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Health & Welfare Plans Newsletter

April 13, 2022

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

Text of FInal HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' (DIY) Software Instructions for the 2021 Benefit Year (PDF)

26 pages; Apr. 13, 2022. "This document provides instructions for the HHS risk adjustment models for the 2021 benefit year, with revisions from the updated 2021 benefit year software instructions posted on the CCIIO website on January 7, 2022." [Also available: Technical Details (XLSX) and 2021 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

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

[Guidance Overview]

A Fix for the ACA's 'Family Glitch'

"If an employee in a family was offered affordable self-only coverage, the employee would still not be eligible for premium tax credits. The family would thus have to purchase two policies -- one for the employee through the employer and one through the marketplace for the remaining family members. The family also may have to meet two deductibles, be subject to two out-of-pocket limits, and might find itself in two different provider networks. Families with more than one employee offered self-only coverage may need to purchase several policies, one for each employee and a marketplace plan for the remaining family members."  MORE >>

The Commonwealth Fund

[Guidance Overview]

Maryland Becomes Tenth State to Enact Paid Family Leave Law

"Paid leave will be available to eligible employees for family leave, medical leave, and family military leave reasons beginning on January 1, 2025.... Beginning October 1, 2023, employees, employers, and self-employed individuals must begin making contributions to the Fund.... Covered employers include any person or governmental authority that employs at least one individual in the state of Maryland."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

Maryland Enacts Paid Family Leave Law

"The law covers the vast majority of employers in the state ... and will ensure that covered private sector employees ... who have worked at least 680 hours over the 12-month period immediately preceding the date on which the leave is to begin have up to 12 weeks annually of paid time off for certain purposes. Benefits will replace 90% of weekly wages for an employer's lowest-income employees (with a smaller percentage for higher-paid workers), up to a maximum of $1,000 per week."  MORE >>

Hunton Andrews Kurth LLP

Seventh Circuit: Raise Effective One Day After Lawyer's Heart Attack Is Excluded from Disability Benefit Calculation

"The district court believed that the definition of 'active work' should be read in conjunction with the definition of 'determination date.' According to the district court, because Ten Pas was considered 'actively at work' through Labor Day weekend, he could not have become disabled until September 2.... The Seventh Circuit found error with the district court's analysis.... Only two things are relevant, the date the disability began, and the last day worked just prior to that date. The district court impermissibly injected the 'active work' definition into the equation." [Ten Pas v. Lincoln National Life Ins. Co., No. 20-1259 (7th Cir. Apr. 11, 2022)]  MORE >>

Roberts Disability Law

Alert (High Risk Issue) icon Sixth Circuit: Employee's Widow Can Bring Life Insurance Claim Against Walmart as Fiduciary

"The 6th U.S. Circuit Court of Appeals said a lower court erred in dismissing Ruth Mae Chelf's claims for breach of fiduciary duty based on the 'ministerial function' exception to ERISA ... That defense was unavailable to Walmart because ... '[Walmart] was a fiduciary as it indisputably exercised control over the Plan's assets when it handled Mr. Chelf's premiums, exercised control over the disposition of the Plan's assets, and had discretionary authority over the administration of the Plan,' [judge Jane B. Stranch] wrote[.]" [Chelf v. Prudential Ins. Co., No. 20-6097 (6th Cir. Apr. 12, 2022)]  MORE >>

Reuters; free registration may be required

Examining HSAs Through a DEI Lens

"EBRI's analysis finds stark differences in HSA behavior based on accountholder race, ethnicity, gender, and income.... Disparities in HSA account balances along racial, ethnic, gender, and income lines are not adequately explained by the length of HSA ownership. Instead, the disparities EBRI observes appear to be largely driven by contributions."  MORE >>

Employee Benefit Research Institute [EBRI]

Oklahoma Bill Would Fine Health Insurance Companies That Do Not Pay Claims

"House Bill 2322, named the Health Care Freedom of Choice Act, would authorize the Oklahoma Insurance Department to hold hearings and levy fines on insurance companies that refuse to pay claims from 'practitioners, hospitals, home care agencies, or ambulatory surgical centers despite them meeting requirements for compensation as laid out in the measure,' according to the bill summary."  MORE >>

Benefits in General

Multiemployer Plan Trustee Tools for Monitoring and Preventing Fraud

"Analyzing and mining data can help plans find interesting or questionable patterns that may be a sign of fraud or waste.... External auditors should take certain steps to detect material errors and irregularities in the plan financial statements.... Multiemployer plan policies detail plan compliance with government regulations, mandate consistency in plan operations, help plans avoid legal liability and give assurance to others that that the plan is well run."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

Employee Benefits Jobs

View job as DB/DC Administrator
          for Primark Benefits DB/DC Administrator

Primark Benefits

Remote / San Mateo CA

View job as DB/DC Administrator
          for Primark Benefits

View job as Retirement Plan Administrator
          for Retirement Plan Specialists, Inc. Retirement Plan Administrator

Retirement Plan Specialists, Inc.

Remote / Oviedo FL

View job as Retirement Plan Administrator
          for Retirement Plan Specialists, Inc.

View job as Client Relationship Manager
          for The Benefit Advantage Client Relationship Manager

The Benefit Advantage


View job as Client Relationship Manager
          for The Benefit Advantage

View job as Retirement Plan Administrator
          for Warren Averett Retirement Plan Administrator

Warren Averett


View job as Retirement Plan Administrator
          for Warren Averett

Press Releases

Jessica Palvino Joins Jackson Walker’s ERISA Practice in Austin

Jackson Walker

Webcasts and Conferences
(Health & Welfare Plans)

Health & Welfare: Beyond the Basics (Level 2)

May 4, 2022 in MA

New England Employee Benefits Council [NEEBC]

Health & Welfare Basics (Level 1)

June 9, 2022 in MA

New England Employee Benefits Council [NEEBC]

Last Issue's Most Popular Items

Changes Afoot for ACA Marketplace Subsidies for Family Members, and for Employer Pricing Strategies


Administration Budget Proposals Tighten Rules for 409A Violations, VEBA Funding and Indemnity Health Plans

Groom Law Group

Infertility HRAs: Compliance Considerations for an Emerging Trend (PDF)

VCG Consultants

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

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