logo logo

Health & Welfare Plans Newsletter

September 16, 2022

3 New Job Opportunities 3 New Job Opportunities


[Official Guidance]

Text of CMS Reissued 2019 Benefit Year HHS Risk Adjustment Data Validation Results and 2020 Benefit Year HHS-RADV Results (PDF)

30 pages. "This memo provides summary information on issuers' reissued 2019 benefit year HHS-RADV results and on issuers' 2020 benefit year HHS-RADV results. The 2019 benefit year HHS-RADV results are being reissued in response to actionable discrepancies under 45 CFR 153.630(d)(2), which challenged the calculation of the 2019 benefit year error rates under the HHS-RADV error estimation methodology."

  • Appendix A: National Program Benchmarks -- 2020 Benefit Year HHS-RADV Compared to Reissued 2019 Benefit Year HHS-RADV (XLSX)
  • Appendix B: 2020 Benefit Year RA State Market Risk Pool Weighted Average Error Rate from the Reissued 2019 Benefit Year HHS-RADV Results and the 2020 Benefit Year HHS-RADV Result (XLSX)
  • Appendix C: 2020 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
  • Appendix D: 2019 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)


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

[Guidance Overview]

Exceptional Usefulness and Quality icon Working with the Affordability Safe Harbors in Light of the 9.12 Percent Affordability Threshold for 2023

"The 2023 plan year will have the lowest [ACA] affordability threshold to date, 9.12 percent.... [T]his article will explore the details employers need to be aware of for the 2023 plan year and discuss some strategies employers can implement to minimize IRC section 4980H exposure."  MORE >>


[Guidance Overview]

Third 'No Surprises Act' Rule Issued; Claims Backlog Persists

"At bottom, the new rule appears to be more provider-friendly than the prior versions. However, more than 46,000 disputes have been filed since the Departments opened their online portal for submissions in April 2022, a figure far outpacing the Departments’ initial estimates for the entire first year."  MORE >>

ArentFox Schiff LLP

[Guidance Overview]

California Poised to Extend COVID-19 Supplemental Paid Sick Leave Requirements

"If signed, AB 152 will extend the COVID-19 SPSL requirements through December 31, 2022 -- three months beyond the current expiration date. The bill would not increase the amount of leave employees may take, but it would give employees an additional three months to use any SPSL for which they may be eligible. The Governor has until September 30, 2022 to sign or veto the bill. If the bill is not enacted, SPSL will expire as currently scheduled."  MORE >>

DLA Piper

[Guidance Overview]

New York PFL Changes for 2023

"After an evaluation of the financial health of the PFL program, the State has decided that it is able to expand benefits under the program, while reducing the employee contribution rate. The 2023 premium amount will be 0.455% of employee's gross wages (down from 0.511% in 2022), capped at an annual maximum employee contribution of $399.43 (down from $423.71 in 2022)."  MORE >>


Court Allows GINA Claims to Proceed Against City of Chicago as Wellness Program Sponsor

"The court noted that GINA allows an employer to obtain genetic information if the employee provides 'prior, knowing, voluntary, and written authorization.' Whether the wellness program is 'voluntary' in light of the financial penalty for nonparticipation is to be determined in further proceedings." [Williams v. City of Chicago, No. 20-0420 (N.D. Ill. Jul. 25, 2022)]  MORE >>

Thomson Reuters / EBIA

Exceptional Usefulness and Quality icon U.S. Employers Double Down on Controlling Healthcare Costs

"Two in 10 employers (20%) added dollars to their healthcare plan without reallocating funds from other benefits or pay. Another 30% expect to do so in the next two years.... Four in 10 employers (41%) reported using a defined contribution strategy with a fixed dollar amount provided to all employees that differs by employee tier. Another 11% are planning or considering doing so in the next two years....A quarter of respondents (27%) used programs to combat fraud, waste and abuse. Another 22% expect to do so by 2024."  MORE >>

Willis Towers Watson

Evaluating PBM Contracts: Basic Financial Elements (PDF)

"Evaluation of a traditional RFP or PBM contract should begin with financial analysis of the following four key elements: discount guarantees (typically understood as point-of-sale ingredient costs), dispensing fees, rebate guarantees, and PBM administrative fees. This paper addresses various points of consideration when attempting a financial analysis of these contract elements."  MORE >>

Wakely Consulting Group

Upcoming Rx Reporting: What About Third-Party Point Solutions?

"As Dec. 27, 2022 -- the deadline to report detailed data to [CMS] about prescription drug pricing and healthcare spending -- approaches, employers should consider whether they must report costs associated with third-party point solutions that provide medical care and are offered to employees. Given the wide range of point solutions available -- from technology to drive engagement, to disease management, fertility benefits, and behavioral health carve-outs -- there isn't a simple answer."  MORE >>


Medicare Telehealth Trends

"The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and March 31, 2022.... The data include Medicare Part B Fee-for-Service Claims for services. All data are preliminary."  MORE >>

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

HHS-OIG Flags Certain Extreme Outlier Telehealth Providers as Potentially Engaging in Fraudulent Billing During the Pandemic

"HHS-OIG identified 1,714 providers who had 'concerning billing on at least one of seven measures… that may indicate fraud, waste, or abuse of telehealth services' and referred these providers to CMS for further investigation. While this could be read to suggest that billing data for the vast majority of providers has a clean bill of health, the report indicates that HHS-OIG identified only the most significant outliers on each metric."  MORE >>

Sidley Austin LLP

Teletherapy Survey Reveals New Best Practices

"The results of this study highlight the convenience of teletherapy, positive experiences patients have and its increase in popularity across generations. The results also confirm ... that most participants (76%) reported being very or extremely satisfied with their most recent telehealth visit. Health insurers and health systems should recognize these positive sentiments and continue to offer and enhance such services."  MORE >>

Corporate Insight

Hill Healthcare Agenda Stalls as Midterm Elections Loom

"[A] short-term funding fix set to run to December probably won't include proposals to extend temporary telehealth flexibilities for employers, improve mental health care and provide more COVID-19 aid.... [A]ction on these issues now isn't likely until late this year in a crowded lame-duck session, complicating the outlook for final passage."  MORE >>


Benefits in General

Case Study: Using Customized Salary Data and Employee Benefits to Attract and Retain Talent

"Closing the gap between data and decisions is critical to building and delivering defensible and effective total rewards programs. Robust compensation and benefits data combined with experience, keen analysis, modern tools and a human touch all contribute to data, analysis and insights that are delivered quickly and accurately. And this is what equips HR teams with powerful insights that influence and inform top management decisions while attracting and retaining critical talent."  MORE >>

Willis Towers Watson

Employee Benefits Jobs

View job as Retirement Plan Administrative Specialist
            for Mueller Financial Services

Retirement Plan Administrative Specialist

Mueller Financial Services

Elgin IL / Chicago IL / Orland Park IL

View job as Retirement Plan Administrative Specialist for Mueller Financial Services

View job as Principal Benefits Expert
            for Mineral

Principal Benefits Expert


Remote / Portland OR

View job as Employee Benefits and Compensation Associate
            for Fox Rothschild LLP

Employee Benefits and Compensation Associate

Fox Rothschild LLP

MN / PA / TX

Selected New Discussions

Is an SMM Required If Welfare Plan Changes Service Providers (But Nothing Else)?

"If the change to the welfare plan is only service providers, but actual contributions, benefits, eligibilties etc all remain the same, is an SMM actually required? Or is it sufficient to provide this information on the annual Open Enrollment paperwork?"

BenefitsLink Message Boards

Mental Health Coverage of a Self-Insured, Non-Grandfathered Plan

"Does anyone know what, if anything, is required to be covered in terms of mental health benefits for a self-insured, non-grandfathered plan?"

BenefitsLink Message Boards

Press Releases

EBRI Announces Upcoming Retirement of President and CEO Lori Lucas

EBRI [Employee Benefit Research Institute]

NCEO Launches the ESOP Finance Toolkit and Lender Directory

National Center for Employee Ownership [NCEO]

Webcasts and Conferences
(Health & Welfare Plans)

Cafeteria Plans 101: The Basics, Mid-Year Election Change Rules and Nondiscrimination Testing

September 29, 2022 WEBCAST

Hunton Andrews Kurth

Last Issue's Most Popular Items

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

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]

Upcoming Key Compliance Deadlines and Reminders for Fourth Quarter 2022


Affordability Percentage for Employer Health Coverage Will Shrink in 2023


Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2022, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.