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Health & Welfare Plans Newsletter

December 13, 2021

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

It’s Almost the End of 2021. Do You Know Where Your Healthcare Dollars Go?

"[The Interim Final Rules require] Reporting Entities ... to report annually information about prescription drug and health care spending.... [The] rules apply broadly to grandfathered plans, church plans, non-federal government plans, and individual coverage through or outside of an exchange.... The data the plans and insurance issuers must submit ranges from general plan identifying information and the states in which the plans operate to more precise information."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

IRS Proposes Delayed Effective Dates for ACA Filing Requirements

"A common error is for an employer to check the 'no' box in response to the question of whether coverage is provided to at least 95% of the employer's full-time employees when, in fact, the employer does provide coverage.... In the past, the IRS does not appear to have imposed penalties for such errors. If that practice changes, service providers completing the forms will need to be extra cautious in avoiding errors."  MORE >>

The Wagner Law Group

[Guidance Overview]

Self-Funded Health Plan Sponsors Are Required to Comply with Illinois Disclosure Law

"Who is required to disclose the comparison to group health plan participants? ... Does this requirement apply to ERISA self-funded plans? ... When should the disclosure be provided to employees? ... Will a business be penalized if its group health insurance coverage benefits are not the same as those included in the Essential Health Benefits list?"  MORE >>

HUB International

[Guidance Overview]

Exceptional Usefulness and Quality icon No Surprises Act Implementation: What to Expect in 2022

"Monitoring of the law's impact, as well as compliance, will be accomplished in various ways. Data reporting by IDR entities will provide some information ... Annual health plan audits conducted by federal agencies can also yield information about prices charged and paid for surprise bills.... State systems may also yield important data as to how the law is working ... To a large extent, oversight and enforcement will rely on complaints."  MORE >>

Henry J. Kaiser Family Foundation

Denial of Residential Mental Health Treatment Benefits Overturned on De Novo Review

"According to the appellate court, the claims administrator's denial was arbitrary and capricious and should not have been upheld by the trial court in the first place -- even under the deferential standard of review. Nevertheless, plan decisions are more likely to be upheld when courts apply deferential review, which is available only if the plan grants the decisionmaker discretionary authority. " [Lyn M. v. Premera Blue Cross, No. 17-1152 (D. Utah Nov. 30, 2021)]  MORE >>

Thomson Reuters / EBIA

No Penalties for 'Late' COBRA Notice Provided During COBRA-19 Outbreak Period

"Explaining that the employer's time frame for providing an election notice was extended during the COVID-19 outbreak period, the court determined that the election notice provided in November 2020 was timely based on the employee's March 2020 termination." [Anglim v. Sharp Med. Staffing, LLC, No. 21-171 (D. Neb. Dec. 2, 2021)  MORE >>

Thomson Reuters / EBIA

At-Home COVID-19 Testing Reimbursement Plan Awaits Details

"Beyond the president's remarks, the Biden administration has not put in place a set policy, although [HHS, DOL and Treasury] are expected to issue joint guidance on or before January 15, 2022."  MORE >>

Ogletree Deakins

When (and Why) Providers Do Not Respond to Changes in Reimbursement Rates

"[This paper examines] the impact of reimbursement rates on health care supply by studying a policy that reduced reimbursement rates by 30% in one of the highest-reimbursing workers' compensation insurance systems in the nation. Despite the large decrease in reimbursement rates, [the authors] find no evidence that the policy affected the amount of health care that injured workers receive or recoveries after injuries. ... [E]stimates suggest that the policy reduced annual workers' compensation medical costs by over $400 million and indicate that providers may be operating on the inelastic portion of the supply curve for care paid for by high-reimbursing payers."  MORE >>

National Bureau of Economic Research [NBER]; purchase required for full document


Prescription Drug Importation Policies: Politically Popular, But Problematic for Public Health (PDF)

"Prescription drug importation as a proposed solution to drug pricing is nothing new. The plan, however, is peppered with public health safety risks that NABP has raised for nearly two decades. NABP understands the efforts to increase patient access to affordable medications, but has argued that such efforts must ensure the safety and security of products."  MORE >>

Faegre Drinker, via National Association of Boards of Pharmacy [NABP]


Sources of Health Care Price Variation Create Barriers to Measuring Health Care Costs

"Many employers who purchase and provide health insurance for their employees do not have access to information on provider prices.... Without price information, patients and purchasers have little ability to use cost to inform their decisions. The institutional dynamics of the US health care system create barriers create barriers to obtaining data to measuring prices. While recent policies open the door to some progress, significant barriers to price information continue to exist for patients, purchasers, and researchers."  MORE >>

Health Affairs Blog

Benefits in General

[Official Guidance]

DOL Regulatory Agenda, Fall 2021, Including Employee Benefit Items

Prerule stage

  • Improved Fee Disclosure for Welfare Plans
  • Improving Participant Engagement and Effectiveness of ERISA Retirement Plan Disclosures
  • Pooled Employer Plans

Proposed Rules (EBSA)

  • Implement SECURE Act and Related Revisions to Employee Benefit Plan Annual Reporting on the Form 5500
  • Improvement of the Form 5500 Series and Implementing Related Regulations Under ERISA
  • Definition of the Term "Fiduciary"
  • Prudence and Loyalty in Selecting Plan Investments and Exercising Shareholder Rights
  • Prohibited Transaction Exemption Procedures
  • Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
  • Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021
  • Short-Term Limited Duration Insurance; Update

Final Rules (EBSA)

  • Pension Benefit Statements -- Lifetime Income Illustrations
  • Adoption of Amended and Restated Voluntary Fiduciary Correction Program
  • Requirements Related to Surprise Billing, Part 1
  • Requirements Related to Surprise Billing, Part 2
  • Amendment of Abandoned Plan Program
  • Requirements Related to Prescription Drug Reporting
  • Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement


Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Official Guidance]

IRS Regulatory Agenda, Fall 2021, Including Employee Benefit Items

Numerous employee benefits items, some of which are:

Proposed Rules

  • Definition of Church Plan
  • Application of Nondiscrimination Requirements, Backloading Limitations, Certain Plan Termination Rules, Benefit Limitations, and Top Heavy Rules to Statutory Hybrid Plans
  • MEPs and the Unified Plan Rule
  • Determination of Line of Business for Purposes of No-Additional-Cost Service and Qualified Employee Discount Fringe Benefits
  • SECURE Act Modifications to Certain Rules Governing 401(k) Plans
  • Guidance on 401(a)(9) Required Minimum Distributions
  • Requirements Related to Surprise Billing, Part 2
  • Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
  • Enrolled Agent Special Enrollment Examination User Fee Update and Enrolled Retirement Plan Agent Special Enrollment Examination User Fee Removal
  • Information Reporting of Health Insurance Coverage and Other Issues Under Sections 6055 and 6056
  • Mortality Tables for Determining Present Value Under Defined Benefit Pension Plans
  • Guidance Under Section 36B Regarding the Premium Tax Credit
  • User Fees Relating to Enrolled Agents and Enrolled Retirement Plan Agents
  • User Fees Relating to Enrolled Actuaries
  • Prescription Drug and Health Care Spending
  • Short-Term Limited Duration Insurance; Update
  • Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021

Final Rules

  • Update to Minimum Present Value Requirements for Defined Benefit Plan Distributions
  • Application of Normal Retirement Age Regulations to Governmental Plans
  • Nondiscrimination Relief for Closed Defined Benefit Plans
  • Minimum Value of Eligible Employer-Sponsored Plans
  • Withholding on Certain Retirement Plan Distributions Under Section 3405(a) and 3405(b)
  • Definition of Medical Care
  • Requirements Related to Surprise Billing, Part 1
  • Requirements Related to Surprise Billing, Part 1 (Temporary Regulation)
  • Requirements Related to Surprise Billing, Part 2 (Temporary Regulation)
  • Prescription Drug and Health Care Spending (Temporary Regulation)


Internal Revenue Service [IRS], U.S. Department of the Treasury

Responding to ERISA Claims: Why You Should Bring Rule 52 Motions Instead of Rule 56 Summary Judgment Motions

"[A] new case highlights why Rule 52 motions may be the preferred motion to efficiently resolve ERISA benefit claims.... In most circuits, with cases involving de novo review, the safer practice is to bring Rule 52 motions for judgment, which allows the court to assess the weight and credibility of the evidence and requires the court to issue findings of fact and conclusions of law." [Avenoso v. Reliance Standard Life Ins. Co., No. 21-1772 (8th Cir. Nov. 30, 2021)]  MORE >>

Lane Powell PC

Employee Benefits Jobs

View job as Retirement Plan Relationship Manager
for ERISA Services, Inc. Retirement Plan Relationship Manager

ERISA Services, Inc.

Remote / AL / GA

View job as Retirement Plan Consultant (RPC)
for Qualified Plan Consultants, LLC (QPC) Retirement Plan Consultant (RPC)

Qualified Plan Consultants, LLC (QPC)


Last Issue's Most Popular Items

Text of 2021 Instructions for IRS Forms 1094-C and 1095-C (PDF)

Internal Revenue Service [IRS]

COVID-Related Benefit Mandates Continue

Spencer Fane

Free At-Home COVID Tests Coming Soon But Questions Abound


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

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