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Health & Welfare Plans Newsletter

November 18, 2021

8 New Job Opportunities 8 New Job Opportunities


[Guidance Overview]

Draft Instructions for Forms 1094-C and 1095-C: Changes Mean Accurate Completion Will Be Imperative for the 2021 Reporting Season

"The draft instructions for the Forms 1094-C and 1095-C for the 2021 reporting season were released in late September with subtle, but important changes. To an untrained eye, these changes may fly under the radar. However, for the first time since the [ACA's] inception, employers who file incorrect or incomplete Forms 1095-C with the IRS may suffer costly penalties."  MORE >>


[Guidance Overview]

New Rule Requires Health Plans and Insurers to Report Prescription Drug Data

"Since the new rule requires covered plans and insurers to report data for prescription expenditures in 2020 and 2021 by December 27, 2022 and annually thereafter, covered plans and insurers will want complete the necessary arrangements to collect the data as soon as possible to minimize the cost and burdens of collecting and preparing the reports required at the end of the year."  MORE >>

Solutions Law Press

[Guidance Overview]

Telehealth and HSA/HDHP Flexibility Scheduled to End January 1

"Upon the expiration of this temporary CARES Act relief, plans will need to be sure to apply prior limitations to the use of telemedicine within an HSA-compatible high deductible health plan, to avoid violation of IRS 'first dollar rules' requiring that the HSA participant first satisfy his/her deductible before receiving plan coverage for most non-preventive services. In addition, plans will need to be sure to follow rules that require the plan to charge a reasonable fee and apply charges to the deductible and out-of-pocket maximums."  MORE >>

HUB International

Air Ambulance Group Sues to Block Surprise Billing Rule's Arbitration Provisions

"The Association of Air Medical Services (AAMS) ... which represents air ambulance providers that are major sources of surprise medical bills, charges that the rule ... calls for the third-party arbiter to put too much weight on ... the insurer's median in-network rate for a service in an area.... The group charges that a fairer process would consider factors such as the type of aircraft used in transportation and the acuity of the patient." [Association of Air Medical Services v. HHS, No. 21-3031 (D.D.C. complaint filed Nov. 16, 2021)]  MORE >>


Eighth Circuit Upholds North Dakota Rules for Pharmacy Benefit Managers

"A unanimous panel of the 8th U.S. Circuit Court of Appeals ruled Wednesday that most of the law did not conflict with the federal law governing employee benefits plans, reversing its own earlier holding. It struck down some parts of the law, limiting fees charged by PBMs to pharmacies, on the grounds that they conflicted with the federal Medicare statute." [Pharmaceutical Care Management Assoc. (PCMA) v. Wehbi, No. 18-2926 (8th Cir. Nov. 17, 2021)]  MORE >>


First Circuit Holds That 'Full and Fair Review' of Claim Denial Requires Disclosure of Medical Reports Generated During Appeal

"ERISA ... requires that plan fiduciaries employ a 'full and fair' claims procedure for reviewing benefit claims. But courts have grappled with ... whether this requires that a plan participant or beneficiary making a claim for benefits be given an opportunity to review and respond to medical reports before they are relied upon by the claims administrator to deny the claim. The answer from the First Circuit is a resounding 'yes,' regardless of what version of the [DOL's] claims regulation applies." [Jette v. United of Omaha Life Ins. Co., No. 20-1713 (1st Cir. Nov. 10, 2021)]  MORE >>

Kantor & Kantor

Key Driver of High Rx Spending: Brand-Name Drug Prices

"High U.S. drug prices are a financial strain for patients, employers, and state and federal governments. [A series of charts presents] the findings from a number of studies on prescription drug costs and spending in the United States with other high-income countries to reveal the main culprit: high U.S. prices for brand-name drugs."  MORE >>

The Commonwealth Fund

Potential Costs and Impact of Health Provisions in the Build Back Better Act

"This brief summarizes major health provisions as of the bill reported to the House Rules Committee on November 3, 2021, which, at the time of publication, has not yet received a CBO score. Negotiations are ongoing and there may be future changes."  MORE >>

Henry J. Kaiser Family Foundation

How an FSA Grace Period and Rollover Impact HSA Eligibility

"If the FSA has a grace period and the employee has no funds remaining in the FSA at the end of the plan year, then the employee may begin contributing to the HSA at the beginning of the new plan year. However, if the employee has any funds remaining in their FSA at the end of the plan year, then they must wait until the grace period ends to begin contributing to an HSA.... If an employee rolls over any unused FSA funds to the new plan year, they would not be eligible to enroll in or contribute to an HSA. In order to be HSA eligible, the employee would need to spend all of their FSA funds by the end of the plan year or transfer the FSA funds to a limited purpose FSA."  MORE >>



Public Opinion Is Unified on Lowering Prescription Drug Prices. Why Are Leaders Settling for Less?

"Democrats and Republicans are crystal clear in polls that they want government to be allowed to negotiate down high drug prices.... The current proposal on drug prices in Biden's Build Back Better spending package with support from Congress (so far) contains strong consumer protections ... But when it comes to allowing the government to negotiate better prices, the provisions are narrow, byzantine and distant."  MORE >>

Kaiser Health News

Benefits in General

[Official Guidance]

IRS Announcement: All of Mississippi Now Qualifies for Expanded Hurricane Ida Relief; Deadlines Extended to January 3

"The updated relief, now covering the entire state of Mississippi, postpones various tax filing and payment deadlines that occurred starting on August 28, 2021.... [A]ffected individuals and businesses will have until January 3, 2022, to file returns and pay any taxes that were originally due during this period."  MORE >>

Internal Revenue Service [IRS]

Sixth Circuit Ruling Highlights Longstanding Questions About Federal Civil Procedures in ERISA Litigation

"Judge Murphy's concurrence, coupled with Judge Thapar's concurring opinion questioning the requirement of administrative exhaustion prior to filing suit on an ERISA claim, has opened a long-overdue dialogue on a number of questionable practices used by courts in ERISA litigation that deviate from the Federal Rules of Civil Procedure and have never been addressed by the Supreme Court." [Card v. Principal Life Ins. Co., No. 20-6217 (6th Cir. Nov. 2, 2021)]  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Employee Benefits Jobs

View job as Distribution Specialist
for Carpenter Morse Group Distribution Specialist

Carpenter Morse Group

Remote / Longwood FL

View job as Distribution Specialist
for Carpenter Morse Group

View job as Employee Benefits Associate
for Willcox & Savage, P.C. Employee Benefits Associate

Willcox & Savage, P.C.

Norfolk VA

View job as Retirement Plan Administration
for The Benefit Advantage Retirement Plan Administration

The Benefit Advantage

Remote / Auburn Hills MI

View job as Education and Enrollment Specialist
for Nationwide Insurance Education and Enrollment Specialist

Nationwide Insurance

Remote / TX

View job as Defined Contribution Retirement Plan Analyst
for Metro Benefits, Inc. Defined Contribution Retirement Plan Analyst

Metro Benefits, Inc.

Remote / Pittsburgh PA

View job as Enrolled Actuary
for Loren D. Stark Company (LDSCO) Enrolled Actuary

Loren D. Stark Company (LDSCO)

Remote / Houston TX

View job as Retirement Services Plan Manager
for OneAmerica Financial Partners, Inc Retirement Services Plan Manager

OneAmerica Financial Partners, Inc

Indianapolis IN

View job as ESOP Administrator
for Blue Ridge ESOP Associates ESOP Administrator

Blue Ridge ESOP Associates

Remote / Charlottesville VA

Press Releases

Groom Elects Christine L. Keller as Executive Principal

Groom Law Group

Benefitfocus Acquires Tango Health, Expanding ACA Compliance and Reporting Capabilities for Employers


AHIP Board of Directors Elects David L. Holmberg, President and CEO of Highmark Health, Chair for 2022

AHIP [America's Health Insurance Plans]

Last Issue's Most Popular Items

ACA Numbers and Limits 2015-2022 (PDF)

Kaufman & Canoles, P.C.

Text of Joint Agencies Interim Final Rule with Request for Comments: Prescription Drug and Health Care Spending

U.S. Department of Health and Human Services [HHS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of the Treasury, and U.S. Office of Personnel Management [OPM]

Fate of OSHA's COVID-19 Vaccine ETS in the Hands of Sixth Circuit Court of Appeals

Jackson Lewis P.C.

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

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