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Health & Welfare Plans Newsletter

February 16, 2022

10 New Job Opportunities 10 New Job Opportunities


[Guidance Overview]

CMS Releases No Surprises Act State Enforcement Letters

"[T]he Enforcement Letters ... provide critical details regarding how the [No Surprises Act (NSA)] intersects with existing state laws and CMS's expectations regarding NSA enforcement in each state.... The diversity of pre-NSA state laws addressing surprise and balance billing ... has presented significant challenges for stakeholders attempting to comply in good faith with the NSA in addition to state requirements, particularly in areas where state and Federal law do not align perfectly."  As of February 11, 2022, CMS has not published Enforcement Letters for Alaska, Arizona, Illinois, Nevada, New York, Ohio, or Tennessee.]  MORE >>

Health Law Advisor, Epstein Becker Green

[Guidance Overview]

Ensuring the Adequacy of ACA Marketplace Plan Networks

"[CMS] recently proposed new federal minimum network standards and compliance procedures for insurers offering coverage through the marketplaces in 2023.... The numeric standards the administration has proposed are similar to (though generally more extensive than) those most states have already established for their individual markets."  MORE >>

The Commonwealth Fund

[Guidance Overview]

March 1 Deadline for Sending Prescription Drug Creditable Coverage Disclosures to CMS

"Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to CMS whether that coverage is 'creditable' or 'non-creditable.' The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that offer prescription drug coverage only to active employees and not to retirees. Calendar year plans must submit this year's disclosure by March 1, 2022."  MORE >>


[Guidance Overview]

An Employer's Guide to California's 2022 COVID-19 Paid-Sick-Leave Law

"[E]mployers will not be able to simply restart policies and practices in 2022 they previously had in place to comply with the 2021 CPSL ... Because 2022 CPSL does not pre-empt local ordinances, employers may have compliance obligations under the state law and possibly up to four similar -- but not identical -- local ordinances in Long Beach, Los Angeles (City and County), and Oakland."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

Alert (High Risk Issue) icon Employer Must Provide Retroactive Coverage and Pay Penalties for COBRA Election Notice Violations

"At trial, the plaintiff argued that the employer prevented him from exercising his COBRA rights by backdating his retirement date and disregarding the date stated on the COBRA election notice. The court agreed with the plaintiff, determining that the employer's failure to correct the plaintiff's COBRA eligibility date was arbitrary and capricious." [Buford v. Gen. Motors, LLC, No. 16-14465 (E.D. Mich. Jan. 26, 2022)]  MORE >>

The Wagner Law Group

Hospitals Charge Double the Price of Specialty Pharmacies for Prescription Drugs

"The study examined data from 2018-2020 and found: [1] Costs per single treatment for drugs administered in hospitals were an average of $7,000 more than those purchased through specialty pharmacies. [2] Drugs administered in physician offices were an average of $1,400 higher. [3] Hospitals, on average, charged double the prices for the exact same drugs, compared to specialty pharmacies. [4] Prices were 22% higher in physicians' offices for the exact same drugs, on average."  MORE >>

America's Health Insurance Plans [AHIP]

Can Telehealth Be Here to Stay?

"Telehealth has proven itself undeniably practical. However, ensuring its long-term survival will require ongoing work and revision, including broadband improvements, permanent Medicare reforms, Interstate Medical Licensure Compact participation and payment parity assurance."  MORE >>

MedCity News

2023 Projections for ACA Affordable Employer Coverage

"Mercer projects the 'required contribution percentage' that determines the affordability of employer-sponsored health coverage under the [ACA] will rise to 9.7% of an employee's household income -- or an applicable employer shared-responsibility (ESR) affordability safe harbor -- for the 2023 plan year. This marks an increase from the 2022 plan-year level of 9.61%.... Mercer also projects that the 2023 play-or-pay federal poverty line (FPL) affordability safe-harbor amount for calendar-year plans will increase to $109.85 per month -- a fairly significant hike from the 2022 amount of $103.15."  MORE >>


What Is a Post-Deductible Health Reimbursement Arrangement?

"A Post-Deductible HRA can be designed to increase consumerism and create a desired balance between employee out-of-pocket responsibility, claims utilization, and total premiums. The financial benefits can be greater in certain situations than others."  MORE >>


Benefits in General


Courts Are Right to Reject Insurer ERISA Attorney Fee Awards

"Once the success threshold has been met, to determine whether a discretionary award of fees is warranted, courts apply a five-factor test ... factors that clearly and intentionally favor successful plaintiffs.... Increasingly, insurance companies are seeking attorney fee awards against claimants who are partially or wholly unsuccessful in overcoming deference and other substantive and procedural advantages to the plan decision makers and are thus unable to have a denial of benefits reversed. For the most part, courts continue to reject attorney fee applications from insurance companies that successfully defeat lawsuits seeking plan benefits."  MORE >>

Kantor & Kantor

Employee Benefits Jobs

View job as Retirement Plan Administrator
for BSP Retirement Services Retirement Plan Administrator

BSP Retirement Services

Remote / Oldsmar FL

View job as Retirement Plan Administrator
for BSP Retirement Services

View job as DC Plan Administrator
for Dienstag Pension Services, Ltd. DC Plan Administrator

Dienstag Pension Services, Ltd.

Remote / Great Neck NY

View job as Investment Consultant Analyst / Associate Consultant - Fiduciary Consulting Services
for Newport Investment Consultant Analyst / Associate Consultant - Fiduciary Consulting Services


Lake Mary FL / Saint Petersburg FL

View job as Retirement Relationship Manager - 401(k), 403(b)
for Newport Retirement Relationship Manager - 401(k), 403(b)


Remote / Folsom CA / Saint Petersburg FL / Lake Mary FL / Chicago IL / West Des Moines IA / Overland Park KS / Minneapolis MN / Lake Mary FL / Charlotte NC / Greensboro NC / De Pere WI / La Crosse WI / AZ / CO / GA / MA / MD / MI / MO / NJ / NY / OH / SC / TX / VA

View job as Senior Consultant, Non-Qualified Plans
for Newport Senior Consultant, Non-Qualified Plans


Remote / Chicago IL / Lake Mary FL / Richmond VA / Dallas TX / Los Angeles CA

View job as Plan Administrator for Non-Qualified Retirement Plans
for Newport Plan Administrator for Non-Qualified Retirement Plans


Lake Mary FL / Dallas TX / Richmond VA / NC

View job as ERISA/Employee Benefits Attorney
for Boutwell Fay LLP ERISA/Employee Benefits Attorney

Boutwell Fay LLP

Remote / Irvine CA / New York NY

View job as Benefits Advisor/Supervisor
for Employee Benefits Security Administration [EBSA] Benefits Advisor/Supervisor

Employee Benefits Security Administration [EBSA]

Remote / Washington DC

View job as Defined Benefit Plan Consultant
for Planned Retirement Consultants & Administrators, LLC Defined Benefit Plan Consultant

Planned Retirement Consultants & Administrators, LLC

Remote / Ridgewood NJ

View job as 401k & Defined Contribution Plan Consultant
for Planned Retirement Consultant & Administrators, LLC 401k & Defined Contribution Plan Consultant

Planned Retirement Consultant & Administrators, LLC

Remote / Ridgewood NJ

Selected New Discussions

What to Do with Uncashed FSA Checks?

"We have outstanding FSA reimbursement checks through our third-party administrator from current and former employees. These are reimbursement checks that have been sent to the employee but the employee has not cashed them. These go back for years, and involve employees who no longer work for us. Some may be deceased. What are the options?"

BenefitsLink Message Boards

Press Releases

Northeast Business Group on Health Releases an Employer Guide to Social Determinants of Health

Northeast Business Group on Health [NEBGH]

Retirement Plan Advisors Announces Participant Advice Solutions

Retirement Plan Advisors, LLC

Consumer Groups and Others to Launch Retirement-Security-for-All Call for Action

Pension Rights Center

Elevate and Visa Collaborate on "Push to Debit" Health Reimbursements


Webcasts and Conferences
(Health & Welfare Plans)

Colorado’s COVID-19 Public Health Emergency Sick Leave Requirements


Ogletree Deakins

Top Five Benefits and Compensation Issues for 2022

February 22, 2022 WEBCAST

Ogletree Deakins

Last Issue's Most Popular Items

Arbitration Under ERISA: A Roadmap for Enforcement


Good Faith Relief Ending for ACA Reporting in 2022

Hall Benefits Law

Illinois Employers with Group Health Plans Must Provide New Benefit Comparison Notice to Covered Illinois Employees

Clark Hill PLC

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

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