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Health & Welfare Plans Newsletter

January 27, 2022

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

Text of CMS Guidance: Federal Independent Dispute Resolution (IDR) Process for Disputing Parties (PDF)

37 pages. "This document provides guidance to disputing parties who are seeking to resolve a claim for payment for [out-of-network (OON)] health care items or services through the Federal IDR Process.... This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process.... This document does not describe the Federal Patient-Provider Dispute Resolution Process for resolving payment disagreements between uninsured or self-pay patients and health care facilities or providers."  MORE >>

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

[Guidance Overview]

Health Plan Fiduciaries Must Solicit Information from Brokers and Consultants

"Plan fiduciaries should consider taking the following actions: [1] Identifying and assigning internal responsibility for soliciting and evaluating required information from brokers and consultants. [2] Introducing contractual obligations on brokers and consultants to provide the required information ... [3] Developing the means to evaluate the information received ... [4] Assessing whether the compensation is, in fact, reasonable[.]"  MORE >>

Ballard Spahr LLP

[Guidance Overview]

DOL Provides Guidance for CAA Broker Compensation Disclosure Requirements

"[T]the DOL did highlight that a key goal of the disclosure requirements is to enhance fee transparency -- including 'for service' arrangements that involve payment of indirect compensation. Disclosures must include information about indirect compensation. The DOL has provided an Example of Indirect Compensation."  MORE >>


[Guidance Overview]

CMS Issues Surprise Billing Process Guide for Certified IDR Entities

"This guide includes detailed information on how the parties may initiate the IDR process and describes the requirements of the process ... It also includes ... guidance on confidentiality standards, fees, and recordkeeping and reporting requirements, as well as how parties may request an extension of certain time periods for extenuating circumstances."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

OSHA Withdraws Vax-or-Test Mandate for Large Employers; State Mandates May Remain

"OSHA's withdrawal of the ETS does not affect employers' compliance obligations under OSHA-approved State Plans or other state or local vaccine or testing requirements. While some jurisdictions mandate vaccines or weekly testing, others block mask and vaccine mandates which the federal rule would have pre-empted."  MORE >>


Agencies' Annual MHPAEA Report to Congress Signals Likely Increase in Enforcement Efforts

"The [2022 MHPAEA Report to Congress] illustrates that meaningful compliance presents challenges for plans, plan sponsors, issuers and third-party plan administrators. Common pitfalls included: failure to demonstrate compliance of NQTLs and factors in application, failure to specify which benefits or benefit classifications were affected by an NQTL, and analyses that were nonresponsive.... The joint report leaves little doubt that increased enforcement is likely in 2022."  MORE >>

Manatt, Phelps & Phillips, LLP

Prepare Yourself for an ACA Audit

"Minimizing risk of a [DOL] audit can be done with several best practices ... Mistakes in reporting under IRS requirements can be tremendously costly. In addition to general non-compliance, an IRS auditor may look for a series of vague or non-specific answers to signal a red flag.... Audit letters typically request specific documents and apply a specific deadline, so it's critical that employers retain all documentation that could be used to respond to an ACA audit."  MORE >>

Tango Health

Desperate for Workers, Small Companies Pump Up Health Coverage

"Beyond wages, health insurance is a signal that employers will invest in their workforce ... Many small employers are covering their employees by using individual coverage health reimbursement arrangements (ICHRAs) ... Blue Cross Blue Shield plans, a major source of coverage for small businesses, are seeing increased activity."  MORE >>

Bloomberg Law

Health Coverage Changes from 2020-2021

"This Data Point examines health coverage trends over time using recently-released NHIS data through September 2021 to assess coverage changes during the pandemic and how they compare to pre-pandemic years, both for the population as a whole, as well as by age and income."  MORE >>

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

California Governor, Legislative Leaders Announce Framework to Extend Supplemental Paid Sick Leave

"Amid the national surge in COVID-19 cases driven by the Omicron variant, Governor Gavin Newsom, Senate President pro Tempore Toni G. Atkins and Assembly Speaker Anthony Rendon ... announced that they have reached an agreement on a framework to ensure employees continue to have access to COVID-19 supplemental paid sick leave through September 30, 2022[.]"  MORE >>

Office of California Governor Gavin Newsom

Benefits in General

Understanding the Great Resignation and Work for Older Adults

"The top reason for leaving or considering leaving [for employees age 50 and over] was being near retirement age. Not surprisingly, the pandemic played a major role -- about two in five (38%) never would have retired, left a job, or considered leaving a job had it not been for the pandemic. One in five retired earlier than planned because of the pandemic."  MORE >>


More Than Half of State and Local Government Employees Contemplating Leaving Their Jobs

"State and local workers say they are considering changing jobs because they want a higher salary or a better benefits package (52%), are burned out from stress during the pandemic (47%), and/or want better work-life balance (36%). Public sector employees are considering retiring and/or leaving the workforce entirely due to pandemic burnout (42%), a desire to do things that bring joy (37%), and tension from working with the public [students' parents] (26%)."  MORE >>


Employee Benefits Jobs

View job as Client Manager DB/DC
for CMC Pension Professionals Client Manager DB/DC

CMC Pension Professionals

Remote / Glendale CA

View job as Client Manager DB/DC
for CMC Pension Professionals

View job as Actuary
for Pension Benefit Guaranty Corporation [PBGC] Actuary

Pension Benefit Guaranty Corporation [PBGC]

Remote / Washington DC

View job as Plan Administrator/ Consulting
for Associated Pension Consultants Plan Administrator/ Consulting

Associated Pension Consultants

Chico CA / Sacramento CA

View job as 401(k) Administrator
for Blue Ridge ESOP Associates 401(k) Administrator

Blue Ridge ESOP Associates


Press Releases

Garrey Joins OneAmerica® to Bolster Health Care Sector Momentum


AIG Retirement Services Selected as Exclusive Retirement Plan Provider for Ontario County, New York

AIG Retirement Services

AIG Retirement Services Appoints Scott Ramey Executive Vice President of Market Strategy and New Business Development

AIG Retirement Services

Webcasts and Conferences
(Health & Welfare Plans)

Mandatory Vaccines, the ETS and OSHA’s Next Steps – Oh My! What Employers Can and Should Do Given the State of Affairs


Stevens & Lee

Last Issue's Most Popular Items

Upcoming Deadlines for ACA Reporting and Similar State Reporting

Venable LLP

Federal OSHA Withdraws Its Vaccine-or-Test ETS: What's Next?


OSHA Withdraws Vaccine or Testing ETS; Intends to Pursue Permanent Standard


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

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