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Health & Welfare Plans Newsletter

June 9, 2022

6 New Job Opportunities 6 New Job Opportunities


[Guidance Overview]

Updated PCORI Fees Payable in 2022

"Due to the fact that the [HHS] did not publish updated National Health Expenditures tables for 2021, this year's fees are based on the projections set out in the 2020 tables.... [P]lans should pay close attention to next year's fee changes as the accuracy of 2020's projections may be affected by current inflationary trends."  MORE >>

Fraser Trebilcock

[Guidance Overview]

Agencies Issue Checklist for Surprise Billing IDR Process

"Explaining that most questions and complaints received to date by the No Surprises Help Desk relate to sending the initial payment or notice of denial (and the associated required disclosures) and providing information about the open negotiation period, the agencies outline the specific steps to follow to comply with these requirements."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Can Our DCAP Reimburse a 'Hold-the-Spot' Fee?

"Although the regulations do not specifically address hold-the-spot fees of the type your participant has asked about, an IRS official has informally commented that a hold-the-spot fee may qualify as an indirect expense if it must be paid to obtain care when the leave is over."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

CMS Speaks: Failing to Pay Agent Commissions Violates ACA

"[In a June 7 FAQ,] CMS said that insurers that pay reduced or no commission to agents and brokers who assist consumers during special enrollment and pay higher amounts for getting people covered during open enrollment in the same benefit year 'violate the guaranteed availability provisions of the [ACA].' "  MORE >>

'Conjunction Junction' and the FMLA

"[T]he court explained that the plain text of the FMLA makes clear that a violation does not require actual denial of FMLA benefits....[T]he court also shared other examples of what could be considered prohibited 'interference' with taking FMLA leave, including: the refusal to grant or accept proper requests for FMLA leave; overly burdensome FMLA approval processes and procedures; and, as in this case, informing an employee with FMLA leave available that missing additional time will have consequences." [Zicarelli v. Dart, No. 19-3435 (7th Cir. Jun. 1, 2022)]  MORE >>

Ice Miller LLP

Second Circuit Finds Administrative Remedies Had Been Exhausted Despite Insurer's Remand for Internal Reconsideration of Benefit Claim

"[T]he court found that 29 C.F.R. Section 2560.503-1 states plainly '[t]he plan administrator shall provide a claimant with … notification of a plan's benefit determination on review' within 45 days.... The review period is bound by strict time limits with protections for delays by the claimant and the claims administrator. Hartford's proposed reading of 503-1's requirements would allow multiple remands and delay resolution indefinitely." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

Roberts Disability Law

Second Circuit: Insurer's Internal Remand Did Not Extend Benefit Determination Deadline

"In a dispute involving long-term disability benefits under a plan governed by [ERISA], the Court of Appeals for the Second Circuit concluded that a benefit determination on administrative review under the [DOL's] claims regulations must decide with finality whether a claimant is entitled to benefits. The court rejected the insurer's argument that the DOL's regulations afforded the insurer flexibility and additional time to remand the matter for further internal consideration." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

Thomson Reuters Practical Law

Employers' Health Plans Should Reflect National Benchmarks for Cancer Screening

"Employers should update any reminder or incentive program to avoid prompting cancer screening more often than recommended.... More frequent repeats of cytology or HPV testing are medically indicated for some people with initial positive tests or at high risk for cervical cancer, so health plans should not implement caps on the frequency of these tests. Employers should encourage health plans to update any quality reporting or gaps in care programs to reflect current evidence-based guidance."  MORE >>

Willis Towers Watson

Benefits in General

[Official Guidance]

Text of EBSA Meeting Notice for ERISA Advisory Council

"[T]he 2101h open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on July 18-20, 2022.... The three-day meeting will take place at the [DOL offices in Washington DC]. The meeting will also be accessible via teleconference and some participants, as well as members of the public, may elect to attend virtually.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The Advisory Council will study the following topics: [1] Cybersecurity Issues Affecting Health Benefit Plans, and [2] Cybersecurity Insurance and Employee Benefit Plans."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Senate Vote to Confirm Lisa Gomez as EBSA Leader Falls Short

"The vote failed 49-51, with all 50 Republicans and Senate Majority Leader Chuck Schumer, D-N.Y., voting no. Mr. Schumer voted no for procedural reasons and immediately filed a motion to reconsider the nomination."  MORE >>

Pensions & Investments

Employee Benefits Jobs

View job as Retirement Plan Sales Representative
          for RMC Group Retirement Plan Sales Representative

RMC Group

Remote / Bonita Springs FL / Bonita Springs FL / Naples FL / Vail AZ / Tucson AZ

View job as Retirement Plan Sales Representative
          for RMC Group

View job as Fiduciary Support Analyst
          for Pentegra Fiduciary Support Analyst


Remote / Blacklick OH

View job as Fiduciary Support Analyst
          for Pentegra

View job as Employee Benefits Attorney
          for United Mine Workers of America Health and Retirement Funds Employee Benefits Attorney

United Mine Workers of America Health and Retirement Funds

Washington DC

View job as Manager, Corporate Benefits
          for Bertelsmann, Inc. Manager, Corporate Benefits

Bertelsmann, Inc.

New York NY / NJ

View job as Manager, Corporate Benefits
          for Bertelsmann, Inc.

View job as Retirement Plan Document & Design Consultant
          for OneAmerica Retirement Plan Document & Design Consultant


Remote / Indianapolis IN

View job as Retirement Plan Document & Design Consultant
          for OneAmerica

View job as ESOP Administrator
          for Blue Ridge ESOP Associates ESOP Administrator

Blue Ridge ESOP Associates


View job as ESOP Administrator
          for Blue Ridge ESOP Associates

Selected New Discussions

Mandatory HSA Contributions

"Is it legal for an employer to mandate a minimum annual HSA contribution from its HDHP-participating employees? Employee HSA contributions are deducted from employee paychecks on a pre-tax basis via a cafeteria plan."

BenefitsLink Message Boards

Press Releases

Groom Ranks High in The Legal 500 United States 2022

Groom Law Group

MissionSquare Retirement Celebrates 50th Anniversary and Launches MissionSquare Foundation with $20 Million Grant for Communities

MissionSquare Retirement

2022 PLANSPONSOR Plan Sponsor of the Year Winners Announced


Pontera and RFG Advisory Announce Partnership to Help Advisors Manage Clients’ Retirement Assets


Webcasts and Conferences
(Health & Welfare Plans)

ADA and FMLA: Back to Basics and Beyond

June 9, 2022 WEBCAST

Seyfarth Shaw LLP

Mid-Year Compliance Update

June 14, 2022 WEBCAST

Sun Life Financial

Do You Know What an NQTL Is?

June 15, 2022 in TX

DAHU [Dallas Association of Health Underwriters]

State Abortion Restrictions and the Impact on Employers, Insurers, and Self-Insured Plans

June 16, 2022 WEBCAST

Groom Law Group

Guidance on Paid Family Leave Laws, Part VI: Connecticut, Delaware, Maryland and Washington, D.C. Paid Family Leave Developments

June 21, 2022 WEBCAST

Seyfarth Shaw LLP

Last Issue's Most Popular Items

District Court: Employer's Health Plan Gender Reassignment Exclusion Violated Title VII

Thomson Reuters Practical Law

Health and Welfare Plans 2022 Update

Frost Brown Todd LLC

Second Circuit: Insurer 'Overturning' Previous Claim Denial Doesn't Reset Response-Time Clock

Reuters; free registration may be required

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

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