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Health & Welfare Plans Newsletter

August 22, 2022

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

Agency Fact Sheet on Requirements Related to Surprise Billing: Final Rules (PDF)

"On August 19, 2022, [HHS, DOL and the Treasury Department] released final rules titled 'Requirements Related to Surprise Billing: Final Rules.' ... The rules finalize certain requirements under the July 2021 interim final rules relating to information that group health plans and health insurance issuers offering group or individual health insurance coverage must share about the qualifying payment amount (QPA).... Information about the QPA that plans and issuers must share.... Payment determinations under the federal IDR process."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

Federal Agencies Revise Approach to Arbitration Under 'No Surprises Act'

"The final rule's most significant change is elimination of the 'rebuttable presumption' in favor of the QPA, a part of the interim final rule that has been the subject of eight lawsuits from providers and two court decisions thus far.... The final rule ... does not dictate which offer the IDR entity should select. It instead focuses on the process that IDR entities should use when choosing between two competing offers."  MORE >>

Health Affairs

[Guidance Overview]

IRS Adjusts Figure Applicable to Employer Mandate

"[S]ome employers may find that the contributions that low-wage employees must pay for coverage under their health plans in 2023 will cause that coverage to be deemed unaffordable. If that occurs, the employer will need to pay an assessment for each full-time employee who forgoes employer coverage and instead obtains subsidized coverage through an ACA health insurance exchange. That assessment is calculated for each month in which coverage remains unaffordable. For 2022, the amount was $343.33 per month ($4,120 for an entire year)."  MORE >>

Ballard Spahr LLP

Federal Independent Dispute Resolution Process Status Update (PDF)

Aug. 19, 2022. "Between April 15th and August 11th, disputing parties initiated over 46,000 disputes through the federal IDR portal, which is substantially more than the Departments initially estimated would be submitted for a full year. Of the disputes initiated between April 15th and August 11th, certified IDR entities rendered a payment determination in over 1,200 disputes. Between April 15th and August 11th, non-initiating parties challenged over 21,000 disputes' eligibility for the federal IDR process, which constitutes nearly half of all disputes initiated."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

Medical Stop-Loss Premiums Up Nearly 10% for 2022

"The average stop-loss coverage premium increase is 9.8 percent for the nearly 250 health plans in Segal's national medical stop-loss database's 2022 dataset.... The most common specific deductible, which 10 percent of plans have, is $250,000. That's up from $200,000 in the 2021 dataset."  MORE >>



Register for the Conference of Consulting Actuaries Annual Meeting

This year’s meeting includes 15 healthcare sessions. Learn about working with auditors, the impact of COVID, market updates in Medicare & ACA, the rise in virtual care, advanced healthcare analytics, plan design & pricing. 18.5 CPD credits available.

Sponsored by Conference of Consulting Actuaries [CCA]

Health Care Costs Expected to Be $13,800 Per Person in 2023

"Faced with the constant upward pressure from health care trends each year, employers are exploring new solutions to trim costs. One approach is to address the high costs associated with patients with chronic and complex health conditions."  MORE >>

BenefitsPro; free registration required

CRS Report: Changes in Employment and Employer-Sponsored Health Insurance Levels During the COVID-19 Pandemic

33 pages. "The four industries with the lowest [employer-sponsored insurance (ESI)] offer rates in 2019 ... account for nearly half of the decrease in employment between March 2019 and March 2021.... Across the different demographic groups, ESI coverage rates generally rose or remained stable among workers and declined or remained stable among the broader working-age adult population." [R47219 Aug. 19, 2022]  MORE >>

Congressional Research Service [CRS]

Employee Benefits Jobs

View job as ERISA Attorney
          for Definiti LLC ERISA Attorney

Definiti LLC


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          for Definiti LLC

View job as Benefits Specialist
          for Air Line Pilots Association Benefits Specialist

Air Line Pilots Association

Remote / Seattle WA

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          for Air Line Pilots Association

Last Issue's Most Popular Items

Text of Agency FAQs Part 55: No Surprises Act Implementation, Including Surprise Billing Protections, Open Negotiation and the Federal IDR Process (PDF)

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

Text of Agency Final Regs: Requirements Related to Surprise Billing (PDF)

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

Inflation Reduction Act Indirectly Impacts Employer-Sponsored Group Health Plans

Thomson Reuters / EBIA

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