logo logo

Health & Welfare Plans Newsletter

December 28, 2021

3 New Job Opportunities 3 New Job Opportunities


[Official Guidance]

Text of CMS Final Rule Rescinding Most Favored Nation Model

12 pages. "In this final rule, [CMS rescinds] the November 2020 [most favored nation (MFN Model)] interim final rule and remove[s] the associated regulatory text at 42 CFR part 513.... [T]he MFN Model is withdrawn, effective [60 days after publication of this rule in the Federal Register]."  MORE >>

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

[Guidance Overview]

Upcoming Deadline icon Connecticut Paid Leave Payments and Connecticut FMLA Changes Coming January 1

"Effective January 1, the existing CT FMLA will change dramatically. Many employers who previously were not covered by the law will now be diving into leave administration. The Connecticut [DOL] regulations regarding these changes are pending. Once released, they will be subject to a 30-day comment period before becoming final."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

Upcoming Deadline icon Washington Cares Fund Update: Employers Advised to Withhold Long-Term Care Premiums Starting January 1

"Washington Governor Jay Inslee has clarified that, starting January 1, 'employers will still be legally obligated to pay the full amount owed to state ESD [Employment Security Department] to begin the long-term care program' under the Washington Long-Term Services and Supports Act, until the legislature changes the law."  MORE >>

Jackson Lewis P.C.

Drilling Down Into Your Network: Where Are All the Dentists?

"Network size alone may not be telling the whole story when it comes to employee access to dental providers.... Geographic access to providers may be measured in different ways.... Are there contracting opportunities in areas with low geographic access? ... Can we better manage plan costs for employees in low geographic access areas who obtain out-of-network care?"  MORE >>


Health Plan Trends of 2022

"Pandemic year three is at hand ... Expect multiple disruptions aimed at improving patient experience and outcomes, including, social determinants of health (SDOH); exchange and Medicare Advantage (MA) plan growth; and advanced digitization. Payers will continue to grapple with the forces of consolidation and value-based care (VBC) as COVID concern runs tandem with delivery system progress."  MORE >>

HealthLeaders Media

New Massachusetts Law Targets Surprise Medical Bills

"The new state law addresses balance-billing in non-emergency scenarios. The state law complements the federal one, but it merely stipulates that a healthcare provider divulge whether they partake in their patient's insurance plan a week before carrying out a non-emergency procedure."  MORE >>

AT&T Slashes Promised Life Insurance for Many Retirees

"AT&T's decision to cut life insurance and death benefits as of Jan. 1 for many of the 220,000 retirees eligible for the benefits has roiled a generation of workers who say their former employer is reneging on a promise. The cuts don't apply to top executives, who have life insurance under a separate company-paid program, which the company can't reduce without their permission."  MORE >>

The Wall Street Journal; subscription may be required

Eighth Circuit Finds Abuse of Discretion When Insurance Company Stopped Payments of Anesthesiologist's Disability Benefit After 10 Years

"The [U.S. Court of Appeals for the Eighth Circuit] concluded that Sun Life abused its discretion by terminating Roehr's benefits based substantially on the same records it had before it when it found him continuously disabled for ten years. In other words, the court found that there was no evidence in the record to justify Sun Life's about-face. The court remanded the matter to the district court with directions to order Sun Life to reinstate Roehr's benefits." [Roehr v. Sun Life Assurance Co. of Canada, No. 21-1559 (8th Cir. Dec. 27, 2021)]  MORE >>

Roberts Disability Law

Affordability Issues with Employer-Sponsored Health Plans Create Mental Health Issues

"[M]ore than one quarter (27%) of employees who had significant medical expenses said those expenses had a major impact on their mental health, while 16% indicated such expenses had a major impact on their family's well-being.... 40% of those with deductibles from $1,000 to $3,999 do not have adequate savings to cover a major medical expense[.]"  MORE >>

BenefitsPro; free registration required


Telehealth Payment Parity Mandates Are Blocking Cost Savings

"[M]ost payment parity mandates require insurers to reimburse telehealth services on the same basis as equivalent in-person services. When permitted to differ, telemedicine reimbursement rates (and costs for patients) tend to be lower. Payment parity mandates thus act as price floors for telemedicine ... [as they] essentially require higher reimbursement rates for telehealth than would be negotiated without the mandate. That makes them price controls, with predictable effects."  MORE >>

The Hill

Benefits in General

[Official Guidance]

Text of DOL Final Revisions to Instructions for 2021 Forms 5500 and 5500-SF (Annual Information Return/Reports)

29 pages. "This document contains final revisions to the instructions for the Form 5500 Annual Return/Report of Employee Benefit Plan and Form 5500-SF Short Form Annual Return/Report of Small Employee Benefit Plan effective for plan years beginning on or after January 1, 2021. These final revisions to the instructions were included in a broader proposal of form and instruction changes published on September 15, 2021. The limited number of instruction changes in this document implement annual reporting changes for multiple-employer plans (including pooled employer plans) that result from statutory provisions in section 101 of the [SECURE Act]. The other changes to the Form 5500 Annual Return/Report included in the September 2021 proposal will be the subject of one or more separate and later final notices.... The final instruction revisions in this document are effective for plan years beginning on or after January 1, 2021."  MORE >>

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

Is Biden's EBSA Nominee Doomed?

"[T]he full Senate has not acted on her nomination, and prior to adjourning the first session of the 117th Congress for the holiday break, [Lisa Gomez] was among several nominees whose nominations will not be allowed to carry over into the second session. They must be resubmitted after the new session convenes in early January and the hearing/approval process repeated."  MORE >>

American Retirement Association [ARA]

Employee Benefits Jobs

View job as Financial Processor (Distributions Specialist)
for Retirement Solutions Specialists Financial Processor (Distributions Specialist)

Retirement Solutions Specialists

Remote / Jacksonville FL

View job as Financial Processor (Distributions Specialist)
for Retirement Solutions Specialists

View job as Senior Plan Consultant
for Sentinel Benefits & Financial Group Senior Plan Consultant

Sentinel Benefits & Financial Group

Remote / Wakefield MA

View job as Senior Plan Consultant
for Sentinel Benefits & Financial Group

View job as Legal Administrative Specialist (Legal Operations)
for Pension Benefit Guaranty Corporation [PBGC] Legal Administrative Specialist (Legal Operations)

Pension Benefit Guaranty Corporation [PBGC]

Remote / Washington DC

Last Issue's Most Popular Items

Seventh Circuit Affirms Doctor Did Not Have Valid Assignment to Pursue ERISA Statutory Penalty Claim Against Plan Administrator

Roberts Disability Law

Payers, Plan Sponsors Hope for 2022 Telehealth, Drug Price Laws


Big MLR Rebates Point to Ever-More-Profitable ACA Exchanges


Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2021, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.