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Health & Welfare Plans Newsletter

October 14, 2022

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

IRS Regs Base Eligibility for ACA Premium Tax Credits on Affordability of Family Coverage; Related Guidance Allows Additional Election Changes

"[T]he regulations have been amended to provide that an eligible employer-sponsored plan is affordable for related individuals (disqualifying them from a PTC) only if the required employee contribution for family coverage does not exceed 9.5% (indexed) of household income.... Related IRS guidance allows participants in non-calendar-year cafeteria plans to revoke their elections for family coverage to allow one or more family members to enroll in a QHP."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Exceptional Usefulness and Quality icon 2022 End of Year Plan Sponsor 'To Do' List for Health and Welfare Plans

"Although [this article identifies] many action items ... employers will focus their 2023 compliance efforts in three areas: [1] how the Supreme Court's Dobbs v. Jackson Women's Health Organization decision impacts their health plans' coverage of abortion services; [2] how the end of the COVID-19 emergency declarations, when announced, will impact their health plans' coverage of COVID-19 and related services; and [3] how to comply with the requirements under the Consolidated Appropriations Act, 2021, including, but not limited to, the prohibitions against surprise billing under the No Surprises Act, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) comparative analysis, broker and consultant compensation disclosures under Section 408(b)(2) of [ERISA], and the medical and drug cost reports that are initially due December 27, 2022, and every June 1 thereafter."  MORE >>

Snell & Wilmer

[Guidance Overview]

States Struggle to Ensure Equal Access to Behavioral Health Services Amid Mental Health Crisis

"Effective review and oversight of MHPAEA enforcement in the states are time- and resource-intensive processes which pose significant challenges to regulators ... Providers and patients are often unaware of insurers' obligations to provide equal access to mental health services under the federal parity law, removing a tool that states rely on to flag potential violations.... Funding from federal grants has been critical in state enforcement efforts[.]"  MORE >>

Robert Wood Johnson Foundation

[Guidance Overview]

Upcoming Deadline icon Colorado Gears Up for Sweeping New Paid Family and Medical Leave Insurance Program

"While Colorado voters approved Proposition 118 nearly two years ago, which set the path for implementation of the FAMLI program, employers and employees will not feel its effects until January 1, 2023. However, due to the impact FAMLI will have on the employment leave landscape, employers may want to begin educating themselves and their employees now on its requirements, as compliance will require cooperation across multiple departments."  MORE >>

Ogletree Deakins

Open Enrollment Brings Opportunities for Employees: How Employers Can Help

"For employees, open season brings an opportunity to select a new healthcare plan that meets their needs. Unless they have the right information to evaluate their choices, however, they could end up with a plan that offers more headaches than health care.... [E]mployers can ensure the plans they offer do not create expensive and unnecessary roadblocks to healthcare services. Plans should be evaluated not just by their organizational costs but also by how they encourage preventive services and adherence to treatment for chronic and serious conditions."  MORE >>

HR Daily Advisor


Pitfalls of Regulating Health Care Prices Are Real But Manageable

"While some attempts by states to establish l rate-setting systems for hospitals have been successful in constraining price growth, many economists are wary of such market intervention. They share concerns that such systems may fall prey to two pitfalls: regulatory failure and regulatory capture.... [W]hile these dangers are real, they are also manageable -- and shouldn't stand in the way of thoughtfully crafted models for reining in health care prices."  MORE >>

The Commonwealth Fund

Employee Benefits Jobs

View job as Compliance Quality Control
            for Pentegra

Compliance Quality Control



View job as Compliance Quality Control for Pentegra

View job as Technical Operations Manager - Financial Services
            for Nationwide Mutual Insurance

Technical Operations Manager - Financial Services

Nationwide Mutual Insurance


View job as Plan Document Specialist
            for Benetrends, Inc

Plan Document Specialist

Benetrends, Inc

Remote / Lansdale PA

View job as Plan Document Specialist for Benetrends, Inc

Selected New Discussions

Employee Premiums for Self-Insured Health Plans: When Do They Become 'Plan Assets'?

"Say the total premium for a month is $1,000, of which the employee pays $200. The employer sets aside $1,000 in an account in its name and EIN and there is no other indicia of ownership or rights by the plan. How do you determine the portion of the account that is plan assets subject to, say, the PT rules? Can you treat the account as using employee contributions first? Would this accounting restart every payroll cycle when new employee premiums are withheld?"

BenefitsLink Message Boards

Applying ACA Rate of Pay Safe Harbor to Employee Paid Both Salary and Hourly Pay

"Looking for guidance on how an employer applies the rate of pay affordability safe harbor to an employee that is paid both a salary (for work performed in one position) and an hourly wage (for work performed in second position). My first thought is to just use the W-2 safe harbor, but the client wants to explore the other possibility. I found language in the final regs allowing the employer to apply different safe harbors to different categories of employees but nothing about applying a safe harbor to an employee with two categories of pay. Any ideas?"

BenefitsLink Message Boards

Press Releases

Blitman and King Hires ERISA Associate

Blitman & King

Webcasts and Conferences
(Health & Welfare Plans)

Why Fertility Benefits Are About More Than Financial Support

October 25, 2022 in TX

Worldwide Employee Benefits Network [WEB] - Dallas Chapter

MHPAEA Litigation and Enforcement Update

October 26, 2022 WEBCAST

Groom Law Group

Last Issue's Most Popular Items

IRS Expands Access to ACA Subsidies for Families


IRS Releases 2022 Draft Instructions for Forms 1094-C and 1095-C


Employer-Sponsored Coverage and Premium Tax Credit Eligibility

Center on Budget and Policy Priorities

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

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