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Health & Welfare Plans Newsletter

January 13, 2022

3 New Job Opportunities 3 New Job Opportunities


[Official Guidance]

Text of OPM FEHB Program Carrier Letter: COVID-19 Over-the-Counter Tests, Vaccines, and Therapeutics (PDF)

"Carriers must cover OTC COVID-19 tests that meet the statutory criteria under section 6001(a)(1) of the FFCRA, including tests that have been authorized, cleared, or approved for use without the involvement of a health care provider.... Carriers must provide education and information resources to support FEHB covered individuals seeking OTC COVID-19 testing, including how to obtain OTC COVID-19 tests directly from their FEHB plan or designated sellers."  MORE >>

U.S. Office of Personnel Management [OPM]

[Guidance Overview]

Exceptional Usefulness and Quality icon Avoiding Employer Mandate Assessments and Penalties Under the ACA

"Form 1094-C: [1] Be very sure that the 'Yes' box is checked on Line 23, column (a) to state that minimum essential coverage was offered for all 12 months.... [2] Know when to check the box on Line 22 for 'Qualifying Offer Method.' ... Form 1095-C: [3] Conduct a coding audit and know where to prioritize.... [4] Review for 'red flag' coding combinations on lines 14 and 16.... [5] Review for incomplete coding on lines 14 and 16.... [6] Make sure the safe harbor code reported on line 16 actually applies.... [7] Ensure the waiting period is coded correctly on lines 14 and 16."  MORE >>


[Guidance Overview]

The OSHA Shot-or-Test Rule: Keeping It All Straight

"Given the uncertainty, employers implementing the testing option should be making a good-faith effort to comply with the ETS ... Employers must generally either require [1] all employees to be fully vaccinated (two weeks from the first dose of Johnson & Johnson vaccine or the second dose of Pfizer or Moderna vaccine) or [2] all unvaccinated employees to undergo weekly testing and wear face coverings."  MORE >>

Groom Law Group

[Guidance Overview]

ACA Contraceptives Noncompliance to Be Investigated; Guidelines Updated for Preventive Services

"[DOL, HHS, and the Treasury Department] have issued FAQs ... [which] address coverage of follow-up colonoscopies after a positive stool-based or direct visualization screening test under US Preventive Services Task Force recommendations. The FAQs also announce the Departments' efforts to investigate and enforce reported noncompliance with the ACA's contraceptives mandate, which generally requires coverage of contraceptives that are approved by the [FDA]."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Departments Issue Rules for Coverage of Over-the-Counter COVID-19 Tests

"Presumably, once established, a direct coverage program would result in administrative cost savings in addition to cost savings associated with the cap on reimbursement. However, it may be challenging for plans and issuers to establish this type of program quickly, particularly if the availability of OTC COVID-19 tests continues to be limited."  MORE >>

Groom Law Group

[Guidance Overview]

New Guidance on Mandatory Coverage for At-Home COVID-19 Tests

"Plans may provide education and information resources to support participants who are seeking OTC COVID-19 tests, as long as the resources make clear that testing is available at no cost and the information is consistent with the test's emergency use authorization."  MORE >>

Ice Miller LLP

[Guidance Overview]

CMS Proposes Rule to Lower Part D Drug Costs for Beneficiaries

"CMS is also defining the term 'price concession' for the first time to include all forms of discounts and direct or indirect subsidies or rebates that serve to reduce the costs incurred under Part D plans by Part D sponsors.... [CMS] expects the changes would reduce beneficiary costs by about 2% or $21.3 billion over 10 years by requiring these pharmacy price concessions to be included in the negotiated price."  MORE >>

K&L Gates

COVID-19 Likely To Drive Up Health Care Costs

"[M]any Americans have put off routine health exams and tests such as mammograms. Or they might not be able to schedule them amid a healthcare system stressed with COVID-19 patients.... Fitch data shows little change in profitability in the health insurance sector from 2019 to 2020, [an analyst] explained, 'which is amazing really, considering that, as you went into 2020, the industry did not know that we were going to have a pandemic. Pricing is typically set around six months before the prices actually take effect.' "  MORE >>

Life Insurers Adapt Pandemic Risk Models After Claims Jump

"A coronavirus pandemic which lasts five years, another pandemic in a decade, and ever more transmissible variants are among the scenarios life insurers are predicting after COVID-19 claims jumped more than expected in 2021. The global life insurance industry was hit with reported claims due to COVID-19 of $5.5 billion in the first nine months of 2021 versus $3.5 billion for the whole of 2020[.]"  MORE >>

Reuters; free registration may be required

A Fresh Look at Addressing Social Needs and Social Determinants of the Workforce

22 pages. "A key issue facing the American healthcare system is the impact of social needs, social risks, and social determinants of health (SDoH) on healthcare.... For employers, understanding these impacts within the context of a population health strategy can foster a broader approach to closing gaps in care and in access to services across employee populations. This report identifies a process model to enhance employee and community well-being."  MORE >>

National Alliance of Healthcare Purchaser Coalitions


Value-Based Coverage for Expensive Gene Therapies: The 'Leaky Bucket' Problem

"[The authors] explore the assumptions that underly 'shared surplus' proposals for allocating economic value of rare gene therapies and identify limitations associated with this approach. [They] then describe three fundamental questions about value and examine how 'leakage' can occur when defining and measuring the value of health care treatments [and] conclude with recommendations to address leakage, including adoption of a societal perspective and new methodological approaches to value assessment."  MORE >>

Health Affairs

Employee Benefits Jobs

View job as Benefits Manager
for Hunton Andrews Kurth Benefits Manager

Hunton Andrews Kurth

FL / GA / NY / TX / VA

View job as Account Manager
for Leading National TPA Account Manager

Leading National TPA


View job as Retirement Plan Administrator
for Integrated Pension Services, Inc. Retirement Plan Administrator

Integrated Pension Services, Inc.

Remote / Leominster MA

Selected New Discussions

Surcharges for Unvaccinated: A Confusing Interaction of HIPAA and the ADA

"The EEOC and the DOL/IRS/HHS have provided helpful guidance for employers who wish to implement a vaccination incentive (or penalty for unvaccinated) for employees in the form of a health contribution surcharge. Assume an employer implements a surcharge program where neither it nor its agent is administering the vaccine; employees instead can obtain one through public outlets. The employer requires a note from the employee's physician if obtaining the vaccine would be medically inadvisable. Wouldn't the requirement for the doctor's note be a 'disability-related inquiry' under the ADA and thus subject the amount of the surcharge to the undefined 'coercive' standard?"

BenefitsLink Message Boards

Dependent Care FSA Funded with After-Tax Employer Contributions

"Say a company had a standard dependent care FSA program, no pre-tax employer contributions to the employee accounts. Company now wants to establish a fund for employer contributions but subject to taxes, for participating DC FSA employees but not directly to their DC FSA accounts (so to avoid any pre-tax issues plus to avoid being considered towards the employees' $5k/$2.5k contributions limit). Anyone seen this before, or something similar? So long as it's post-tax and not directly to their accounts, any hurdles?"

BenefitsLink Message Boards

Press Releases

Groom Law Group Announces Promotions

Groom Law Group

Fidelity InvestmentsĀ® Adds $146 Billion in Assets to Workplace Benefits Platform In 2021

Fidelity Investments

Webcasts and Conferences
(Health & Welfare Plans)

Compliance Basics: Health, Welfare and Retirement (Level 1)

February 16, 2022 WEBCAST

New England Employee Benefits Council [NEEBC]

Mastering the FMLA: Gaining Critical Knowledge and Skills to Administer FMLA Leave

March 8, 2022 WEBCAST


Last Issue's Most Popular Items

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

Health Affairs

Broker and Consultant Compensation Disclosures of General Agent Commissions


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


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

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