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Health & Welfare Plans Newsletter

November 3, 2021

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

Upcoming Deadline icon Upcoming Compliance Deadlines for Health and Welfare Plans

"If an employer has taken advantage of any of the temporary relief opportunities offered on account of the COVID-19 pandemic for cafeteria plans or flexible spending arrangements, the employer will need to amend relevant plan documents to reflect changes that they made.... All plans now need to cover the full cost of COVID-19 testing and vaccinations, but plan amendments may be especially important for discretionary changes, such as the coverage of over-the-counter drugs and menstrual products under a health FSA or the elimination of any deductible for telemedicine expenses in a high-deductible health plan."  MORE >>

Ballard Spahr LLP

[Guidance Overview]

Health Plan Investigations: The ACA's 'Prudent Layperson' Standard

"[In] the preamble to the interim final rule 'Requirements Related to Surprise Billing; Part I,' DOL, [HHS], and Treasury explained that denials cannot be based solely on diagnosis code and must instead be evaluated under the prudent layperson standard.... The practical effect is that the agencies have codified DOL's enforcement position under the ACA's emergency services rule that the use of a True ER List is impermissible as a sole basis to deny claims."  MORE >>

Groom Law Group

[Guidance Overview]

Illinois General Assembly Passes Legislation Providing COVID-19-Related Paid Administrative Leave for School and Public College and University Employees

"On October 28, the Illinois General Assembly passed legislation that, if signed by Governor Pritzker, will provide mandatory paid administrative leave for school and Illinois public college and university employees for COVID-19-related absences.... [P]er the current version of the legislation, any sick days previously taken by a school district employee in accordance with COVID-19 guidance issued by the State and/or its agencies since the beginning of the 20-21 school year must be returned to the employee."  MORE >>

Franczek P.C.

Sixth Circuit: District Courts Retain Jurisdiction Over an ERISA Suit That Has Been Remanded to the Plan Administrator

"When a district court orders a remand to the plan administrator, it retains jurisdiction over the case while the administrator reconsiders the claim. The first panel should have vacated the district court's judgment in favor of Principal and remanded the case to the district court with instructions that it remand the case to Principal. Because the first panel remanded the matter to Principal, the district court erroneously determined that it had nothing else to do.... The district court did have jurisdiction over Card's motions for fees and to reopen the case." [Card v. Principal Life Ins. Co., No. 20-6217 (6th Cir. Nov. 2, 2021)]  MORE >>

Roberts Disability Law

Insurance and Benefit Policy Trends for 2022

"Before the pandemic, setting health insurance rates followed a formulaic pattern. But, with COVID-19 throwing healthcare costs for a 2-year loop, finding a relevant comparable year on which to set premiums is a major challenge.... [N]ow may be an opportunity to examine the totality of what each employer offers. If an employer is offering a particularly costly benefit but the employees aren't utilizing that benefit, that may be worth reexamining."  MORE >>

HR Daily Advisor

Exceptional Usefulness and Quality icon Unvaccinated? Don't Count on Leaving Your Family Death Benefits

"[W]ith COVID, some front-line workers have been considered eligible for accidental death benefits because they are presumed to have gotten sick on the job ... Now that vaccines are widely available, some employers have considered limiting other benefits paid to unvaccinated workers, including reducing short-term disability payments[.]"  MORE >>

Kaiser Health News

Four Steps to Your Most Successful Open Enrollment Ever

"[1] Explain the variables they should consider when determining the right plan ... [2] Do the math for them ... [3] Highlight important aspects of coverage, especially for big-ticket items ... [4] Make it easy to include their spouse/partner in the decision."  MORE >>


CMS Finalizes Fee Hikes for Hospital Price Transparency Requirements

"Beginning Jan. 1, the Biden administration will increase the penalty for certain hospitals that are not in compliance with its hospital price transparency requirements. [CMS announced] that it will set a minimum civil monetary penalty of $300 per day for hospitals with 30 or fewer beds.... [H]ospitals with more than 30 beds ... will be charged $10 per bed per day, which will cap at $5,500 daily."  MORE >>


Democrats Reach Deal on Drug Pricing Reform That Caps Costs, Negotiates Parts D and B Prices for Some Drugs

"Democrats have reached a deal on lowering prescription drug prices that ... will give Medicare the power to negotiate for a certain number of drugs.... [T]he deal will enable Medicare to negotiate the price of certain drugs in Medicare Parts B and D. It also caps out-of-pocket spending on beneficiary drug costs at $2,000 a year and would set a cap on insulin for $35."  MORE >>


Centene to Exit the PBM Business

"Centene, the nation's largest Medicaid managed-care company, is planning to stop its work as a pharmacy middleman, or pharmacy benefit manager. Executives last week said the company is issuing a $30 billion request for proposals from an outside contractor to take over the work"  MORE >>

Ohio Capital Journal

Benefits in General

[Official Guidance]

More Ida Relief from IRS: Sept. 15, Oct. 15 Deadlines, Other Dates Extended to Jan. 3 for Parts of Connecticut

"Victims of Hurricane Ida in parts of Connecticut now have until January 3, 2022, to file various individual and business tax returns and make tax payments.... [T]he IRS is offering this relief to those parts of the state designated for either individual or public assistance. Currently, this includes Fairfield and New London counties, including the Mashantucket Pequot Tribal Nation and the Mohegan Tribal Nation."  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Actuarial Consultant
for October Three Consulting LLC Actuarial Consultant

October Three Consulting LLC

Remote / Chicago IL / Irving TX / Jacksonville FL

View job as Actuarial Consultant
for October Three Consulting LLC

View job as Plan Document Specialist
for AimPoint Pension Plan Document Specialist

AimPoint Pension


View job as Plan Document Specialist
for AimPoint Pension

View job as Regional Employee Benefits Compliance Lead
for Hilb Group Regional Employee Benefits Compliance Lead

Hilb Group

Remote / Cranston RI / Needham Heights MA

View job as Regional Vice President, Outside Sales Consultant
for RetireWell Administrators, Inc. Regional Vice President, Outside Sales Consultant

RetireWell Administrators, Inc.

Remote / NY

View job as Retirement Plan Administrator
for Horace Mann/Benefit Consultants Group Retirement Plan Administrator

Horace Mann/Benefit Consultants Group

Cherry Hill NJ

Press Releases

The Center for Board Certified Fiduciaries™ (CBCF™) Is Affiliating with Wake Forest University School of Professional Studies (SPS)

Center for Board Certified Fiduciaries

EPIC National Employee Benefits Practice Receives Impressive Net Promoter Score


Vestwell Announces Plan to Acquire BNY Mellon's Sumday


Webcasts and Conferences
(Health & Welfare Plans)

Coming Soon: Disclosures From Group Health Plan Brokers and Consultants

November 18, 2021 WEBCAST

Groom Law Group

Last Issue's Most Popular Items

New Health Plan Requirements for Employers in 2022: Consolidated Appropriations Act Checklist

The Alliance

IRS Information Letter Addresses Employee Prescription Drug Rebates and HDHPs


Self-Funded Employers May Need to Pay Washington State Mental Health Program Fee


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

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