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Health & Welfare Plans Newsletter

December 29, 2021

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Text of CMS Notice: Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2023 Benefit Year (PDF)

"[T]he premium adjustment percentage for the 2023 benefit year is 1.4408219719 ... which represents an increase in [employer-sponsored insurance] premiums of approximately 44.1 percent over the period from 2013 to 2022.... [T]he 2023 maximum annual limitation on cost sharing is $9,100 for self-only coverage and $18,200 for other than self-only coverage. This represents an approximately 4.6 percent increase above the 2022 parameters of $8,700 for self-only coverage and $17,400 for other than self-only coverage ... Using the 2023 premium adjustment percentage ... results in the 2023 required contribution percentage under section 5000A of the Code of 8.00 × 1.0210488592 or 8.17 percent ... an increase of approximately 0.08 percentage points from 2022."  MORE >>

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

[Official Guidance]

Text of CMS Proposed Regs: ACA Benefit and Payment Parameters for 2023

408 pages. "This proposed rule includes proposed payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as proposed 2023 user fee rates for issuers offering qualified health plans (QHPs) through federally-facilitated Exchanges and State-based Exchanges on the Federal platform. This proposed rule also proposes requirements related to prohibiting discrimination based on sexual orientation and gender identity; guaranteed availability; the offering of QHP standardized options through Exchanges on the Federal platform; requirements for agents, brokers, web-brokers, and issuers assisting consumers with enrollment through Exchanges that use the Federal platform; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; re- enrollment, and requirements related to a new State Exchange improper payment measurement program. This proposed rule also seeks comment on how HHS can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges."  MORE >>

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

[Guidance Overview]

Text of CMS Fact Sheet: Proposed Notice of Benefit and Payment Parameters for 2023

"Overall, the proposed rule minimizes the number of significant regulatory changes to provide states and issuers with a more stable and predictable regulatory framework that facilitates a more efficient and competitive market. These changes would further the Biden-Harris Administration's goal of advancing health equity by addressing the health disparities that underlie our health system. They also build on the [ACA] to expand access to quality, affordable health coverage and care by lowering premiums, strengthening markets, and enhancing the consumer experience."  MORE >>

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

[Guidance Overview]

New York DOL Releases Final Regs for State Sick Leave Law

"In response to comments from the public about the proposed regulations, the Department clarified some critical issues, but it also left many questions unaddressed -- and in some instances, the Department's response muddies the water rather than clarifies the issues it addresses."  MORE >>


[Guidance Overview]

Alert (High Risk Issue) icon New York City Now Requires Employers to Grant Paid COVID-19 Child Vaccination Leave

"Employers that fail to compensate employees for protected leave may be liable for up to three times the wages that they should have paid or $250, whichever is greater. Employers may also be liable for a civil penalty of $500."  MORE >>

Ogletree Deakins

Eleventh Circuit Affirms Allstate Retirees Are Not Entitled to Lifetime Vesting in Life Insurance

"The Eleventh Circuit concluded that [1] Allstate did not violate ERISA Section 502(a)(1)(B) because it had the authority under the Summary Plan Descriptions ('SPDs') to terminate the retiree life insurance benefits for both putative classes and [2] any claims for breach of fiduciary duty under ERISA Section 502(a)(3) were time barred." [Klaas v. Allstate Ins. Co., No. 20-14104 (11th Cir. Dec. 28, 2021)]  MORE >>

Roberts Disability Law

Facilitating Consumer Choice: Standardized Plans in Health Insurance Marketplaces

"This report provides an overview of the evidence to date on how standardized plans can potentially benefit consumers, improve health equity, and enhance plan competition. This brief also describes the current landscape of standardized plans in State-based Marketplaces and the current proposal to add standardized plans to for Plan Year 2023."  MORE >>

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Hospital Lawsuits Over Unpaid Bills Increased in Wisconsin from 2001 to 2018

"[H]ospital lawsuits increased by 37 percent, from 1.12 per 1,000 residents in 2001 ... to 1.53 per 1,000 residents in 2018 ... The majority of the increase occurred between 2006 and 2009 ... The average size of lawsuits was stable over time, with the average lawsuit size varying between $2,522 and $3,939 across years ... whereas the share of cases that resulted in wage garnishment increased by 27 percent[.]"  MORE >>

Health Affairs


2021: A Disastrous Year in Federal Healthcare Spending

"For current and future taxpayers, 2021 was a brutal year -- at least when it comes to healthcare spending. Congress and the Biden administration approved tens of billions in new expenditures. Much of that money was, or will be, wasted on inefficient programs and subsidies that do little to improve the quality of care that Americans receive.... The ACA subsidies were particularly heinous.... While they only lasted until September, the COBRA subsidies weren't much better."  MORE >>

Sally Pipes, in Forbes; subscription may be required

Employee Benefits Jobs

View job as Distribution Specialist
for Carpenter Morse Group Inc. Distribution Specialist

Carpenter Morse Group Inc.


View job as Distribution Specialist
for Carpenter Morse Group Inc.

View job as Implementation Specialist
for Ubiquity Retirement + Savings Implementation Specialist

Ubiquity Retirement + Savings


View job as Implementation Specialist
for Ubiquity Retirement + Savings

Last Issue's Most Popular Items

Text of IRS Rev. Proc. 2022-11: Methodology for Calculating Qualifying Payment Amount Under the 'No Surprises Act' in 2022 (PDF)

U.S. Treasury Department; U.S. Department of Health and Human Services [HHS]; and U.S. Department of Labor [DOL]

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

Jackson Lewis P.C.

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

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

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

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