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Health & Welfare Plans Newsletter

September 15, 2022

5 New Job Opportunities 5 New Job Opportunities


[Official Guidance]

Text of Agencies' Request for Information: Advanced Explanation of Benefits and Good Faith Estimate for Covered Individuals

26 pages. "This document is a request for information (RFI) to inform DOL, HHS, and the Treasury and OPM's rulemaking for advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA). This RFI seeks information and recommendations on transferring data from providers and facilities to plans, issuers, and carriers; other policy approaches; and the economic impacts of implementing these requirements."  MORE >>

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

[Guidance Overview]

Affordability Percentage for Employer Health Coverage Will Shrink in 2023

"Employers should review the required employee contribution for 2023 coverage if they plan to meet the ACA's affordability limit under the applicable safe harbor. For the many plans using the FPL affordability safe harbor, the considerations differ for calendar- and noncalendar-year plans."  MORE >>


[Guidance Overview]

California Bill Would Broaden Leave to Care for Designated Person

"By amending the California Family Rights Act (CFRA), the bill would expand the definition of who an employee could take leave to care for. The bill defines 'designated person' as 'any individual related by blood or whose association with the employee is the equivalent of a family relationship.' Employers can limit employees to one designated person per 12-month period."  MORE >>

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

[Guidance Overview]

Rules Finalized for Oregon's Paid Family and Medical Leave Insurance Program and Equivalent Plan Application Process

"The PFMLI program will be funded by employer and employee contributions in the form of payroll deductions beginning January 1, 2023 and will provide employees with up to 12 weeks of paid time off for leave that qualifies as family, medical, or safe leave, absent undue hardship, beginning on September 3, 2023. [This article provides] a summary of the more notable rules governing the PFMLI program and how an employer may submit an equivalent plan application."  MORE >>


Texas District Court Judge Finds ACA Preventive Services Requirement Invalid

"Judge O'Connor did not immediately issue an order blocking enforcement of the coverage requirements. He also did not specify whether such an order would be nationwide, for his district only, for all the named plaintiffs, or only for Braidwood. These issues are held for further argument before Judge O'Connor." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

The Commonwealth Fund

Court Ruling May Spur Competitive Health Plans to Bring Back Copays for Preventive Services

"If the preventive services coverage mandate is partly struck down, the result could be a confusing patchwork of health plan benefit designs offered in various industries and in different parts of the country. Patients who have serious medical conditions or are at high risk for such conditions may have a hard time finding a plan that fully covers preventive and screening services."  MORE >>

Kaiser Health News

Upcoming Key Compliance Deadlines and Reminders for Fourth Quarter 2022

"Open enrollment season is here once again! The rush of meeting deadlines to offer benefits, educate employees on benefit changes, and make sure all required notices are provided and filings are timely made could cause some stress and anxiety.... Here are potential action items for the fourth calendar quarter (through Dec. 31, 2022)."  MORE >>


Inflation Reduction Act May Impact Employer Health Plans

"While there is no direct impact on employer-sponsored health plans, caps on Medicare Part D out-of-pocket limits and other cost reductions could affect prescription drug coverage creditable status. Employers must provide notice of a health plan's creditable coverage status at different times, and at least annually before October 15."  MORE >>


CRS Legal Sidebar: Supreme Court Allows Health Plans to Limit Dialysis Benefits

"Congress may consider legislation that further addresses the coordination of Medicare and employer- based coverage with respect to benefits for ESRD patients. Federal legislation could, among other things, address a level of dialysis coverage that must be provided by a group health plan, or amend the MSP statute to address further the circumstances under which employers may limit such benefits." [LSB10819 Sep. 14, 2022] [Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]  MORE >>

Congressional Research Service [CRS]

Smaller Hospitals More Likely to Be Noncompliant with Price Transparency Rule

"While price transparency compliance ranged from 13% to 49% of hospitals studied, the findings revealed that facilities with fewer beds were less likely to be compliant with the rule. Additionally, hospitals located in the South and the West were also associated with less transparency."  MORE >>

HealthLeaders Media


To Slow Health Care Spending, Look to Lifestyle Medicine

"If we are serious about changing the unsustainable trajectory of US health care spending, it is time to stop just managing illness and start finally addressing the root causes of chronic disease and their associated costs."  MORE >>

Health Affairs

Employee Benefits Jobs

View job as DB Pension Administrator
            for Primark Benefits

DB Pension Administrator

Primark Benefits

Remote / San Mateo CA

View job as DB Pension Administrator for Primark Benefits

View job as Retirement Plan Relationship Manager – DB or DC Focus
            for Trinity Pension Consultants

Retirement Plan Relationship Manager – DB or DC Focus

Trinity Pension Consultants

Remote / Akron OH / AL / KY / MO / TN

View job as Retirement Plan Relationship Manager – DB or DC Focus for Trinity Pension Consultants

View job as Distribution Specialist
            for Trinity Pension Consultants

Distribution Specialist

Trinity Pension Consultants

Akron OH

View job as Distribution Specialist for Trinity Pension Consultants

View job as Compliance Analyst
            for Empower

Compliance Analyst



View job as Compliance Analyst for Empower

View job as Third-Party Plan Administrator
            for Saltmarsh, Cleaveland & Gund

Third-Party Plan Administrator

Saltmarsh, Cleaveland & Gund

Remote / Tampa FL

Selected New Discussions

Application of COBRA to On-Site Health Clinics

"I have an employer that employs select employees to work in medical and laboratory settings (small percentage of the employee population). Many of these 'health plan' services provided on-site are required under OSHA. Although the services go beyond the limited on-site exception for ERISA, we can take care of documents and Form 500 reporting. The critical issue is COBRA. The services go beyond the limited on-site clinic exception for COBRA. But from a policy standpoint this makes no sense to require COBRA for health services required for a job when the employees are no longer employed. Any thoughts?"

BenefitsLink Message Boards

Press Releases

2022 SOA Elections Results: Announcing New 2022–2023 Board Members and President-Elect and Vice-Chair

Society of Actuaries

Webcasts and Conferences
(Health & Welfare Plans)

Top Secret - Ways to Health Benefits Transparency, Cost and Quality Performance

October 26, 2022 in SC

Southeast Benefits Education Network [SBEN]

Last Issue's Most Popular Items

2023 ACA Compliance Planning: Important Steps for Employers

Fisher Phillips

Things Employees Should Do After Open Enrollment


Federal Authorities Clarify Independent Dispute Resolution Process Under No Surprises Act

Fisher Phillips

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

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