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Health & Welfare Plans Newsletter

September 9, 2022

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

Exceptional Usefulness and Quality icon Addressing Employee Health Plan Exception Requests: Requests for Employer to Reimburse Outside the Plan

"Reimbursement of Internal Revenue Code Section 213(d) health expenses creates a group health plan, which would trigger the full array of group health plan laws (ERISA, COBRA, HIPAA, ACA, HSA eligibility, Section 105(h), etc.). Therefore, employers should avoid providing reimbursement for any Section 213(d) medical expenses outside of the group health plan unless it is part a HRA or wellness program that is integrated with the health plan."  MORE >>


[Guidance Overview]

Health Insurance Premium Tax Credit and Cost-Sharing Reductions

16 pages. "This report describes current law and applicable regulations and guidance, specifically with regard to how the PTC and CSR requirements apply in tax year 2022." [R44425, updated Sep. 7, 2022]  MORE >>

Congressional Research Service [CRS]

[Guidance Overview]

Updated CMS Instructions Limit Rx Reporting for Wellness Services

"If an employer's wellness services fit within the definition of an excepted benefit, then the wellness service shouldn't be subject to reporting. But if the wellness service is billed as a claim under the major medical plan, it may still be included in reporting as the TPA or insurer may not be able to separate those claims out from the reporting submission."  MORE >>


[Guidance Overview]

Departments Issue Final Surprise Billing Rule and ACA FAQs

"The final surprise billing rule provides that certified IDR entities should select the offer that best represents the value of the item or service under dispute, after considering both the QPA and certain other factors (rather than assuming that the QPA alone is the correct value). In addition, the departments issued ACA FAQs Part 55, which answer questions on the NSA and the Transparency in Coverage rules[.]"  MORE >>

Willis Towers Watson

District Court Holds That Key ACA Preventive Services Requirements Are Unconstitutional

"Judge O'Connor held that a key part of the preventive services mandate -- namely, the requirement that most commercial plans cover services with an 'A' or 'B' recommendation from the U.S. Preventive Services Task Force (USPSTF) without cost sharing -- violates the Appointments Clause and is thus unconstitutional. He also ruled that the requirement that insurers and plans cover an HIV prevention medication known as preexposure prophylaxis (PrEP) violated one plaintiff's rights under the Religious Freedom Restoration Act (RFRA)." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

Health Affairs

Many Preventive Medical Services Cost Patients Nothing, But a Federal District Court Decision Could Change That

"A key part of the ruling by Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas says one way that preventive services are selected for the no-cost coverage is unconstitutional. Another portion of his ruling says a requirement that an HIV prevention drug therapy be covered without any cost to patients violates the religious freedom of an employer who is a plaintiff in the case. It is not yet clear what all this means for insured patients. A lot depends on what happens next." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

Kaiser Health News

How a Facebook Messenger Chat Can Become a 'Usual and Customary' FMLA Notice Procedure for an Employer

"Because the terminated employee's manager accepted previous messages regarding absences via Facebook Messenger, the Company's position that using Facebook Messenger was not its 'usual and customary' notice practice for reporting FMLA absences, was called into question. The [Fourth Circuit] found that previous utilization of Facebook Messenger to communicate absences raised a question of material fact for a jury to determine if a Facebook Messenger Chat satisfied the FMLA's notice requirements." [Roberts v. Gestamp West Virginia, LLC, No. 20-2202 (4th Cir. Aug. 15, 2022)]  MORE >>


Can Our DCAP Reimburse a Participant's Claim for a 'Late Fee'?

"[If] the charge is a late pickup fee, ... the fee can be reimbursed under your DCAP, so long as it is for taking care of the child and satisfies the other criteria for reimbursement under your plan and the Code. But if the charge is for late payment of a bill from the day-care center, it probably would not qualify for reimbursement from a DCAP."  MORE >>

Thomson Reuters / EBIA

Tips to Improve Your Pre-Enrollment Campaign Today

"Brand your pre-open enrollment campaign ... Supercharge your communication plan ... Meet with your benefits vendors and tech partners ... Host a series of webinars."  MORE >>

Tango Health

HIPAA Resolution Agreement Emphasizes the Importance of Proper Disposal of PHI

"OCR has specifically stated in FAQ guidance that covered entities are not permitted to simply abandon PHI or dispose of it in dumpsters or other containers that are accessible by the public or other unauthorized persons. Failure to implement reasonable safeguards to protect PHI in connection with waste disposal (such as removing or obliterating any individually identifiable information) can result in impermissible disclosures of PHI and costly liability under HIPAA."  MORE >>

Thomson Reuters / EBIA

The Mirage of 'Unlimited' PTO

"While unlimited PTO has its benefits for employers, it can lead to significant cultural problems by creating an atmosphere of uncertainty and tension in the workplace where employees don't know where they stand with management and relative to their colleagues. The alternative ... is a set of clearly defined policies ... [which] could include convertible PTO (which allows employees to direct unused vacation time toward other priorities), increased compensation, a pre-specified number of days off, or some combination of all the above."  MORE >>

HR Daily Advisor

Supporting Preparations for and Return from Parental Leave

"Policies similar to Ramp Down/Ramp Up benefit companies by giving employees the space and support that they need to prepare for parenthood -- and to parent -- while maintaining high levels of productivity and commitment to the company."  MORE >>

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

Benefits in General

[Official Guidance]

IRS Disaster Relief Announcement AZ-2022-08, for Victims of Arizona Severe Storms

"Victims of Arizona severe storms occurring between July 17 and July 18, 2022, now have until November 15, 2022, to file various individual and business tax returns and make tax payments ... Individuals and households affected by severe storms that reside or have a business in the Salt River Pima-Maricopa Indian Community qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Ways to Help Employees Feel Valued, from a Pat on the Back to ESOP

"[1] Genuine, specific recognition of good work ... [2] Greater job autonomy ... [3] Customized employee benefits ... [4] Profit-sharing plans and other incentive pay ... [5] Nonqualified deferred compensation and other key employee benefits ... [6] ESOP."  MORE >>

Principal Financial Group

Employee Benefits Jobs

View job as Manager - Defined Contribution Plans
          for M2B Retirement Consulting LLC Manager - Defined Contribution Plans

M2B Retirement Consulting LLC

Remote / PA

View job as Manager - Defined Contribution Plans
          for M2B Retirement Consulting LLC

View job as Compliance Analyst - Defined Contribution Plans
          for M2B Retirement Consulting LLC Compliance Analyst - Defined Contribution Plans

M2B Retirement Consulting LLC

Remote / PA

View job as Compliance Analyst - Defined Contribution Plans
          for M2B Retirement Consulting LLC

View job as Employee Benefits Attorney
          for Butterfield Schechter LLP Employee Benefits Attorney

Butterfield Schechter LLP

San Diego CA

View job as Employee Benefits Attorney
          for Butterfield Schechter LLP

View job as ERISA Production Manager
          for July Business Services ERISA Production Manager

July Business Services


View job as ERISA Production Manager
          for July Business Services

Press Releases

AHT Insurance Announces the Addition of Michael Wright as Managing Director, Employee Benefits Group

Armfield, Harrison & Thomas, LLC [AHT Insurance]

Are You the Next 401(k) Champion®?

Jackson, Grant Investment Advisers, Inc.

Morgan Stanley at Work Unveils First-of-Its-Kind Participant Aggregation Platform to Create a Seamless Experience for Plan Advisors

Morgan Stanley

Last Issue's Most Popular Items

Health Insurance Oversight System (HIOS) Prescription Drug Data Collection (RxDC) User Manual (PDF)

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

ERISA 408(b)(2) Now Covers Health Plan Payments to Covered Service Providers

Boutwell Fay LLP, via Journal of Pension Benefits

State of the States: Paid Family Medical Leave Overview

Voya Financial

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

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