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Health & Welfare Plans Newsletter

October 6, 2022

4 New Job Opportunities 4 New Job Opportunities

 

[Guidance Overview]

Exceptional Usefulness and Quality icon Addressing Employee Health Plan Exception Requests, Part VII: Correcting an Erroneous Section 125 Cafeteria Plan Election Mid-Year

"Informal IRS guidance provides that employers can undo a mistaken employee cafeteria plan election and implement the intended election mid-year where there is 'clear and convincing evidence' of an error. This is a very high standard that will apply only in very limited circumstances."  MORE >>

Newfront

[Guidance Overview]

California Increases Benefits Under Paid Family Leave Law

"The amendment changed two key benefit provisions ... First, current wage replacement rates were extended through 2024.... [T]hose earning as much as $27,000 per year will continue to receive 70% of their weekly income and everyone else will receive 60% of their weekly income. These rates were set to expire at the end of 2022. Second, beginning in 2025, benefits for low-wage workers will increase to 90% of their weekly income."  MORE >>

OneDigital

Court Defers to Insurer's Discretionary Authority

"[B]ecause the new insurer had discretionary authority under the LTD policy, the court was required to consider whether the new insurer's interpretation of the benefits eligibility exclusion was reasonable. Here, the court found that reasonable grounds did exist to support insurer's interpretation and decision, even if it wasn't the best reading of the policy exclusion." [Stewart v. Hartford Life & Accident Ins. Co., No. 21-11919 (11th Cir. Aug. 10, 2022)]  MORE >>

The Wagner Law Group

Plan in Effect at Time of Benefit Denial Controls Over Earlier Version

"[T]he participant asserted that the new plan -- which did not have an illegal acts exclusion -- was in effect at the time of the original benefit denial and thus should apply to his situation. The court agreed, citing Ninth Circuit precedent establishing that an ERISA cause of action (reason to bring a lawsuit) arises at the time benefits are denied, and benefits do not vest 'unless and until the employer says they do'[.]" [Foote v. Beverly Hills Hotel & Bungalows Employee Benefit Employee Welfare Plan, No. 20-10573 (C.D. Cal. Aug. 26, 2022)  MORE >>

Thomson Reuters / EBIA

Supreme Court Upholds Marietta Memorial Hospital's Employee Plan's Lower Reimbursement Rates for Dialysis Services (PDF)

"The Supreme Court's decision increases the possibility that private health plans may try to limit their outpatient dialysis benefits by shifting costs to Medicare. Shifting the cost of dialysis care from private healthcare insurers to federal and state governmental payers could jeopardize the integrity of the Medicare Trust Fund over time and, as a result, Congress may be poised to address this [issue]." [Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]  MORE >>

Benesch, via RPA News

Workplace Life, Disability and Supplemental Health Premium Rebounds in Second Quarter 2022

"New annualized premium for workplace life insurance, disability insurance and supplemental health products increased in the second quarter ... Overall, U.S. workplace life carriers wrote $587 million in total new annualized premium sales in the second quarter, 8% higher than second quarter 2021. Through the first six months of 2022, new workplace life insurance annualized premium totaled $2.2 billion, falling 3% from the same period in 2021."  MORE >>

LIMRA

[Opinion]

Alert (High Risk Issue) icon IRS Penalizing Employers Before Checking Household Income, Making the IRS Enforcement Position More Stringent Than the Actual Law

"It appears the IRS is proposing a penalty to any employer who has a full-time employee who receives a premium tax credit in addition to the employer not qualifying for any of the three affordability safe harbors or who leaves line 16 blank.... The IRS should be reviewing the household income of each individual listed on the Form 14765 before any Letter 226J is sent out. By not doing so the IRS is not only wasting the valuable resources of employers, but is proposing penalties to employers who do not owe a penalty."  MORE >>

Accord

[Opinion]

The New Medicare Part D Out-of-Pocket Cap Will Have Unintended Consequences. Here's How to Address Them

"Assuming 20 percent coinsurance, the cap means that both a $10,000 drug and a $100,000 drug will have the same out-of-pocket cost for Medicare Part D beneficiaries, who will then have fewer incentives to use lower-cost drugs. It will also increase manufacturers' incentives to raise their drugs' launch prices. Proposals to completely eliminate cost sharing would further reduce the incentive to hold down drug prices. This is in addition to the incentives to have higher drug launch prices in response to the inflation caps."  MORE >>

Health Affairs Forefront

Benefits in General

[Official Guidance]

IRS Disaster Relief Announcement SC-2022-06, for Victims of Hurricane Ian in South Carolina Statewide

"Victims of Hurricane Ian that began September 25 in South Carolina now have until February 15, 2023, to file various individual and business tax returns and make tax payments ... Individuals and households affected by Hurricane Ian that reside or have a business anywhere in the state of South Carolina qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

[Official Guidance]

IRS Disaster Relief Announcement NC-2022-10, for Victims of Hurricane Ian in North Carolina Statewide

"Victims of Hurricane Ian that began September 28 in North Carolina now have until February 15, 2023, to file various individual and business tax returns and make tax payments ... Individuals and households affected by Hurricane Ian that reside or have a business anywhere in the state of North Carolina qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Defined Benefit Consultant
            for AimPoint Group

Defined Benefit Consultant

AimPoint Group

Remote

View job as Defined Benefit Consultant for AimPoint Group

View job as Defined Contribution Consultant
            for AimPoint Group

Defined Contribution Consultant

AimPoint Group

Remote

View job as Defined Contribution Consultant for AimPoint Group

View job as Pension Compliance Administrator
            for Associated Pension Consultants

Pension Compliance Administrator

Associated Pension Consultants

Remote

View job as Pension Compliance Administrator for Associated Pension Consultants

View job as Retirement Plan Services Manager
            for Alerus

Retirement Plan Services Manager

Alerus

Remote

View job as Retirement Plan Services Manager for Alerus

Press Releases

BMO Offers Free Access to Headspace to North American Employees and Their Families

BMO Financial Group

Webcasts and Conferences
(Health & Welfare Plans)

Global Benefits Trends: Supporting International Remote Work and Employee Assistance Plans

October 13, 2022 in OH

Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

Nothing is Certain Except Death and Taxes

October 26, 2022 WEBCAST

Boutwell Fay LLP

Last Issue's Most Popular Items

COVID-19 Relief Provisions Expire in 2023 for Flexible Spending Accounts

TRI-AD

Texas District Court Vacates HHS Guidance on Mandatory Coverage of Gender Dysphoria Treatments Under ACA Section 1557

Thomson Reuters Practical Law

Navigating Open Enrollment Notice Requirements

Faegre Drinker

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

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