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Health & Welfare Plans Newsletter
December 28, 2021
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3 New Job Opportunities
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[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 [T]he MFN Model is withdrawn, effective [60 days after publication of this rule in the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]
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[Guidance Overview]
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.
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[Guidance Overview]
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.
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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 >>
Milliman
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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
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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 >>
InsuranceNewsNet.com
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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
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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
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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
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[Opinion]
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
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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]
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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]
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Employee Benefits Jobs |
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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
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Payers, Plan Sponsors Hope for 2022 Telehealth, Drug Price Laws
AISHealth
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Big MLR Rebates Point to Ever-More-Profitable ACA Exchanges
AISHealth
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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.
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