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Health & Welfare Plans Newsletter

November 17, 2022

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[Guidance Overview]

2023 PCORI Fee Amounts Announced

"The fee will now be $3.00 per plan enrollee, up from $2.79 for the 2022 plan year.... For plan years ending in 2022, PCORI is due by July 31, 2023. For plan years ending January 2023 through September 2023, PCORI fees are not due until July 31, 2024."  MORE >>

Assured Partners

[Guidance Overview]

IRS Revises October 2022 Additional Election Change Guidance to Remove Non-Calendar-Year Plan Requirement

"Under the revised guidance, cafeteria plans -- regardless of plan year -- can be amended to allow prospective midyear election changes from family coverage to employee-only coverage (or family coverage including one or more already-covered related individuals) under a group health plan that is not a health FSA and provides minimum essential coverage if [certain] conditions are satisfied[.]"  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Surprise Billing Final Regs Issued (PDF)

"The final regulations focus on ... [1] The factors that an IDR entity should consider when making a payment determination as part of the IDR process; [2] The requirements for an IDR entity's written decision; and [3] The disclosures by plans and issuers regarding the qualifying payment amount (QPA) to address 'downcoding'.... The final regulations are applicable with respect to items or services provided or furnished on or after October 25, 2022, for plan years beginning on or after January 1, 2022."  MORE >>

Husch Blackwell

[Guidance Overview]

Upcoming Deadline icon December 27 Is Deadline for Mandatory Rx Data Collection Reporting

"[T]he employer remains liable for noncompliance, even if it has an enforceable agreement with its vendor to ensure compliance, unless the plan is fully-insured and the agreement is with the insurer.... [T]here is no way for an employer to confirm on the HIOS module that a vendor uploaded the file(s) it agreed to upload ... [T]he employer should obtain written assurance from the plan's vendor(s) and rely on contractual provisions for recourse if a vendor fails to fulfill its RxDC reporting service as agreed."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

HHS Proposal Would Modify HIPAA Standards for Certain Electronic Pharmacy-Related Transactions

"The modifications in the proposed regulations are intended to provide more robust data exchange, improved coordination of benefits, and expanded financial fields that would avoid the need to manually enter certain data. To this end, the proposals would modify the current retail pharmacy standards by altering the use or structure of data fields, inserting new data segments, and adding new functionality."  MORE >>

Thomson Reuters / EBIA

Inflation Causing Americans to Skimp on Critical Health Care Expenses

"As food insecurity deepens, Americans are also struggling to pay for critical health care expenses. Many have cancelled or postponed plans in the past 12 months to see a specialist (14%), take a prescribed medication (10%) or get an annual physical (11%) due to high inflation, the survey said. And almost one-fifth of Gen Z (17%) and millennials (19%) have cancelled or postponed plans in the past 12 months to see a mental health professional."  MORE >>

No Surprises Act Prevents More Than 9 Million Surprise Bills Since January 2022 (PDF)

"During the first three quarters of 2022, there were an estimated 9 million NSA eligible claims, or about 0.5% of all commercial claims. Of these, 275,000 claims were submitted to IDR for dispute resolution. Health plans have received a total of 110,000 IDR batches."  MORE >>

America's Health Insurance Plans [AHIP] and Blue Cross Blue Shield Association

Paid Military Leave Lawsuits Continue to Capture Attention

"Thus far, no specific group of employees has been awarded a final judgment granting military leave pay, but as the cases are working their way to final resolution, it has become clear that potentially valid paid military leave claims may be brought against employers who cannot distinguish paid leave provided in non-military settings from that sought for military service absences. A few of the significant recent decisions addressing these claims are discussed below."  MORE >>

Quarles & Brady LLP

Benefits in General

[Official Guidance]

IRS Disaster Relief Notice IL-2022-08, for Victims of Illinois Severe Storm and Flooding

"Victims of Illinois severe storm and flooding occurring between July 25 and 28, 2022, now have until February 15, 2023, to file various individual and business tax returns and make tax payments ... [I]ndividuals and households affected by the severe storm and flooding that reside or have a business in St. Clair county qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Offer Benefits That Fit Life Stages of Workers to Attract and Retain Employees

"How do you know what benefits to offer? ... The benefits all generations want ... Health and family planning benefits by generation ... Financial planning benefits by generation ... Work-life flexibility and training benefits by generation."  MORE >>

Principal Financial Group

Employee Benefits Jobs

View job as  Senior Relationship Manager 2-4, ERISA, Retirement
            for National Benefit Services

Senior Relationship Manager 2-4, ERISA, Retirement

National Benefit Services


View job as  Senior Relationship Manager 2-4, ERISA, Retirement for National Benefit Services

Press Releases

Former Carpenters' Benefit Plan Administrator Sentenced to Six Months' Home Confinement, Three Years' Probation for Embezzling $140,000

U.S. Department of Justice [DOJ]

OneDigital Announces Acquisition of The Fiducia Benefits Group


Last Issue's Most Popular Items

Minimum Essential Coverage Reference Chart (PDF)

Center on Budget and Policy Priorities

CRS Report: Health Care-Related Expiring Provisions of the 117th Congress, Second Session (PDF)

Congressional Research Service [CRS]

District Court Finds Section 1557 Does Not Prohibit Discrimination on Account of Sexual Orientation or Gender Identity

Thomson Reuters Practical Law

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

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