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Health & Welfare Plans Newsletter

June 1, 2022

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

Broker and Consultant Fee Transparency to Group Health Plans

"Covered service providers must disclose to covered plans specified information regarding the services to be provided and the compensation the covered service provide reasonably expects to receive ... for any new contracts or arrangements as of [December 27, 2021].... While the disclosures contemplated by the statutory provision are intended to come from the covered service provider, the fiduciary responsibility rest with the covered plan sponsor."  MORE >>

Fraser Trebilcock

[Guidance Overview]

Upcoming Deadline icon Machine-Readable Transparency in Coverage File Requirement Is Looming

"Group health plans and issuers are now required to make publicly available a machine-readable file (MRF) disclosing information about costs, covered items and services starting on July 1, 2022.... MRFs must contain specific information, follow a specific format and be posted on a publicly accessible website. Both fully insured and self-funded plan sponsors must comply with the requirements and will need to lean heavily on their carriers and third-party administrators (TPAs) for compliance assistance."  MORE >>


[Guidance Overview]

Selected State Health Developments, First Quarter 2022 (PDF)

"Prescription drug pricing and [PBM] restrictions took the spotlight as California, Michigan, Nebraska, New York, Oklahoma, Washington and West Virginia enacted new laws. Paid leave also garnered attention as California, Connecticut, Maine, New Mexico, Oregon, Washington and Washington, DC, looked to expand existing programs or considered new paid leave mandates. Illinois, New York and Washington updated their health plan reporting requirements. Insurance coverage mandates for services like contraceptives and abortion passed in California, Maine, New Jersey and Washington. Several states -- including Indiana, Washington and Wisconsin -- joined an interstate compact that makes it easier for group health plans to provide mental health services via telehealth."  MORE >>


[Guidance Overview]

Form 5500 -- Questions Frequently Asked by Group Health Plans

"Group health plans with at least 100 plan participants must file a Form 5500 annually. The number of Form 5500s a plan must file depends on the number of participants in each plan and whether the plan has a wrap document. Form 5500s are due seven months after the end of the plan year, and a two-and-a-half-month extension is available. Delinquent filers may take advantage of a voluntary delinquent filer program to mitigate penalties for late or missed filings."  MORE >>


District Court Limits Disability Insurer's Ability to Expand Administrative Record Because of Failure to Comply with Claim Deadlines

"Lincoln's failure to comply with the extension requirements and the appeal deadlines were not de minimis violations because they did not demonstrate 'good cause' that their violation was due to 'matters beyond its control.' ... [A] plan's desire to obtain another medical review and subsequent decision is not considered a 'special circumstance' that permits a 45-day extension." [Fredrich v Lincoln Life & Annuity Company of New York, No. 21-5482 (E.D.N.Y. May 13, 2022)]  MORE >>

Roberts Disability Law

Why Your Benefit Communication Strategy Needs a Fresh Look and Where to Begin

"Your challenge may not be a shortage of information on your company's benefits, policies, and procedures. The actual issue may be having too much content that isn't organized or easily accessible. Developing FAQs that address common concerns helps you reduce time spent on phones, live chats, and emails, while also assisting more employees at once."  MORE >>

Tango Health

Availability of Leave Upon Miscarriage or Other Pregnancy Loss

"8.7% of U.S. organizations surveyed offer paid leave related to miscarriages while 13.2% offer unpaid leave related to miscarriage or pregnancy loss. Miscarriage leave or leave for other types of pregnancy loss often falls under an employer's bereavement leave policy ... Several federal laws may allow for employee time off after a miscarriage or other pregnancy loss.... Currently, two states have laws requiring private companies to provide bereavement leave[.]"  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

2022 Medical Loss Ratio Rebates

"[I]nsurers estimate they will issue a total of about $1 billion in MLR rebates across all commercial markets in 2022 ... Expected rebate amounts vary by market segment, with the majority going to individual market enrollees, including ACA Marketplace enrollees. Insurers in the individual market estimate they will issue $603 million in rebates, small group market insurers will issue $275 million in rebates, and large group market insurers will issue $168 million in rebates later this year."  MORE >>

Henry J. Kaiser Family Foundation

Price Regulation, Global Budgets, and Spending Targets: A Road Map to Reduce Health Care Spending and Improve Affordability

"[The authors] review several policy options to reduce health care spending and improve affordability ... provide examples of these options currently in practice at the state and federal levels and discuss how those experiences can inform future efforts ... describe the policy design considerations and discuss the tradeoffs and implications of adopting each option and design decision ... [and] discuss the legislative and regulatory pathways for adopting new policies, as well as considerations for monitoring and enforcement."  MORE >>

Henry J. Kaiser Family Foundation

GAO Report: Limited Data Hinders Understanding of the Role and Value of Short-Term Individually Owned Health Insurance During the COVID-19 Pandemic

"GAO found that limited and inconsistent data hinder understanding of the role short-term [health insurance] plans played during the COVID-19 pandemic for those who lost [employer-sponsored health plan coverage], such as whether they were used by consumers as temporary coverage or as a longer-term alternative to PPACA-compliant plans.... In addition, data collected on short-term plans varied across the six states that GAO reviewed."  MORE >>

U.S. Government Accountability Office [GAO]

Employee Benefits Jobs

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Press Releases

The PensionInspector™ Announces New 'Inflation Eraser' App

The PensionInspector

Milliman Wins Two International Employee Communication Awards Recognizing Outstanding Achievement in Benefits Communication


Envestnet Strengthens its Retirement Solutions Ecosystem with Acquisition of the Marketplace


Webcasts and Conferences
(Health & Welfare Plans)

Prescription Benefits Dollars & Sense: Marketplace Trends

June 23, 2022 WEBCAST

Corporate Synergies

Global Compensation and Benefits: Working Across Jurisdictions

June 23, 2022 WEBCAST

Eversheds Sutherland

Last Issue's Most Popular Items

Her First Colonoscopy Cost Her $0; Her Second Cost $2,185. Why?

Kaiser Health News

No Surprise: 'Pure' Reference-Based Pricing Is Always Superior


Arbitration of ERISA Claims: Where Are the Courts and Congress Headed?

Cohen & Buckmann, P.C.

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

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