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Health & Welfare Plans Newsletter

April 6, 2022

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

IRS Proposed Regs Revise Premium Tax Credit's Affordability Test to Fix 'Family Glitch'

"[T]he proposed regulations would provide that an eligible employer-sponsored plan is affordable for related individuals if the portion of the annual premium the employee must pay for family coverage does not exceed 9.5% of household income.... They would similarly define the employee's required contribution for family coverage as the portion of the annual premium charged for coverage of the employee and all other individuals in the employee's family who are offered coverage. The proposed regulations would also address situations where an individual has offers of coverage from more than one employer, either as an employee or a related individual."  MORE >>

Journal of Accountancy

[Guidance Overview]

Biden Administration Proposes to Fix the 'Family Glitch'

"The proposed rule should not affect liability under the employer mandate. Why? The employer mandate requires certain large employers to offer coverage to employees and dependents. But penalties for violating the mandate are triggered only when an employee receives premium tax credits through the marketplace. As discussed below, the proposed rule would extend marketplace tax credits to only the family members of workers who are not offered affordable job-based family coverage. It would do nothing to affect the eligibility of employees and thus should not implicate the employer mandate."  MORE >>

Health Affairs

[Guidance Overview]

Upcoming Deadline icon Reminder: San Francisco 2021 Annual Reporting Deadlines

"After a two-year hiatus, ... May 2, 2022, is the deadline for employers subject to San Francisco's Health Care Security Ordinance (HCSO) and those covered by San Francisco's Fair Chance Ordinance to file an annual report ... to substantiate compliance with these ordinances for 2021.... Covered employers who fail to submit the 2021 Employer Annual Reporting Form can be subject to a penalty of $500 for each quarter that the violation occurs."  MORE >>

Burnham Benefits

[Guidance Overview]

Illinois Provides Paid Administrative Leave to Vaccinated Employees for Absences Related to COVID-19 and Requires Payment to Support Staff on Days of School Closure

"The law requires public school districts, public charter schools, and public universities to reimburse all sick leave taken by fully vaccinated teachers and employees during the 2021-2022 school year if the leave was taken due to a confirmed or probable diagnosis of COVID-19, being identified as a 'close contact' of an individual with COVID-19, or due to a required exclusion from school due to COVID-19, either experienced by the employee or a child of the employee."  MORE >>

Franczek P.C.

Fifth Circuit Clarifies Standard for Remanding ERISA Claim to Administrator After Initial Denial

"The appellate court held that Reliance Standard [in its denial of the LTD claim] had not made any merits determination regarding benefits; it had made only a determination that Newsom was not a full-time employee at the time of his disability, and therefore had not met the eligibility requirements ... Once Reliance Standard determined that Newsom was ineligible for coverage, it ended the inquiry and did not develop any record regarding the merits of Newson's claim. The court held that remand was necessary for Reliance Standard to develop [such a record]." [Newsom v. Reliance Standard Life Ins. Co., No. 20-1994 (5th Cir. Feb. 18, 2022)]  MORE >>

Faegre Drinker

Ninth Circuit Reverses Decision Requiring Reprocessing of 67,000 Behavioral Health Claims; Hands United Healthcare a Win

"The Ninth Circuit decision means that UBH no longer has to reprocess the tens of thousands of claims ... UBH was still adjusting its criteria and guidelines at the time of the Ninth Circuit's decision. It is not clear whether UBS will now 'walk back' its revised criteria ... This decision signifies great latitude for plan administrators and seems to mark a deviation from an otherwise broad national movement toward enforcement of mental health parity laws[.]" [Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]  MORE >>

ArentFox Schiff LLP

District Court Declines to Enforce Limitations Period That Was Not Disclosed in Benefit Denial Letter

"[The district court] held that a health plan's 180-day deadline for filing suit was unenforceable because the plan's final benefits denial letter did not disclose the deadline to a claimant. Applying Utah's six-year limitations period for breach of contract claims, the district court concluded that the claim was timely." [A. v. United Healthcare Ins. Co., (D. Utah Mar. 30, 2022)]  MORE >>

Thomson Reuters Practical Law

Proposal Could Lessen Family Members' Dependence on Employer Health Plans

"Starting in 2023, if coverage for the family as a whole costs more than about 10 percent of household income under the lowest-cost employer-sponsored option, then the nonemployee family members will be eligible for financial assistance in the ACA marketplace, if the proposal take effect."  MORE >>

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

Impact of the Pandemic on Commercial Health Insurance: Spending, Risk Both Increasing

"Employees and their families are sicker than they were pre-pandemic.... Reductions in preventive care spend during the pandemic are projected to rebound in 2022 but fail to reach pre-pandemic levels.... Telehealth utilization accelerated and shifted to virtual primary care and condition management.... Gaps in primary care utilization are even more pronounced in low-income communities.... Significant growth in employee demand for behavioral health services is projected to continue.... Demand for musculoskeletal services was exacerbated by the pandemic and is expected to grow in 2022.... Investments in health and wellbeing programs have grown."  MORE >>

Watko Benefit Group

Workplace Life, Disability and Supplemental Health Sales Increased in 2021

"Voluntary workplace life insurance premium ... jumped 60% in the fourth quarter to $614 million.... Voluntary disability premium jumped 10% ... For the year, voluntary long-term disability premium rose 20%, and short-term disability premium increased 5%, compared with prior year.... For the year, supplemental health new premium rose 6% to nearly $2.6 billion, compared with sales from the same period in 2020."  MORE >>


Employers Meet Employee Needs by Diversifying Benefit Offerings

"Employers are ... increasing flexibility and placing a greater emphasis on voluntary benefit options across a variety of categories. 77 percent of employers now offer an average of five health plan options between HDHP and PPOs, and nearly two thirds now offer both an HSA and FSA.... [E]mployers limited out-of-pocket cost increases to two percent or less on average. Employers also picked up the five percent premium increase for individual PPOs.... HDHP elections experienced a significant decline in 2022 for the first time in three years when employees had a choice between a PPO and HDHP."  MORE >>


Benefits in General

[Official Guidance]

Text of IRS PMTA 2022-04: IRC 501(c)(6) Organizations Providing Pension and Health Benefits (PDF)

20 pages. "This memorandum addresses a 2012 private letter ruling, PLR 201246039 ... [which] was issued ... prior to a significant court case on the issue and does not reflect the current position of our office. In the PLR, dated August 21, 2012, the IRS issued a favorable ruling to an IRC 501(c)(6) Business League that provided pension and health benefits to its eligible members.... [T]he 2012 PLR has been called into question because of the reasons cited in this memorandum[.]" [Program Manager Technical Advice dated Oct. 26, 2021; published Apr. 5, 2022.]  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Inflation and ERISA Penalties: Hand in Hand for 2022

"The Federal Civil Penalties Inflation Adjustment Act of 2015 directs the US [DOL] to make annual inflation adjustments to specified [ERISA] violations.... [A table] compares penalty amounts assessed for violations after January 15, 2021, through January 15, 2022, to penalty amounts assessed after January 15, 2022."  MORE >>

McDermott Will & Emery

Employee Benefits Jobs

View job as Retirement Plan Assistant Administrator
          for Gateway Pension Services, Ltd. Retirement Plan Assistant Administrator

Gateway Pension Services, Ltd.

Saint Louis MO

View job as Retirement Plan Assistant Administrator
          for Gateway Pension Services, Ltd.

View job as Retirement Plan Administrator
          for Premier Plan Consultants Retirement Plan Administrator

Premier Plan Consultants

Remote / San Diego CA

View job as Retirement Plan Administrator
          for Premier Plan Consultants

View job as Pension Administrator
          for CPS Insurance Services Pension Administrator

CPS Insurance Services

Remote / Newport Beach CA

View job as Pension Administrator
          for CPS Insurance Services

View job as General Attorney
          for Pension Benefit Guaranty Corporation [PBGC] General Attorney

Pension Benefit Guaranty Corporation [PBGC]

Remote / Washington DC

View job as General Attorney
          for Pension Benefit Guaranty Corporation [PBGC]

View job as Account Manager
          for MAP Retirement USA, LLC Account Manager

MAP Retirement USA, LLC

Remote / Appleton WI

View job as Account Manager
          for MAP Retirement USA, LLC

Press Releases

RTD Financial Named to List of Nation’s Top DC Advisor Teams

RTD Financial Advisors, Inc.

Rhett Patterson Joins OneDigital as Vice President of Client Retirement Services


Fisher Investments Earns Fiduciary Excellence Certification

Fisher Investments

Hub International Bolsters Retirement Capabilities with Acquisition of 401(k) Advisors, Inc. in Illinois

HUB International

ERISA Compliance Expert Joni Jennings Joins Newfront Retirement Services Team


AIG Retirement Services Launches FutureFIT Wellness Check, a New Financial Wellness Assessment Tool Connecting Retirement Plan Participants with Personalized Action Plans

AIG Retirement Services

Webcasts and Conferences
(Health & Welfare Plans)

FMLA Workshop

April 26, 2022 WEBCAST

Ogletree Deakins

Deciphering the New Group Health Plan Requirements Under the CAA: Session 3 - Transparency, Part 1

May 25, 2022 WEBCAST

Thompson Hine LLP

Last Issue's Most Popular Items

Text of IRS Proposed Regs: Affordability of Employer Coverage for Family Members of Employees

Internal Revenue Service [IRS]

Fact Sheet: IRS Proposal to Fix 'Family Glitch' and Lower Health Care Costs

Executive Office of the President

Court Orders Aetna to Boost Coverage for Mental Health Treatment in ERISA Case

Hall Benefits Law

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

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