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Health & Welfare Plans Newsletter

September 1, 2022

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

Agency FAQs Reveal Employers Continue to Struggle with Implementation of No Surprises Act and Transparency in Coverage Requirements

"The DOL, HHS and the Treasury recently issued joint guidance in the form of [FAQs which] ... [1] elaborate on and relax [the requirement that plans make machine-readable files publicly available on the plan's website no later than 7/1/2022] ... [2] specify the three ways in which plans and issuers must satisfy the notice obligation ... [3] [clarify how] protections would apply for plans with no network (e.g., reference-based pricing plans) or plans that only extend in-network coverage."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

After Multiple Strikes, Final Rules Issued for the No Surprises Act

"In addition to removing the presumption in favor of the QPA in the IDR process, the final rules require additional disclosures related to the QPA.... The Departments continue to consider comments on whether further additional disclosures related to the QPA calculation methodology should be required with an initial payment or notice of denial of payment, or upon request."  MORE >>

Troutman Pepper

[Guidance Overview]

Considerations for Nondiscrimination in Health Plans

"Group health plans that exclude or limit coverage for gender affirming care (e.g., care related to gender identity or gender dysphoria) risk discrimination claims on the basis of sex and transgender status in violation of the Constitution's Equal Protection Clause, Title VII of the Civil Rights Act of 1964 and the [ACA's] Section 1557 nondiscrimination rules."  MORE >>


[Guidance Overview]

ALE Affordability Updates for 2023

"In 2023 the affordability percentage will decrease to 9.12 percent. The IRS provides three affordability 'safe harbors' to help employers comply with the affordability requirement."  MORE >>


[Guidance Overview]

San Francisco Updates Contractor-Lessee Health Plan Standards

"Beginning Jan. 1, 2023, San Francisco contractors and lessees (and their subcontractors and subtenants) must comply with new health plan standards for covered employees under the Health Care Accountability Ordinance (HCAO). Effective July 1, a new poster and notice and higher alternative payment took effect for HCAO-covered employees ... Also effective July 1, a higher alternative payment took effect for covered employees at the San Francisco International Airport[.]"  MORE >>


Fifth Circuit Rules in Section 1557 Litigation

"The decision means that HHS is permanently barred from interpreting or enforcing Section 1557 in a way that would require the religious plaintiffs in Franciscan Alliance to perform or provide insurance coverage for services related to gender transition or abortion.... This article discusses this case and also summarizes the status of other litigation over rules to implement Section 1557." [Franciscan Alliance, Inc. v. Becerra, No. 21-11174 (5th Cir. Aug. 26, 2022)]  MORE >>

Health Affairs

Sixth Circuit Upholds Application of Probate Exception to Medical Plan's ERISA Suit Seeking Equitable Lien on Settlement Proceeds

"The district court dismissed the complaint after finding the 'probate exception' deprived the federal court of subject-matter jurisdiction. The majority of the Sixth Circuit panel agreed with defendants that AEP forfeited any challenge to the district court's conclusion that federal courts lack jurisdiction to hear its claims." [American Electric Power Service Corporation v. Fitch, No. 22-3005 (6th Cir. Aug. 30, 2022; unpub.)]  MORE >>

Roberts Disability Law

Understanding Coverage Issues for COVID-19 Vaccines and Treatments

"[T]his report: [1] provides an overview of the current coverage and payment of COVID-19 vaccines and treatments across payers; [2] identifies expected gaps in coverage after the end of U.S. Government-provided supply and key considerations for coverage determinations post-PHE; and ... [3] concludes with potential next steps for payers as they navigate the coverage and payment process to prevent gaps in availability of lifesaving COVID-19 vaccines and treatments."  MORE >>

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Employee Benefits Jobs

View job as Pension Compliance Specialist
          for CUNA Mutual Pension Compliance Specialist

CUNA Mutual

Madison WI

View job as Pension Compliance Specialist
          for CUNA Mutual

View job as Manager II, Operations - Client Services
          for CUNA Mutual Manager II, Operations - Client Services

CUNA Mutual

Remote / Madison WI

View job as Manager II, Operations - Client Services
          for CUNA Mutual

View job as Business Systems Analyst
          for IJOIN Business Systems Analyst



View job as Business Systems Analyst
          for IJOIN

Webcasts and Conferences
(Health & Welfare Plans)

HIPAA Tips: Telehealth After the Pandemic


Williams Mullen

The Ever-Evolving Standard of Review in ERISA Health and Disability Litigation

October 19, 2022 WEBCAST

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

Prescription Drug Reporting Deadline Approaching


Benefits-Related Provisions of the Inflation Reduction Act of 2022

Groom Law Group

Additional Health Plan Price Transparency Disclosures Coming Soon


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

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