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Health & Welfare Plans Newsletter

December 16, 2021

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[Guidance Overview]

Group Health Plans Subject to New Prescription Drug and Health Care Spending Reporting Requirements

"The IFR allows a fully-insured group health plan to enter into a written agreement with an insurance issuer under which the issuer agrees to provide the report to the Departments and accepts liability for failure to do so.... [S]ponsors of self-funded group health plans may enter into similar agreements with other entities ... [U]ltimate liability for the reporting will remain with a plan sponsor of a self-funded plan regardless of the agreement."  MORE >>

Foley & Lardner LLP

[Guidance Overview]

Making a List, Checking It Twice: Year-End Guidance on Drug Cost Reporting

"The interim final regulations ... confirmed earlier guidance that initial reporting for 2020 and 2021 will be due by December 27, 2022.... The new interim final rules also clarify that only limited data must be reported at the plan level. Instead, insurers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs) may aggregate much of the drug cost data by state and by market segment ... within the state."  MORE >>

Ogletree Deakins

[Guidance Overview]

IRS's Final 2021 ACA Reporting Forms and Instructions Include Important Process Changes

"The deadline extension is automatic, but the alternative method of furnishing forms to certain individuals requires careful consideration of the detailed requirements described in the instructions. Elimination of the good faith penalty relief for incorrect or incomplete information means filers need to really scrutinize their returns before filing."  MORE >>

Thomson Reuters / EBIA

How Budget Bill Could Affect Employer Plans

"Decrease in the ACA affordability threshold ... New penalty for mental health parity noncompliance ... Expansion of the premium tax credit for lower-income individuals ... Reinstatement and expansion of the qualified bicycle commuting reimbursement exclusion ... Limitation on cost-sharing requirements for certain insulin products ... Inclusion of new reporting requirements for PBMs."  MORE >>

Hall Benefits Law

Fifth Circuit Lifts Stay of CMS Vaccine Mandate for Healthcare Workers in Most States

"The court decided to limit the injunction to the 14 states that filed the initial action ... This decision did not impact the preliminary injunction over the 10 states that filed suit in Missouri v Biden ... Meaning, that only [24 states] are currently protected by court order and are not required to comply with the CMS mandate." [State of Louisiana v. Becerra, No. 21-30734 (5th Cir. Dec. 15, 2021)]  MORE >>

Fraser Trebilcock

Premium Increase Upon Retirement Was a COBRA Qualifying Event

"[T]he appellate court agreed that the employee's placement on unpaid leave was not a qualifying event, explaining that there was a reduction of hours ... but not a corresponding loss of health coverage.... Because the retirement (a termination of employment for COBRA purposes) resulted in a higher premium for the same health coverage (because it was now considered retiree coverage), the employee experienced a loss of coverage, resulting in a COBRA qualifying event." [Randolph v. E. Baton Rouge Parish Sch. Sys., No. 21-30022 (5th Cir. Nov. 30, 2021)]  MORE >>

Thomson Reuters / EBIA

ERISA Preemption and the Illinois Consumer Coverage Disclosure Act

"While the Illinois [DOL] is correct that the Illinois Consumer Coverage Disclosure law does not affect plan design or implicate the savings clause in Section 514, the focus in its FAQ on the law not mandating benefit structure fails to consider the impact of the new law on uniform national plan administration with respect to reporting and disclosure."  MORE >>

Foley & Lardner LLP

National Health Spending Increased in 2020 Due to Impact of COVID-19 Pandemic

"[H]ealth expenditures grew in 2020 at the fastest rate of growth experienced since 2002. However, when spending for federal public health and other federal programs (which includes COVID-19 supplemental funding) is removed, NHE growth was only 1.9%, a slower rate of growth from the 4.3% increase in 2019, largely due to reduced use of medical care goods and services because of the pandemic."  MORE >>

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

40% of Health Payments Tied to Alternative Payment Models in 2020

"Roughly 40% of U.S. healthcare payments were tied to alternative payment models (APMs) last year ... 38.2% of healthcare payments in 2019 and 40.9% of payments in 2020 were tied to an APM.... [T]he commercial insurance business had 32% of its dollars in an APM for 2019 and only slightly increased to 35% the next year."  MORE >>


Workplace Life, Disability and Supplemental Health Products Record Double-Digit Growth in Third Quarter 2021

"n a very competitive job market, employers recognize the need to offer a robust benefits package to attract and retain the best talent. [LIMRA] research suggests non-medical benefits to rise at least 20% over the next five years."  MORE >>


In a Competitive Job Market, Helping with Student Loan Payments May Give Your Business the Edge

"[T]he annual limit on tuition assistance, and by extension on student loan repayment assistance, is $5,250 ... The $5,250 annual limit applies to both student loan repayments, and tuition reimbursement.... You need a written plan document.... The assistance must be fully employer-funded and may not be offered as an alternative to employees' existing or additional cash compensation.... You must substantiate proper use of the funds for permitted tuition or student loan repayments."  MORE >>

E is for ERISA

Employee Benefits Jobs

View job as Defined Contribution Administrator
for Pension Kinetics, Inc. Defined Contribution Administrator

Pension Kinetics, Inc.

Remote / Westminster CA

Press Releases

Custodia Financial and Its Retirement Loan Eraser Program Announce DE&I Certification

Custodia Financial

OneDigital Acquires Benemax


Last Issue's Most Popular Items

COVID-19 Health and Welfare Plan Relief: What's Still Effective? What's Expiring?

HUB International

New Auditing Standard: SAS 136 Will Impact Employee Benefit Plan Audits

Meaden & Moore

Upcoming ACA Deadlines to Mark on Your Calendar

Tango Health

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

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