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Health & Welfare Plans Newsletter

January 5, 2022

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

Alert (High Risk Issue) icon New Employer Health Plan Compliance Responsibilities for 2022

"2022 will bring the greatest number of group health plan compliance changes since 2014, when the bulk of the [ACA's] provisions went into effect. The Biden Administration delayed a few requirements that were slated to take effect this year, and a few more are now subject to 'good-faith compliance' standards.... [1] Group health plan compensation disclosure requirements ... [2] Surprise billing protections ... [3] Health coverage identification cards ... [4] Employer reporting changes ... [5] Online data files ... [6] Medical and Rx claims data reporting."  MORE >>

MZQ Consulting, LLC

[Guidance Overview]

Alert (High Risk Issue) icon Health Plans Face New Liabilities for Inaccurate Provider Directories (PDF)

"Beginning in 2022, group health plans, insurance issuers and providers must take specific steps to improve provider directories and bear certain costs when inaccurate directories cause patients to incur out-of-network charges.... [G]roup health plans and issuers [must] satisfy each requirement listed in [a chart which also] includes any CAA details about each requirement, as well as open questions that hopefully will be addressed in future guidance."  MORE >>


[Guidance Overview]

DOL Issues Temporary Enforcement Policy and Guidance on ERISA Disclosure Requirements for Group Health Plan Services

"The determination of whether a service provider meets the definition of a 'covered service provider' depends on the facts of the particular situation. Any service provider should be prepared if audited to explain how it concluded that it is not a covered service provider consistent with a reasonable good faith interpretation of the statute.... The [DOL] clarified that the ERISA Section 408(b)(2)(B) requirement applies to both large and small group health plans."  MORE >>

Morgan Lewis

[Guidance Overview]

DOL Releases Field Assistance Bulletin on Disclosure Requirements for Brokerage and Consulting Service Providers Under ERISA 408(b)(2)

"DOL will likely be adding compliance with ERISA section 408(b)(2)(B) to its enforcement activities both for plan sponsors and for service providers of brokerage and consulting services to ERISA plans in the near term. As a result, plan service providers as well as responsible plan fiduciaries should be prepared to articulate a reasonable and good faith basis for their conclusions in connection with implementing practices regarding section 408(b)(2)(B) disclosures."  MORE >>

Groom Law Group

[Guidance Overview]

Early 2022 To-Do: Employer Fiduciary Responsibilities for Health and Welfare Plans

"New rules apply to health plan service provider compensation in 2022 that employers must know and be equipped to manage. This e-alert provides employers with background on these new rules, describes the new rules from the employer's perspective and suggests an employer action plan for 2022."  MORE >>

Smith & Downey, P.A.

[Guidance Overview]

CMS Addresses Expanded External Review Requirements for Surprise Medical Billing

"[CMS] has updated its external review procedures under the [ACA] to address issues involving surprise medical billing under the No Surprises Act (NSA)  ... CMS's guidance addresses state-law external review procedures that cannot accommodate external reviews of NSA-related adverse benefit decisions involving surprise billing. The requirement to provide for external review of surprise medical billing matters, as added by the NSA, is effective for plan years beginning on or after January 1, 2022."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Family Medical Leave Compliance: A New Years' Resolution You Should Keep

"After an employee has taken protected leave under FMLA or CFRA, that employee is entitled to return to their job or an equivalent job, subject to very limited exceptions. Commonly, an employee requests continued leave as an alternative to reinstatement after protected leave has expired. Employers should exercise extreme caution at this critical junction to prevent litigation."  MORE >>


[Guidance Overview]

New York State DOL Adopts Paid Sick Leave Regs

"In its Notice of Adoption, NYSDOL discussed over 25 categories of public comments it received in response to the proposed regulations, but declined to revise the regulations based on those comments.... [E]mployers should take note of a few key points[.]"  MORE >>

Hodgson Russ LLP

[Guidance Overview]

Colorado Moves Forward on Paid Family and Medical Leave

"The voter-approved law ... will provide eligible employees with partial wage replacement for 12-16 weeks of leave, depending on the circumstances. Employees will be able to take paid leave for many of the same reasons permitted under the federal [FMLA]. The program also will extend paid leave so victims of domestic violence, sexual assault or stalking can handle related issues."  MORE >>


DOL Takes on Data-Miner Over Novel Health Insurance Plan

"DMP sued the [DOL] in October 2019, a year after it sought an advisory opinion that would allow it to market the plans as compliant with [ERISA] ... [DOL Advisory Opinion 2020-01A] said agreeing to be tracked online did not create any employment relationship recognized by ERISA. U.S. District Judge Reed O'Connor disagreed, saying DMP's thousands of health-plan purchasers are clearly ERISA-eligible 'working owners' who have a stake in DMP and actively provide services to it." [Data Marketing Partnership LP v. DOL, No. 19-800 (N.D. Tex. Sep. 28, 2020; appeal to 5th Cir. No. 20-11179; oral arg. Jan. 5, 2022)  MORE >>


New Surprise Billing Regs: Assessing a Patient's Network Status Will Be a Key Challenge for Providers

"With new surprise billing regulations in place, providers should ensure they have efficient processes for gauging whether a patient is in-network. For some providers, the task may prove to be more trouble than it's worth in terms of opportunities to balance-bill patients. The new regulations make communication between providers and insurers even more important."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Considerations When Purchasing Stop-Loss Insurance

"[1] Choose the right type of deductible.... [2] Set the right attachment point.... [3] Establish a reasonable coverage period.... [4] Negotiate lasering.... [5] Ensure that the stop-loss policy and plan document align."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

Benefits in General

[Guidance Overview]

New Audit Standard for Employee Benefit Plans: What You Need to Know

"One of the more significant changes in the standard is the introduction of the ERISA Section 103(a)(c)(3) audit ... [which] will provide a two-pronged opinion covering the audit and whether the certified investment information contained in the financial statements agrees to the certification. In addition, all ERISA audit reports ... will have expanded wording relating to both auditor responsibilities and management responsibilities."  MORE >>

Clark Schaefer Hackett

[Guidance Overview]

DOL Finalizes Revisions to 2021 Form 5500 Instructions to Reflect SECURE Act Changes

"The final changes are limited to the changes that implement the SECURE Act provision that amended ERISA Section 103(g) to require certain MEPs, including PEPs, to include participating employer information with their annual returns. The final changes also clarify that multiple employer welfare arrangements (MEWAs) will still be required to report participating employer information."  MORE >>

Thomson Reuters Practical Law

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Press Releases

HealthComp Appoints Michael Scallen to Vice President of Sales


Cohen & Buckmann Elevates Lauri London to Partner

Cohen & Buckmann P.C.

IMG Launches PTOgo, a New Journey Medical Products for Companies and Staff Traveling Overseas

International Medical Group® [IMG®]

Webcasts and Conferences
(Health & Welfare Plans)

Ask a Benefits Lawyer (Part II)!

January 13, 2022 WEBCAST

Boutwell Fay LLP

Last Issue's Most Popular Items

DOL Provides Guidance on CAA Fee Disclosure Rules for Group Health Plans

Boutwell Fay LLP

Understand Your Rights Against Surprise Medical Bills

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

To Deduct or Not to Deduct: Washington Cares Act Dilemma Requires Employers to Make a Choice This January

Fisher Phillips

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

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