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Health & Welfare Plans Newsletter

September 14, 2022

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[Guidance Overview]

2023 ACA Compliance Planning: Important Steps for Employers

"[1] Adjust to a lower affordability threshold ... [2] Be aware of the affordability safe harbors ... [3] Recognize that ESRP penalty amounts continue to rise ... [4] Calendar the Form 1094-C/1095-C deadlines ... [5] Use current draft ACA reporting forms."  MORE >>

Fisher Phillips

[Guidance Overview]

Federal Authorities Clarify Independent Dispute Resolution Process Under No Surprises Act

"The interim final rules require plans and issuers to disclose the QPA for each item or service to providers and facilities with each initial claim payment or notice of denial of payment in any case where the QPA set the relevant cost-sharing amount. Additionally, when a plan or issuer changes a provider or facility's service code to one of lesser value, the plan or issuer must now provide additional information for this 'downcode' process."  MORE >>

Fisher Phillips

Things Employees Should Do After Open Enrollment

"Share the following list with your employees to make sure they are fully equipped to benefit from their plan elections: [1] Be on the lookout for new ID cards ... [2] Set up your user account ... [3] Schedule your annual exams ... [4] Double-check your first paystub ... [5] Lastly, track all health-related expenses."  MORE >>


Is Accidental Sharing of Personal Information Reportable?

"[An] employee's health plan enrollment information does not become protected health information (PHI) subject to HIPAA until it is in the hands of the health insurer (or, if the plan is self-funded, the staff or service provider responsible for plan administration). The enrollment information entered on an employee portal would likely be considered an employment record (rather than PHI) ... Assuming then that HIPAA does not apply, the response to an accidental disclosure of personal information will depend on state law[.]"  MORE >>

HR Daily Advisor

Total Rewards for Part-Time, Gig Workers Are Key to Sustainability

"The decision to introduce alternative work arrangements needs to also consider the significant implications to total rewards.... Covering health and retirement benefits for part-time workers increases overall labor costs.... [O]rganizations with a vision to enable their new work strategies with a holistic view on total rewards design will outperform competitors in the long run."  MORE >>

Willis Towers Watson

Use of Health Care Services for Mental Health Disorders and Spending Trends

"The percentage of the population under age 65 with employment-based health coverage diagnosed with a mental health disorder increased from 14.2 percent in 2013 to 18.5 percent in 2020.... [T]he percentage of enrollees using outpatient services increased from 12 percent to 16 percent ... Overall spending on mental health care services as a percentage of total spending increased from 6.8 percent in 2013 to 8.2 percent in 2020."  MORE >>

Employee Benefit Research Institute [EBRI]

Hospitals Divert Primary Care Patients to Health Center 'Look-Alikes' to Boost Finances

"A growing number of hospitals are outsourcing often-unprofitable outpatient services for their poorest patients by setting up independent, nonprofit organizations to provide primary care. Medicare and Medicaid pay these clinics ... significantly more than they would if the sites were owned by hospitals."  MORE >>

Kaiser Health News

What Personal Injury Lawyers Need to Know About ERISA Liens

"It is critical for the personal injury lawyer to obtain the benefit plan and not just rely on the summary plan description (SPD).... It is just as important for personal injury lawyers to attempt to negotiate with the benefit plans as early as possible.... Any leverage to negotiate a lower reimbursement is lost if the attorney waits too long."  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

Lawyering Is a Stressful Occupation: Sixth Circuit Upholds Attorney's Disability Claim, Rejects Insurer's Claim for Equitable Relief

"Provident had learned that Messing had done part-time legal work, but it could not prove that it would have terminated his claim if it had known about that work. The evidence only showed that Provident would have reevaluated Messing's claim, and 'a review of Messing's claim does not necessarily mean it would have terminated his benefits earlier.' Because Provident had not introduced satisfactory evidence of inducement, it could not prevail on its restitution theory." [Messing v. Provident Life and Accident Ins. Co., No. 21-2780 (6th Cir. Sep. 9, 2022)]  MORE >>

Kantor & Kantor LLC

'Probate Exception' Precludes Federal Jurisdiction Over ERISA Lawsuit

"As plan sponsor for the group health plan, the plaintiff subsequently filed an ERISA action in federal district court seeking an equitable lien by agreement over the wrongful death settlement funds in the possession of the decedent's estate, in order to recoup the funds the plan paid for the beneficiary's accident-related medical treatment.... [T]he district court concluded that the relief the plaintiff's ERISA claim sought would interfere with the distribution process approved by the probate court for the settlement funds, thus triggering the probate exception." [American Electric Power Service Corporation v. Fitch, No. 22-3005 (6th Cir. Aug. 30, 2022; unpub.)]  MORE >>

The Wagner Law Group

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Press Releases

Prudential and MetLife Entrusted to Fulfill $16 Billion in Pension Obligations for 100,000 IBM Retirement Plan Participants and Beneficiaries

Prudential Financial, Inc.

Prime Pensions Acquires Associated Pension Consultants

Prime Pensions

Sana Expands Affordable Health Insurance Offerings for Small Businesses to Alabama


PAi to Offer CoPilot Prime Solo(k) with American Funds for Small Businesses


DOL Seeks Nominations for 2023 ERISA Advisory Council

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Voya to Launch First-of-Its-Kind Workplace Benefits- and Savings-Connected Digital Platform

Voya Financial

Webcasts and Conferences
(Health & Welfare Plans)

Hot Topics in the Multiemployer Benefits World



2022 Vorys Benefits Conference

September 27, 2022 in OH


Last Issue's Most Popular Items

Cybersecurity Leading Practices: Navigating the DOL Guidance (PDF)


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The Wagner Law Group

Post-Dobbs Update: What Every Employer Needs to Know Now (PDF)


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

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