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Health & Welfare Plans Newsletter

November 19, 2021

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

HHS Announces Adjustments to Civil Monetary Penalties for HIPAA, MSP, and SBC Violations, Effective November 15, 2021

"Offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary: $9,753 (up from $9,639). Failure of responsible reporting entities to provide information identifying situations where the group health plan is primary: $1,247 (up from $1,232).... The penalty for a health insurer's or non-federal governmental health plan's willful failure to provide an SBC is $1,190 (up from $1,176) for each failure."  MORE >>

Thomson Reuters / EBIA

Court Dismisses Former Employee's COBRA Claims Against TPA

"The court found that due to a mistake, the employee's insurance coverage was not actually terminated by the insurer, and her benefit claims were ... Noting that the insurer had not attempted to recoup any benefits, the court concluded that the employee had suffered no damages." [McKenna v. ZO Skin Health, Inc., No. 20-783 (N.D. Ohio Sep. 8, 2021)]  MORE >>

Thomson Reuters / EBIA

Eighth Circuit Holds ERISA Does Not Preempt North Dakota Laws Regulating Pharmacy Benefits Managers

"On remand from the Supreme Court ... the Eighth Circuit ... held that none of the challenged provisions meets the connection-with standard for ERISA preemption. Certain provisions of the [North] Dakota law merely authorize pharmacies to do certain things that involve noncentral matters of plan administration with de minimus economic effects that impact the uniformity of plan administration across states." [Pharmaceutical Care Management Assoc. (PCMA) v. Wehbi, No. 18-2926 (8th Cir. Nov. 17, 2021)]  MORE >>

Roberts Disability Law

Supreme Court to Decide Medicare Dialysis Case

"DaVita argues that treating dialysis benefits less favorably than other benefits violates the MSPA. Marietta Memorial Hospital Employee Health Benefit Plan argues it hasn't violated the [Medicare Secondary Payer Act (MSPA)] because it provides the same dialysis benefits to all plan participants and reimburses dialysis providers uniformly regardless of whether the patient has end-stage renal disease. The 6th Circuit agreed with DaVita that the health plan may have violated three provisions of the MSPA." [Marietta Memorial Hospital Employee Health Benefit Plan v. Davita, Inc., No. 19-4039 (6th Cir. Oct. 14, 2020; cert. pet. granted Nov. 5, 2021)]  MORE >>

National Conference of State Legislatures [NCSL]

Employer-Provided COVID-19 Testing: An Employee Benefits Q&A

"Does a medical plan have to cover all testing for unvaccinated employees enrolled in coverage? ... If a plan does not currently cover employment-based testing, may it be amended to do so? ... Are there factors employers may want to consider if they want unvaccinated employees to pay for their own testing? ... What if an employer decides to pay for employment-based testing outside of the medical plan? ... If an employer pays for employment-based testing, are employees subject to a tax on the cost of the testing?"  MORE >>

Ogletree Deakins

Employer Cost-Sharing Arrangements for Preventive Medications and Services in Response to IRS Notice 2019-45 (PDF)

"IRS Notice 2019-45 [increased] the flexibility of health savings account (HSA)-eligible health plans to cover specific low-cost preventive services ... on a pre-deductible basis.... The percentage of employers that eliminated cost sharing for various pre-deductible services ranged from a low of 25 percent to a high of 40 percent. Between nearly one-half and two-thirds required a copayment from employees, depending on the health care service."  MORE >>

Employee Benefit Research Institute [EBRI]

CRS 'Insight': FY2022 NDAA Parental Leave Benefits

"Several proposals included in the FY2022 [National Defense Authorization Act (NDAA)] would amend parental leave policies for servicemembers and federal civilians[.]" [IN11802 Nov. 18, 2021]  MORE >>

Congressional Research Service [CRS]

State Legislator Aims to Tweak Georgia Surprise Billing Law for Self-Funded Health Care Plans

"House Bill 234 aims to amend Title 33 under Georgia Code by providing an option for self-funded health care plans exempt from state regulations under federal law to opt-in to Georgia's Surprise Billing Consumer Protection Act.... [Rep. Lee Hawkins] said that the bill that would allow such health care plans to voluntarily agree to comply with the Surprise Billing Consumer Protection Act's provisions isn't in conflict with ERISA."  MORE >>

Gainesville Times


Middlemen, Not Drug Companies, Are Pushing Up Insulin Prices, and Congress Doesn't Have the Right Plan to Fight Back

"[B]etween 2014 and 2018, the net price received by manufacturers decreased by 31%. For every $100 in spending on insulin in 2014, manufacturers received $70 and middlemen in the supply chain received $30. By 2018, the manufacturer share had declined to $47 and middlemen share had increased to $53. Why should the people who are distributing insulin, such as pharmacy-benefit managers (PBMs), pharmacies and wholesalers, get more than half of the money spent by consumers when they have little to no role in the flow of new drug discoveries?"  MORE >>

MSN News

Employee Benefits Jobs

View job as Customer Experience Specialist
for AimPoint Pension Customer Experience Specialist

AimPoint Pension


View job as Customer Experience Specialist
for AimPoint Pension

View job as Pension Consultant
for Pension Associates Pension Consultant

Pension Associates

Remote / Stamford CT

View job as Growth Support Specialist
for PAi Retirement Services, A Newport Company Growth Support Specialist

PAi Retirement Services, A Newport Company

Remote / De Pere WI / Sioux Falls SD

Press Releases

Fidelity Investments Launches Guaranteed Income Direct to Help Workers Convert 401(k) and 403(b) Savings Into Annuities at Retirement

Fidelity Investments

Report Now Available: United States Health and Medical Insurance Market: Growth, Trends, COVID-19 Impact, and Forecasts (2021-2026)

Epstein Becker Green Reports Telemental Health’s Influence Grows Throughout COVID-19 Pandemic

Epstein Becker & Green

Last Issue's Most Popular Items

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


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

Solutions Law Press

Telehealth and HSA/HDHP Flexibility Scheduled to End January 1

HUB International

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

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