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Health & Welfare Plans Newsletter

August 24, 2022

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

New 'No Surprises Act' Regs Address 'Downcoding' and Vacated QPA Presumption

"New regulations require 'downcoding' QPA disclosures, but plan and issuer 'downcoding' policies remain a subject of pending litigation.... [The new final rule] directs certified IDR entities to consider the QPA as well as certain other specific factors when resolving out-of-network rate disputes."  MORE >>

Nixon Peabody LLP

[Guidance Overview]

ACA Section 1557: The Past Is the Present and May Be the Future

"HHS has now reproposed rules that would reinstate the 2016 definition of covered entity and then expand upon it.... [S]elf-funded plan sponsors could potentially have to revert back to providing the annual notice and work with their [TPA] to ensure the notices are included in all of the required communications. Any TPA that receives federal financial assistance in another part of its business would likely be subject to these rules, even if the plan sponsor is not directly subject to them."  MORE >>

HUB International

[Guidance Overview]

Exceptional Usefulness and Quality icon Administering COBRA Continuation Coverage in Mergers and Acquisitions Can Be Complicated

"Applying COBRA coverage rules in the merger and acquisition (M&A) context has always been challenging. Various COBRA rules spelled out are in regulations from the [IRS] and other guidance and case law. But then there is the 'real world'; how can these rules be applied in the context of an ever-changing and evolving M&A environment?"  MORE >>

Paul M. Hamburger, via HR Daily Advisor

Fifth Circuit Affirms Rejection of DOL Advisory Opinion, Greenlights 'Partnership' Arrangement for Non-ACA Health Plan

"[T]he Fifth Circuit Court of Appeals largely upheld a district court decision to reject a [DOL] advisory opinion that would have restricted a new arrangement designed to avoid major [ACA] protections and state regulation of private health insurance.... LP Management Services ... [had] requested an advisory opinion from [DOL] on whether its partnership arrangement qualified as a single-employer self-insured group health plan under [ERISA].... [I]ndividuals and small businesses could become 'partners' and buy into the health insurance plan merely by agreeing to download software and provide user data[.]" [Data Marketing Partnership, LP v. DOL, No. 20-11179 (5th Cir. Aug. 17, 2022)]  MORE >>

Health Affairs

Court Finds Employee-Paid LTD Policy Was Part of Employer's ERISA Plan

"[T]he insurer asserted that the LTD policy was covered by ERISA and failed to meet the requirements of the DOL safe harbor because: [1] it was a component of the entire group health plan to which the employer contributed (through the basic life policy); and [2] it was endorsed by the employer.... [T]he court agreed with the insurer, finding that the four 'policies were jointly offered 'as part of the [employer's] employee benefits program,' which implicates ERISA regardless of the lack of employer contribution to the LTD portion of the overall plan.' " [Duncan v. Unum Life Ins. Co. of Am., No. 20-600 (M.D. Tenn. Jul. 18, 2022)]  MORE >>

The Wagner Law Group

Business Group on Health 2023 Health Care Strategy and Plan Design Survey

"After experiencing no increase in actual health care cost from 2019 to 2020, employers experienced a significant return to rising costs, with a median 2021 cost increase of 8.2%.... [E]mployers expect to cover 82% of the cost of employee coverage in 2022, up from 80% the year before ... Large employers overwhelmingly (99%) said they were concerned about prescription drug trend.... Long-term mental health issues, both observed and anticipated, are the leading health-related impact of the pandemic[.]"  MORE >>

Business Group on Health

Employee Benefits Jobs

View job as North America Total Rewards Manager
          for Air Products and Chemicals, Inc North America Total Rewards Manager

Air Products and Chemicals, Inc

Macungie PA

View job as North America Total Rewards Manager
          for Air Products and Chemicals, Inc

View job as Benefits Analyst
          for Chromalloy Benefits Analyst


Palm Beach Gardens FL

View job as Benefits Analyst
          for Chromalloy

Last Issue's Most Popular Items

New 'No Surprises Act' FAQs Build on Recent Final Regs

Health Affairs

Inflation Reduction Act Expands Insulin Safe Harbor for HDHPs

Ogletree Deakins

Agencies Issue Guidance Regarding Coverage of Family Planning Services and Emergency Contraceptives Under the ACA After Dobbs

Woodruff Sawyer

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

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