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Health & Welfare Plans Newsletter

October 4, 2022

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[Guidance Overview]

HHS, Treasury and Labor Issue More Guidance on the No Surprises Act

"The Final Rules expand on the interim final rules and incorporate the court's striking of certain provisions.... However, the myriad rules surrounding the process increase complexity and compliance costs for both medical providers and plans/issuers. Additionally, the Final Rules almost pre-suppose that certified IDR entities are well-trained in medical procedures, medical billing and insurance."  MORE >>


[Guidance Overview]

Getting a Handle on the New Transparency Requirements

"[1] Tackle ID card requirements ... [2] Be prepared for prescription drug reporting ... [3] Enter into written agreements regarding submission of RxDC reports ... [4] Take logistical steps to prepare to submit RxDC files where necessary ... [5] Prepare to provide personalized cost-sharing information."  MORE >>


[Guidance Overview]

New California 'Designated Person' Standards Could (Further) Complicate Leave Administration

"Under both the amended [California Family Rights Act (CFRA) and California's Healthy Workplaces Healthy Families Act (HWHFA)], employees will be able to identify a designated person for whom they want to use leave when they request unpaid (CFRA) or paid (HWHFA) leave.... [U]nder both amended laws, employers will be able to limit an employee to one designated person per 12-month period. How these [two laws] define designated person, however, differs slightly."  MORE >>


Employers Can Enjoy Greater Control and More Transparency with a Level-Funded Health Plan

"The level premium is tripartite. One component is set in reserve to cover expected claims based on factors including employee demographics.... A second portion of the level premium goes toward stop-loss insurance.... The level premium's third piece is an administrative fee ... Level-funded plans provide transparency to employers ... [It's] usually easy to switch back to a fully insured plan later if conditions warrant."  MORE >>

Financial Advisor


AHIP Comment Letter to HHS on Proposed Regs for Nondiscrimination in Health Programs and Activities (PDF)

31 pages. "[AHIP offers] detailed comments on how HHS should maintain regulatory flexibility to focus on quick and streamlined access to interpretation, with written translations provided upon request.... [AHIP's] comments include additional recommendations to modify notice timing and frequency, as well as other suggestions to further improve the notice requirements ... AHIP recommends HHS convene a stakeholder process to gather additional input about the use and application of clinical algorithms."  MORE >>

America's Health Insurance Plans [AHIP]

Benefits in General

[Official Guidance]

Text of IRS Proposed Regs: Substantially Higher User Fees Relating to Enrolled Actuaries

"The proposed regulations increase both the enrollment and renewal of enrollment user fees for enrolled actuaries from $250.00 to $680.00. The proposed regulations affect individuals who apply to become an enrolled actuary or seek to renew their enrollment."  MORE >>

Internal Revenue Service [IRS]

Alert (High Risk Issue) icon House Passes ERISA Bill to End Arbitration and Require De Novo Review of Benefit Claims

"On September 29, 2022, the U.S. House of Representatives passed the [Employee and Retiree Access to Justice Act (part of HR 7780)] ... [which] seeks to amend ERISA's civil enforcement provision (ERISA Section 502) to make any arbitration provisions in ERISA plans invalid and unenforceable ... [unless] the participant or beneficiary consented in accordance with particular rules ... Additionally, the Act would eliminate discretionary authority for claim administrators and allow only de novo review of a benefit claim in court."  MORE >>

Faegre Drinker

Employee Benefits Jobs

View job as Relationship Manager
            for The Standard

Relationship Manager

The Standard

Austin TX

View job as Relationship Manager for The Standard

Selected New Discussions

Multiemployer H&W Fund Could Be ERISA-Exempt per DOL Voluntary Plan Safe Harbor? [Do You Have an Answer?]

"Can a multiemployer health & welfare fund (which, by definition is not an 'employer' or an 'employee organization') take advantage of the DOL voluntary plan safe harbor contained in DOL Reg. Section 2510.3-1(j) to avoid application of ERISA (assuming it otherwise satisfies the safe harbor requirements)?"

BenefitsLink Message Boards

Press Releases

Financial Advisors Vote for The Wagner Law Group as the Best ERISA Law Firm for 2022

The Wagner Law Group P.C.

Wealthspire Advisors Partners with Chapter to Offer Comprehensive Medicare Guidance for Clients Approaching Retirement

Wealthspire Advisors LLC

Blitman & King Hires ERISA Associate

Blitman & King

Last Issue's Most Popular Items

Recent CMS FAQs Simplify RxDC Reporting


Severe Sleep Apnea Diagnosis Panics Reporter Until He Finds a Simple, No-Cost Solution

Kaiser Health News

Departments Release Guidance on Surprise Billing and Machine-Readable Files


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

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