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Health & Welfare Plans Newsletter

June 30, 2022

7 New Job Opportunities 7 New Job Opportunities

 

[Official Guidance]

Text of CMS Medical Loss Ratio (MLR) Annual Reporting Form Filing Instructions for the 2021 MLR Reporting Year (PDF)

"These are the filing instructions for the report to the Secretary required by section 2718 of the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees. The data included in the MLR Annual Reporting Form (MLR Form) are the exact data that will be used to calculate an issuer's MLR and rebates, if any, under section 2718 of the PHSA[.] " [Also available: MLR 2021 Annual Reporting Form (XLSX) and MLR 2021 Calculator and Formula Tool (XLSM)]  MORE >>

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

[Guidance Overview]

Exceptional Usefulness and Quality icon Impact of the Dobbs Decision on Cafeteria Plans and Medical Travel

"Can an employer reimburse abortion travel expenses in excess of the limits under Code section 213(d)? ... Can abortion travel expenses be reimbursed through an HRA or Health FSA? ... What kind of documentation is required to reimburse abortion travel benefits under an FSA or HRA/EBHRA? ... Can abortion travel expenses be reimbursed through an HSA? ... Can abortion travel benefits be provided through an EAP? ... What if a state attempts to ban abortions obtained outside of the state? What if a state attempts to ban reimbursement for abortions?"  MORE >>

Alston & Bird, via TRI-AD

Exceptional Usefulness and Quality icon Proactive Considerations for Employers and Potential Approaches to Abortion-Related Benefits

"An employer's particular approach will need to consider the organization's culture, employee expectations, and the ability of their carriers and vendors to administer these benefits.... [E]mployers [should consider] ... [1] whether the additional benefits for abortion raise any concern with mental health parity requirements that apply to group health plans ... [2] the appropriate taxation of travel and lodging reimbursements under IRS rules; and [3] the potential risks of civil and/or criminal liability based on the states in which their employees live.' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

Ice Miller LLP

Exceptional Usefulness and Quality icon Overturning of Roe v. Wade Creates Challenging Legal Issues for Self-Funded Health Plan Sponsors

"[If] a state has a law making it a crime for anyone to pay for or reimburse the costs of an abortion, it would be very difficult to argue that ERISA preempts said law as applied to self-funded ERISA plans ... On the other hand, laws like [Oklahoma's] -- which provide for a civil cause of action against anyone who pays for or reimburses the costs of an abortion -- are likely preempted by ERISA as it relates to ERISA self-funded group health plans.... There are numerous issues and considerations beyond the state law issues[.]' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

McAfee & Taft

Alert (High Risk Issue) icon Second Circuit Ruling Highlights ERISA Claim Procedure Deadlines

"While the court ... acknowledged that administrators are entitled to flexibility in administering benefits, the Second Circuit concluded the need for flexibility cannot outweigh the purpose of the regulation to limit the number of appeals a claimant must pursue. Hence, the court determined that Hartford was obligated to decide McQuillin's entitlement to benefits within 45 days of his appeal submission, and the failure to do so rendered the duty to appeal exhausted after 45 days elapsed without a benefit determination." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

District Court Dismisses Provider's Claims Against Insurer for Cost of COVID-19 Tests, But Potential ERISA Claim Remains

"In a dispute over reimbursements for COVID-19 testing, a district court concluded that the coverage mandates under the [FFCRA] and the [CARES Act] did not create a private right of action. The court therefore dismissed claims by a health provider alleging that a health plan's insurer violated the CARES Act by underpaying it for COVID-19 testing for five individuals." [Saloojas, Inc. v. Aetna Health of Calif., Inc., No. 22-1703 (N.D. Cal. June 23, 2022)]  MORE >>

Thomson Reuters Practical Law

Accidental Death Claims and the Presumption Against Suicide Under ERISA (PDF)

"[In] most cases, a court will find that, even where the presumption against suicide in claims for benefits under accidental death or accidental death and disability policies is the correct standard, there was sufficient evidence in the record to rebut the presumption."  MORE >>

The Wagner Law Group, via Benefits Law Journal

Open Enrollment: Setting Yourself Up for Success Starts Now

"A live, in-person Open Enrollment session may work for your organization, especially if you have been planning to bring everyone together.... Live virtual meetings can be productive if managed well, though technical difficulties and a lack of attention to virtual meeting etiquette can often get in the way.... [Some employers] have replaced live gatherings, whether virtual or in-person, with a communication campaign that is varied and effective."  MORE >>

Newfront

OPM to Federal Employees: If You Need to Travel for an Abortion, You Can Use Sick Leave

"The federal government's HR agency confirmed that federal employees may use sick leave to travel to obtain reproductive health services, although the measure falls short of employee groups' request for paid administrative leave after abortion ruling."  MORE >>

Government Executive

Benefits in General

Exceptional Usefulness and Quality icon Health & Welfare Plan and 401(k) Plan Integration Issues in Strategic M&A Transactions: Important Diligence Topics and Best Practices (PDF)

"This article provides an overview of common integration-related issues that arise with respect to 401(k) and health and welfare plans in strategic mergers and acquisitions (M&A) transactions, and [discusses]: [1] The areas on which buyers their advisors should focus during diligence in order to best integrate a target's health and welfare plans; [2] Similar issues that arise with respect to 401(k) plans; and [3] Some of the unique concerns surrounding health and welfare and 401(k) plans sponsored by professional employer organizations (PEOs)."  MORE >>

White & Case LLP, via Benefits Law Journal

Employee Benefits Jobs

View job as Senior Defined Contribution Account Manager
          for Nova 401(k) Associates Senior Defined Contribution Account Manager

Nova 401(k) Associates

Remote

View job as Senior Defined Contribution Account Manager
          for Nova 401(k) Associates

View job as Retirement Plan Consultant/Relationship Manager
          for Associated Pension Consultants Retirement Plan Consultant/Relationship Manager

Associated Pension Consultants

Remote / Chico CA / Sacramento CA

View job as Retirement Plan Consultant/Relationship Manager
          for Associated Pension Consultants

View job as Enrolled Actuary
          for Loren D. Stark Company Enrolled Actuary

Loren D. Stark Company

Remote

View job as Enrolled Actuary
          for Loren D. Stark Company

View job as Compliance Specialist II
          for EPIC RPS Compliance Specialist II

EPIC RPS

Remote

View job as Compliance Specialist II
          for EPIC RPS

View job as Defined Contributions Retirement Plan Consultant
          for Economic Group Pension Services (EGPS) Defined Contributions Retirement Plan Consultant

Economic Group Pension Services (EGPS)

Remote

View job as Defined Contributions Retirement Plan Consultant
          for Economic Group Pension Services (EGPS)

View job as Defined Contribution Analyst
          for Economic Group Pension Services (EGPS) Defined Contribution Analyst

Economic Group Pension Services (EGPS)

Remote

View job as Defined Contribution Analyst
          for Economic Group Pension Services (EGPS)

View job as Sr Principal, Actuarial Services, Post Retirement Welfare Benefits
          for National Rural Electric Cooperative Association (NRECA) Sr Principal, Actuarial Services, Post Retirement Welfare Benefits

National Rural Electric Cooperative Association (NRECA)

Arlington VA

View job as Sr Principal, Actuarial Services, Post Retirement Welfare Benefits
          for National Rural Electric Cooperative Association (NRECA)

Webcasts and Conferences
(Health & Welfare Plans)

Benefits, Leaves, Pay, and Accommodations Post-Dobbs: Critical Reminders for Employers

July 1, 2022 WEBCAST

Ogletree Deakins

Landmark Ruling Overturns Abortion Rights: Examining the Decision’s Employee Implications

July 6, 2022 WEBCAST

Thompson Hine LLP

Breaking Down Dobbs: Employer Considerations in a Complicated Landscape

July 14, 2022 WEBCAST

ERIC [ERISA Industry Committee]

Last Issue's Most Popular Items

Navigating Employer-Provided Benefits in the Wake of Dobbs

Sherman Howard

In Matter of First Impression, Eleventh Circuit Holds ERISA Beneficiary Can Recover Monetary Benefits Lost Due to a Breach of Fiduciary Duty

Roberts Disability Law

Is Your Plan Adequately Covered by an ERISA Fidelity Bond?

EisnerAmper

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

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