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Health & Welfare Plans Newsletter

June 29, 2022

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Draft 2022 IRS Form 1095-A and Instructions: Health Insurance Marketplace Statement (PDF)

Jun. 28, 2022. "Form 1095-A provides information you need to complete Form 8962, Premium Tax Credit (PTC). You must complete Form 8962 and file it with your tax return (Form 1040, Form 1040-SR, or Form 1040-NR) if any amount other than zero is shown in Part III, column C, of this Form 1095-A (meaning that you received premium assistance through advance payments of the premium tax credit (also called advance credit payments)) or if you want to take the premium tax credit."  MORE >>

Internal Revenue Service [IRS]

[Official Guidance]

Draft of 2022 IRS Form 1095-B and Instructions: Health Coverage Report (PDF)

Jun. 28, 2022. "This [draft of] Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year.... [If] individuals in your tax family are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit." [Also available: Draft of 2022 IRS Form 1094-B, Transmittal of Health Coverage Information Returns]  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Bloomington Becomes the Fourth Minnesota City to Require Paid Sick and Safe Leave

"[T]he Ordinance requires employers with five or more employees to provide employees with 1 hour of sick and safe time for every 30 hours worked within the geographic boundaries of Bloomington, up to a maximum of 48 hours in a year. Employers with fewer than five employees must still comply with the requirements of the Ordinance, but may provided the sick and safe time as unpaid."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

An Enchanting Look at New Mexico's Paid Sick and Safe Leave Final Regs and Other Guidance

"On June 21, 2022, New Mexico's Department of Workforce Solutions (DWS) published final regulations implementing the Healthy Workplaces Act (HWA), which will take effect throughout most parts of the 'Land of Enchantment' on July 1, 2022. The HWA will allow all private-sector employees to accrue paid leave that they can use for sick time, safe time, or other reasons for themselves or to care for or assist a broad list of family members."  MORE >>


[Guidance Overview]

Upcoming Deadline icon New Mexico's Paid Sick Leave Law Becomes Effective on July 1, 2022

"The [Health Workplaces Act (HWA)] covers employees performing work in New Mexico -- regardless of the location of the employer's business -- including part-time, temporary, and seasonal employees.... As of July 1, 2022, employees start accruing PSL. Employers may not offset this requirement with any leave an employee has already used or earned since January 1, 2022."  MORE >>

Ogletree Deakins

Alert (High Risk Issue) icon Second Circuit: Benefit Claim Must Be Fully Determined on Internal Appeal Review Within 45 Days

"[T]he Second Circuit rejected the claim administrator's argument that reversing the claim denial and remanding the claim internally for reevaluation satisfied the regulations -- instead, a decision on whether or not benefits would be awarded was required." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

Faegre Drinker

Supreme Court Opens Door to Limiting Reimbursement Rates for Outpatient Dialysis Treatment

"[G]roup health plans may explore excluding outpatient dialysis as an in-network benefit or, at least, changing the reimbursement rate for out-of-network providers of outpatient dialysis services. This appears to be a permissible practice if the reimbursement rate is uniform and applies to all participants, regardless of an ESRD diagnosis. This may, however, only be possible for self-funded group health plans." [Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]  MORE >>

Miller Johnson

Supreme Court Declines to Consider Potential Fiduciary Duties of Pharmacy Benefit Managers

"The Supreme Court declined to take up a lawsuit debating whether a pharmacy benefit manager has a fiduciary duty to lower drug prices, handing the industry a major win.... The decision comes amid increased scrutiny from the federal government and Congress on the PBM industry's role in the drug supply chain. The lawsuit focuses on whether a PBM has a fiduciary duty under [ERISA] to lower drug prices if it has the ability to do so." [Doe v. Express Scripts, No. 18-346 (2d Cir. Dec. 7, 2020; cert. pet. denied Jun. 27, 2022)]  MORE >>


Navigating Employer-Provided Benefits in the Wake of Dobbs

"Relegating control over the access to abortion services to the states creates a complex legal minefield for employers who intend to continue to support access to these services for their employees. This advisory provides employers with options to consider when navigating the new landscape.' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

Sherman Howard

2022 ERISA Advisory Council Issue Statement: Cybersecurity Issues Affecting Health Benefit Plans (PDF)

"The 2022 Advisory Council will examine cybersecurity issues affecting health benefit plans. The examination will identify issues and vulnerabilities affecting these plans and faced by plan sponsors, fiduciaries, and service providers, as well as how those may differ by plan size. The Council will also examine existing relevant frameworks, approaches and initiatives tailored to health care and health plan cybersecurity concerns and the interaction between overlapping regulatory regimes for health plans."  MORE >>

Advisory Council on Employee Welfare and Pension Benefit Plans, Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

The Return on Investment for Providing Employer-Sponsored Health Insurance (PDF)

10 pages. "[Employer-sponsored health insurance] will provide an estimated 47% ROI to employers with 100 or more employees in 2022 and a 52% return in 2026. Key drivers of ROI include $275.6B from improved productivity in 2022 and $346.6B in 2026, $101B from a reduction in direct medical costs in 2022 and $108B in 2026, and $119.2B from tax benefits in 2022 and $139.7B in 2026."  MORE >>

Avalere Health, for U.S. Chamber of Commerce

What the Pandemic's End Could Mean for Health Coverage

"After 2½ years of dealing with COVID-19, the health community is bracing for what some are calling 'The Great Unwinding' ... potentially the biggest coverage event since the [ACA] was implemented nearly a decade ago.... When the public health emergency declaration ends -- which is expected to happen later this year -- millions of Americans are at risk for losing Medicaid or ACA coverage."  MORE >>

Benefits in General

Alert (High Risk Issue) icon In Matter of First Impression, Eleventh Circuit Holds ERISA Beneficiary Can Recover Monetary Benefits Lost Due to a Breach of Fiduciary Duty

"In following the Supreme Court and its sister circuits which have recognized that courts in equity could traditionally order an 'equitable surcharge' to be paid by a breaching fiduciary to remedy a loss to a beneficiary, the court held that a beneficiary of an ERISA plan can bring a lawsuit under Section 1132(a)(3) against a fiduciary to recover benefits that were lost due to the fiduciary's breach of its duties." [Gimeno v. NCHMD, Inc., No. 21-11833 (11th Cir. Jun. 28, 2022)]  MORE >>

Roberts Disability Law

2022 ERISA Advisory Council Issue Statement: Cybersecurity Insurance and Employee Benefit Plans (PDF)

"The 2022 Advisory Council intends to examine the role that cybersecurity insurance plays in addressing cybersecurity risks for employee benefit plans. The Council intends to build on prior Council reports focused on privacy and security issues (2011) and cybersecurity for retirement plans (2016).... [T]he Council intends to look at the insurance topic as it relates to all types of benefit plans-- not only defined contribution and defined benefit pension plans but also group health and other welfare benefit plans."  MORE >>

Advisory Council on Employee Welfare and Pension Benefit Plans, Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Is Your Plan Adequately Covered by an ERISA Fidelity Bond?

"Section 412 of [ERISA] requires every person who handles funds or other property of a plan to be bonded ... Such persons include plan fiduciaries but may also include any director, officer or employee of the fiduciary.... Based on [an] analysis of 2020 plan year 5500s, nearly 10% of plans were inadequately covered by their fidelity bonds.... [T]here are several risks associated with not meeting the requirements,"  MORE >>


Employee Benefits Jobs

View job as Plan Administrator
          for Aimpoint Pension Plan Administrator

Aimpoint Pension

Remote / Pompano Beach FL

View job as Plan Administrator
          for Aimpoint Pension

View job as Retirement Specialist, Senior
          for Alerus Retirement Specialist, Senior



View job as Retirement Specialist, Senior
          for Alerus

Press Releases

James Watt Joins Retirement Research Center

Defined Contribution Institutional Investment Association [DCIIA]

Lockton Announces Beth Latchana as Director of Compliance Services


Wellbeats and Launch My Health Partner to Improve Health and Wellbeing Using Food as Medicine Approach


Webcasts and Conferences
(Health & Welfare Plans)

Review of Dobbs and Its Impact on Benefit Plans

July 22, 2022 WEBCAST

PLI [Practising Law Institute]

Last Issue's Most Popular Items

The Impact of Dobbs on Employer-Provided Health Benefits

Ropes & Gray LLP

Employers May Have to Pay More in 2022 Under New ACA Limits


The Immediate Aftermath of Dobbs, and the Coming Legal Morass

The Commonwealth Fund

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

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