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Health & Welfare Plans Newsletter

January 12, 2022

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

Upcoming Deadline icon Deadline Approaches for Disclosure to CMS of Medicare Part D Creditable Coverage

"The regulations also require group health plan sponsors with Part D eligible individuals to submit a similar notice to [CMS] ... The filing deadline is 60 days following the first day of the plan year. If you operate a calendar year plan, the deadline is the end of February."  MORE >>

Fraser Trebilcock

[Guidance Overview]

Broker and Consultant Compensation Disclosures of General Agent Commissions

"This post addresses the narrow question of the reporting of general agent commissions under the new rules and in light of Field Assistance Bulletin 2021-03. The question is of practical interest, and it also sheds light on the [DOL's] initial approach to the interpretation of the statute."  MORE >>


[Guidance Overview]

HHS Addresses Coverage of Preventive Items Along with At-Home Tests for COVID-19

"The same guidance separately addresses the coverage of follow-up colonoscopies for those age 45 to 49 without cost sharing and clarifies how insurers and plans should be covering the full scope of contraceptives under the [ACA]."  MORE >>

Health Affairs

[Guidance Overview]

Plans and Insurers Must Cover Over-the-Counter COVID-19 Tests

"The guidance is effective for tests purchased on or after January 15, 2022, and provides, among other things, that [1] over-the-counter tests generally must be covered without cost to the participant, [2] only diagnostic tests are required to be covered without cost, not employer-mandated tests or other tests for surveillance purposes, and [3] a plan or insurer can apply limits on the number of covered tests per month, with a safe harbor limit of eight tests per eligible individual per month."  MORE >>

Eversheds Sutherland

[Guidance Overview]

You Can Go Home Again: Agencies Release New Group Health Plan Coverage Requirements for COVID-19 Tests

"[Plan] sponsors will want to contact their pharmacy benefit managers or other networks in short order to determine whether they have a direct coverage solution that will satisfy the safe harbor requirements and allow the plan to impose a dollar limitation on out-of-network costs."  MORE >>


[Guidance Overview]

Health Plan Coverage Required for COVID-19 Testing

"Although plans may not apply medical management to the purchase of over-the-counter test kits, they may implement reasonable steps to prevent fraud or abuse.... Plan sponsors are allowed to amend their plans to address the new guidance without satisfying notice requirements for modifications."  MORE >>

Ballard Spahr LLP

[Guidance Overview]

Coverage Requirement for At-Home COVID-19 Testing: Interaction with Vaccine Mandates and Mitigating Cost Impacts

"Plans may require attestation that test is not for employment purposes ... [although] it would be very difficult for a plan to determine whether an employee is in violation of the attestation ... [and] the plan would be prohibited from sharing the data with the employer.... Individualized clinical assessment still necessary for other forms of testing ... [although] most doctors can plausibly order a test on the basis of individuals being in a high-transmission area."  MORE >>


[Guidance Overview]

Federal Agencies Issue Guidance Requiring Coverage of Over-the-Counter COVID-19 Tests

"Until a plan establishes a direct coverage program, the plan must reimburse participants' actual cost to purchase the OTC Tests. Given the variability in the price of OTC Tests (including those sold on secondary markets), employers may see a significant increase in costs to the plan."  MORE >>


[Guidance Overview]

New Guidance on Health Plan Coverage of OTC COVID Tests

"[If] a health plan intends to limit which OTC COVID-19 tests qualify for coverage, they will need to carefully evaluate and identify which tests (including new tests entering the market) meet these requirements and provide appropriate guidance to participants."  MORE >>

Warner Norcross & Judd LLP

[Guidance Overview]

Group Health Plans Required to Cover COVID-19 Tests at Home, Sweet Home

"A group health plan may limit its reimbursement of at-home tests to the lesser of $12 or the actual cost of the test, if [certain] requirements are met ... If a group health plan satisfies these requirements, it may also impose cost-sharing on at-home tests that are purchased from non-preferred pharmacies and retailers."  MORE >>

Miller Johnson

[Guidance Overview]

Network Adequacy Standards for QHPs and More Guidance for 2023

"The most significant issue in the 2023 draft letter is its proposed substantive standards for network adequacy.... HHS also details its expectations for collecting information from insurers about whether in-network providers are offering telehealth services or not.... HHS proposes a similar approach for appointment wait times."  MORE >>

Health Affairs

State Trends in Employer Premiums and Deductibles, 2010–2020

"Premium contributions and deductibles in employer health plans accounted for 11.6 percent of median household income in 2020, up from 9.1 percent a decade earlier.... Middle-income workers in Mississippi and New Mexico faced the highest potential costs relative to income, 19 percent and 18 percent, respectively. The total cost of premiums plus potential spending on deductibles ranged from a low of $6,528 in Hawaii to a high of more than $9,000 in Florida, Kansas, Missouri, South Dakota, and Texas."  MORE >>

The Commonwealth Fund

Sixth Circuit Finds ERISA Life Insurance Claim Time-Barred Under Clear Repudiation Rule

"Prudential informed the executor in December 2014 that the benefits had already been paid. When the executor received the Form 712 form, it was confirmation that the benefits would not be paid to the children and constituted a clear and unequivocal repudiation of benefits. The one-year contractual limitations period began to run from this date." [D.S.S. v. Prudential Insurance Company of America, No. 21-5315 (6th Cir. Jan. 10, 2022)]  MORE >>

Roberts Disability Law

Benefits in General

[Official Guidance]

IRS Disaster Relief Notice WA-2022-01, for Victims of Washington State Flooding and Mudslides

"Victims of flooding and mudslides beginning November 13, 2021 now have until March 15, 2022, to file various individual and business tax returns and make tax payments ... Individuals and households affected by the flooding and mudslides that reside or have a business in Clallam, Skagit, and Whatcom counties and the Lummi Nation, Nooksack Indian Tribe, and Quileute Tribe qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

2021 National Taxpayer Advocate Report to Congress (PDF)

234 pages. "Calendar year 2021 was surely the most challenging year taxpayers and tax professionals have ever experienced -- long processing and refund delays, difficulty reaching the IRS by phone, correspondence that went unprocessed for many months, collection notices issued while taxpayer correspondence was awaiting processing, limited or no information on the Where's My Refund? tool for delayed returns, and -- for full disclosure -- difficulty obtaining timely assistance from TAS.... One irony of the past year is that, despite its challenges, the IRS performed well under the circumstances." [Also available: 2022 NTA Purple Book, Compilation of Legislative Recommendations to Strengthen Taxpayer Rights and Improve Tax Administration.]  MORE >>

Taxpayer Advocate Service, Internal Revenue Service [IRS]


PEOs and the Transformation of Workplace Benefits

"While [Professional Employer Organizations (PEOs)] respond to long-standing challenges faced by smaller employers and have the potential to increase access to workplace benefits, this Article argues that they also introduce new and significant governance concerns that are not adequately addressed by the existing regulatory framework.... [T]his Article recommends strengthening and uniformly applying registration, disclosure and oversight requirements for all non-employer intermediaries, including PEOs."  MORE >>

Natalya Shnitser, via SSRN

Employee Benefits Jobs

View job as Plan Administrator (TPA)
for ForUsAll Plan Administrator (TPA)


Remote / San Carlos CA

View job as Tax Operations Consultant
for Empower Retirement Tax Operations Consultant

Empower Retirement


View job as Benefits Specialist
for Gallagher Benefits Specialist


Rolling Meadows IL

View job as Internal Sales Consultant
for Independent Retirement Internal Sales Consultant

Independent Retirement

Remote / ID / OR / WA

Selected New Discussions

At-Home COVID-19 Testing -- Antibody Test Covered as Well as Antigen Test?

"We read the new FAQs 51 as requiring that plans cover at home antigen AND antibody tests, provided they meet the statutory criteria of FFCRA 6001(a)(1) (e.g. approved by FDA or have an EUA). This is based on FAQ 42, Q4 which includes serological tests, i.e. antibody tests, in the definition of in vitro diagnostic tests. Commentary thus far focuses on the antigen test (i.e. to detect the virus) and not antibody, so just looking to see if others interpreting these FAQs to also cover at home antibody tests."

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Press Releases

Sequoia Launches New Total Rewards and People Policy Benchmarking Online Resource to Accelerate Insights Into Action


Honored Nominees for NTSA 2022 Elite Advisor Awards Unveiled

National Tax-Deferred Savings Association [NTSA]

Entire Keightley & Ashner Team to Join the Wagner Law Group

Wagner Law Group P.C.

Webcasts and Conferences
(Health & Welfare Plans)

Mental Health Parity (for Employees)

January 20, 2022 WEBCAST

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

Cyber Liability Insurance Simplified

January 20, 2022 WEBCAST


Your Journey Through New Transparency Requirements

January 26, 2022 WEBCAST

Corporate Synergies

Last Issue's Most Popular Items

CMS Q&As for Employees: How to Get Your At-Home Over-the-Counter COVID-19 Test for Free

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

Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests

U.S. Department of Health and Human Services [HHS]

HRSA Updates to ACA Preventive Health Care Guidelines

Health Resources and Services Administration [HRSA], U.S. Department of Health and Human Services [HHS]

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

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