that any operational changes they followed are incorporated into their written plan documents.... These rules also apply to Health FSAs and DCAPs that are separate plans from the employer's section 125 cafeteria plan."  MORE >>


[Guidance Overview]

IRS Provides Guidance on COBRA Election and Payment Deadlines

"[A] plan may not require a qualified beneficiary to make an initial COBRA premium payment before November 1, 2021, as long as the payment is made within one year and 45 days of the individual's COBRA election.... [F]or periods not covered by the initial COBRA premium payment ... [Notice 2021-58] indicates that the payments are due one year from the date that the payment originally would have been due, taking into account the normal 30-day grace period."  MORE >>

McDermott Will & Emery

[Guidance Overview]

New Surcharge on Insured and Self-Insured Plans Covering Washington State Residents

"Washington state recently enacted an assessment on health insurance carriers, self-funded MEWAs, and employers that sponsor self-insured plans that cover Washington state residents. These entities will be required to report and pay an assessment on a quarterly basis to the WA Partnership Access Line (PAL) Fund for each month in a quarter that the plan covers one or more lives in Washington state."  MORE >>

HUB International

Report of the State All Payer Claims Databases Advisory Committee, with Recommendations, Pursuant to ERISA Section 735 (PDF)

30 pages. "The primary focus of these recommendations ... is to guide Secretary Walsh in developing a standardized reporting format for the voluntary reporting by self-funded group health plans to State All Payer Claims Databases (APCDs), and to help in developing guidance to States on the process by which States may collect data from such plans. Additionally, the Committee's recommendations include longer-term recommendations that Secretary Walsh and other health agency leadership may wish to consider to strengthen the path toward actionable data and effective data-driven health care transformation."  MORE >>

State All Payer Claims Databases Advisory Committee [SAPDAC], U.S. Department of Labor [DOL]

How Billing Turns a Routine Birth Into a High-Cost Emergency

"[O]ver the past 20 years, hospitals and doctors have learned there's great profit in upcoding visits. After all, the insurer isn't in the exam room to know what transpired. [One] investigation ... found that between 2001 and 2008 the number of Level 4 and 5 visits for patients who were sent home from the ER nearly doubled to almost 50% of visits.... [A Colorado study] looked at emergency visit billing from 2009 to 2016 and found that the percentage of emergency visits coded as Level 5 steadily grew from 23% to 34% for patients with commercial insurance."  MORE >>

Kaiser Health News

Report Addresses State All-Payer Claims Database Reporting by Group Health Plans, Including Privacy Concerns

"The committee's report acknowledges that health plans (as HIPAA covered entities) have expressed privacy and security concerns over providing participants' claims data to APCDs ... The report includes several recommendations intended to encourage self-funded health plans to voluntarily contribute claims data information to APCDs, ... The report also includes recommendations for creating standards for the electronic format and exchange of health data and related information by APCDs.... The report also provides recommendations on the process for submitting data to state APCDs."  MORE >>

Thomson Reuters Practical Law

Prescription Drug Supply Chains: An Overview of Stakeholders and Relationships

49 pages. "Financial incentives drive the structure of prescription drug supply chains and the behavior of stakeholders. Approximately 80 percent of spending but only 10 percent of prescriptions are for brand-name drugs.... Three distributors ... account for nearly all the U.S. market. Customers include large pharmacy chains, independent pharmacies, physician offices, and hospital systems.... PBMs assemble networks of pharmacies that agree to the PBM's payment terms in exchange for an increase in prescription volume from PBM patients. The three largest PBMs ... cover three-fourths of U.S. prescription claims."  MORE >>

RAND Corporation

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Notice MS-2021-03, for Victims of Hurricane Ida in Mississippi

"Victims of Hurricane Ida that began August 28, 2021 now have until January 3, 2022, to file various individual and business tax returns and make tax payments ... Individuals and households affected by remnants of Hurricane Ida that reside or have a business in Amite, Claiborne, Copiah, Covington, Franklin, George, Hancock, Harrison, Jackson, Jefferson, Jefferson Davis, Lawrence, Lincoln, Pearl River, Pike, Simpson, Walthall, Wayne, and Wilkinson counties qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Retirement Account Administrator, Senior
for Alerus Retirement Account Administrator, Senior



View job as Senior Legal Content Specialist - Benefits
for Bloomberg Industry Group Senior Legal Content Specialist - Benefits

Bloomberg Industry Group

Arlington VA

View job as Cash Balance Actuary
for Alerus Cash Balance Actuary



View job as Retirement Plan Services Relationship Manager
for Fulton Bank Retirement Plan Services Relationship Manager

Fulton Bank

Remote / Lancaster PA / DE / MD / NJ / VA

View job as Pension Administrator
for Creative Pension Consultants, Inc. Pension Administrator

Creative Pension Consultants, Inc.

Remote / Albany NY

View job as Benefits Advisor
for Employee Benefits Security Administration [EBSA] Benefits Advisor

Employee Benefits Security Administration [EBSA]

Remote / Washington DC

View job as Third-Party Plan Administrator
for Saltmarsh, Cleaveland & Gund Third-Party Plan Administrator

Saltmarsh, Cleaveland & Gund

Remote / Tampa FL

Press Releases

ASPPA Honors Nova 401(k)’s Craig Hoffman

Nova 401(k) Associates

MDsave Launches Transformative Healthcare Purchasing Platform Designed Specifically for Employers


Webcasts and Conferences
(Health & Welfare Plans)

2022 On-Site Employee Health Clinics Congress

January 13, 2022 in CA

BRI Network

Last Issue's Most Popular Items

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

Society of Professional Benefit Administrators [SPBA]

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

Epstein Becker Green, via Employee Benefit Plan Review

Employer Group Launches Its Own PBM


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

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