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Health & Welfare Plans Newsletter

April 28, 2022

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[Official Guidance]

Text of CMS 2023 Final Letter to Issuers in the Federally-facilitated Exchanges (PDF)

28 pages. "This 2023 Final Letter provides updates on operational and technical guidance for the 2023 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2023 Final Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs).... The 2023 Final Letter focuses on guidance that has been updated for the 2023 plan year, and refers issuers to the 2017 through 2022 Letters to Issuers in the Federally-facilitated Exchanges in all instances where CMS guidance has not changed."  MORE >>

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

[Guidance Overview]

HHS Notice of Benefit and Payment Parameters for 2023 Final Rule: Fact Sheet

"Overall, the final rule seeks to strengthen the coverage offered by qualified health plans (QHPs) on the federal Marketplace. These policies will also ensure consumers can more easily find the right form of quality, affordable coverage for their circumstances.... [1] Standardized plan options.... [2] Network adequacy.... [3] Changes to actuarial value (AV) de minimis ranges.... [4] refine essential health benefits (EHB) nondiscrimination policy for health plan designs.... [5] Special enrollment period (SEP) verification.... [6] FFM and SBM-FP user fees.... [7] Risk adjustment.... [8] HHS risk adjustment data validation (HHS-RADV).... [9] Advanced payments of the premium tax credit (APTC) proration.... [10] Require the display of explanations for QHP recommendations on web-broker websites." [Also see HHS press release.]  MORE >>

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

[Guidance Overview]

Alert (High Risk Issue) icon Health Plan Sponsors Must Obtain Fee Disclosures from Consultants and Brokers (PDF)

"Health plan fiduciaries are now obligated to obtain broad fee disclosures from their group health plan consultants and brokers.... Consultants and brokers for health plans are also now required to provide plan fiduciaries (usually, plan sponsors) a description of their services and all direct and indirect compensation that they expect to receive for providing their services.... [T]he new fee disclosure rules [apply to] all contracts entered into, extended or renewed on or after December 27, 2021."  MORE >>

Ice Miller LLP, via Employee Benefit Plan Review

[Guidance Overview]

Alert (High Risk Issue) icon Prescription Drug Reporting Rules Present Challenges (PDF)

20 pages. "The new reporting requirement is particularly challenging for self-funded group health plan sponsors with multiple vendors and complicated plan designs. Sponsors of self-funded plans -- especially those using carve-out and point-solution vendors to administer aspects of their health plans -- must identify impacted vendors, coordinate their reporting, and verify that the reporting is complete and not duplicative. The current system does not automatically generate a verification for plan sponsors when a report is submitted or accepted without errors."  MORE >>


Washington State LTC Insurance Program Survives First Federal Challenge But Could See Others at State Level

"Washington state's first-of-a-kind, public long-term care insurance program survived its first legal challenge this week, as Federal Judge Thomas S. Zilly ruled that he lacked jurisdiction.... [Judge Zilly said] that taxpayers can still challenge the law through the state's administrative and judicial systems, but it is not a federal matter[.]" [Pacific Bells, LLC v. Inslee, No. 21-1515 (W.d. Wash. Apr. 25, 2022)]  MORE >>

McKnights Senior Living

Employee Benefits Jobs

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Remote / Roseville CA

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Press Releases

Honoring Retirement Plan Education Superstars

PSCA [Plan Sponsor Council of America]

Last Issue's Most Popular Items

How the ACA Family Glitch Fix Would Impact Employers and the Exchange

Tango Health

Transparency in Coverage Final Rules


Employer-Provided Health Coverage: State-to-State 2022 (PDF)

America's Health Insurance Plans [AHIP]

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

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