logo logo

Health & Welfare Plans Newsletter

August 17, 2022


[Official Guidance]

Technical Assistance for Certified Independent Dispute Resolution (IDR) Entities (PDF)

21 pages; August 2022. Topics include: [1] Batching and bundling, [2] Eligibility for the Federal IDR process, and [3] Failure to submit information in response to a certified IDR entity"s request.  MORE >>

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

[Guidance Overview]

Decoding the New Rules for Prescription Drug and Other Healthcare Spending Transparency

"Key requirements for plans and issuers are providing personalized cost-sharing information and ensuring other information on costs is publicly available.... Many employers think that personalized cost-sharing information ... has the potential for near-term impact on employee healthcare purchasing behaviors once implemented. But overall sentiment leans toward a small (53%) or moderate (24%) effect ... Price transparency will likely benefit employees more than employers."  MORE >>


[Guidance Overview]

HHS Proposed Regs Reinterpret ACA Section 1557

"The 2022 Proposed Rule re-expands the interpretation of 'on the basis of sex' to prohibit discrimination on the basis of sexual orientation and gender identity. The 2022 Proposed Rule additionally expands the interpretation to prohibit discrimination against someone for seeking reproductive care and discrimination on the basis of pregnancy or related conditions, including 'pregnancy termination.' "  MORE >>


[Guidance Overview]

HHS Again Proposes Nondiscrimination Regs Under Section 1557 of the ACA

"While gender identity and sexual orientation protections are a primary focus of the proposed regulations, along with protections for disabled individuals and individuals with limited English proficiency (LEP), a number of other issues are addressed, including several for which HHS has requested comments."  MORE >>

The Wagner Law Group

When Being Wrong Isn't Enough: Eleventh Circuit Upholds Benefit Decision with Which It Disagrees

"This case serves as a stark reminder of the uphill battle ERISA claimants face when confronted with the abuse of discretion standard of review. Ms. Stewart proved to a federal appellate court’s satisfaction that her claim administrator had misread the policy, but that wasn’t enough. It is no surprise that state legislatures across the country have increasingly reacted to cases like this by prohibiting insurers from including discretionary authority provisions in their policies." [Stewart v. Hartford Life & Accident Ins. Co., No. 21-11919 (11th Cir. Aug. 10, 2022)]  MORE >>

Kantor & Kantor LLC

What Employers Should Consider When Purchasing Group Disability Insurance

"[1] What is the reputation of the carrier? ... [2] Does the policy contain discretionary language? ... [3] Are the benefits taxable? ... [4] What is the definition of disability? ... [5] What is the elimination period? ... [6] What are the limitations and exclusions?"  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Benefits in General

A Beneficiary Form Is the Most Important Employee Benefit Form

"[T]he varied distribution protocols outlined in different life insurance and 401(k) plan provider documents are often contrary to what one might expect would be the distribution protocol.... [T]he distribution of large sums of money could potentially be against the deceased employee's wishes. The best way to avoid this issue is to make sure that an individual employee's life insurance and 401(k) beneficiary form(s) exist, is current, and matches any estate planning documents."  MORE >>

Masuda Funai

Press Releases

Carrum Health Selected as Trusted Partner by Accolade to Help Employers Achieve Immediate and Tangible Cost Savings

Carrum Health

Webcasts and Conferences
(Health & Welfare Plans)

Don't Be a Victim in the PBM Shell Game: How to Regain the Upper Hand in Managing Pharmacy Costs

August 25, 2022 WEBCAST


Last Issue's Most Popular Items

Inflation Reduction Act's Health Care Provisions Could Affect Employers

Society for Human Resource Management [SHRM]; membership may be required to view article

When the Federal No Surprises Act's Dispute Resolution Process Does Not Apply: No 'Surprise Billing'

K&L Gates

IRS Issues Affordability Percentage Adjustment for 2023

Woodruff Sawyer

Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2021, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.