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Health & Welfare Plans Newsletter

January 11, 2023

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

Congress and Regulators Issue Welcome Deadline Relief for Group Health Plans

"The relief comes in the form of a permanent extension of certain [ACA] reporting deadlines, a temporary reprieve from new prescription drug reporting requirements, and a two-year continuation of the ability to offer telehealth and remote care services under HSA-compatible high deductible health plans."  MORE >>

Spencer Fane

[Guidance Overview]

HHS Proposed Rule Would Change HIPAA Standards for Certain Electronic Pharmacy-Related Transactions

"The affected retail pharmacy transactions include health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of benefits. Additionally, under the proposed rule, the Medicaid pharmacy subrogation transaction standard would become applicable to all health plans."  MORE >>

Hall Benefits Law

[Guidance Overview]

DC Employers Must Report Compliance With, or Exemption From, the DC Parking Cashout Law by January 15

"Unless exempt, employers that offer a parking benefit must provide a Clean-air Transportation Fringe Benefit, develop a transportation demand management plan, pay a fee, or discontinue the parking benefit. All covered employers must submit a compliance report to the DDOT every two years or be subject to fines and penalties."  MORE >>

Nixon Peabody LLP

General Reasons for Leave Call-Ins Satisfied FMLA Requirements

"The Family and Medical Leave Act (FMLA) allows employers to establish call-in requirements for employees to use FMLA leave. But an employee's reference to flare-ups, if connected to FMLA certification, may suffice to satisfy call-in requirements." [Render v. FCA US LLC, No. 21-2851 (6th Cir. Nov. 16, 2022)]  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

District Court Applies Novel Class Standing Doctrine to Significantly Narrow Claims in ERISA Healthcare Coverage Class Action

"The court found that, despite having Article III standing, Mr. Curtis's challenges to physical therapy denials were too dissimilar to denials received by other potential class members for the five other therapies -- speech, pulmonary rehabilitation, cognitive rehabilitation, occupational, and voice -- for Mr. Curtis to have class standing to litigate claims related to these services on behalf of the class." [Curtis v. Aetna Life Ins. Co., No. 19-01579 (D. Conn. Jan. 4, 2023)]  MORE >>

Kantor & Kantor LLC

Employers Can Help Retiring Workers Navigate Post-Employment Benefits

"Given that much of the current focus of financial wellness programs is aimed at helping employees fulfill their current and future needs, which includes preparing for a secure retirement, it can be short-sighted not to treat post-employment benefits as the concluding step in an employee's financial wellness journey."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

Pharmacy Benefit Managers and the Federal Trade Commission: A Relationship Gone Sour

"On June 7, 2022, the [FTC] announced its decision to launch an inquiry into the business practices of pharmacy benefit managers (PBMs).... This is not ... the first time that the FTC crossed paths with the PBMs. Earlier encounters offer a useful window into the evolving PBM market and the associated policy challenges. This Viewpoint offers a reminder of why PBMs emerged in the first place, why they have amassed such alarming influence, and how they positioned themselves as powerful actors within the prescription drug distribution system."  MORE >>

JAMA Health Forum

North Carolina Treasurer Hopes to Cut Family Health Premiums for State Employees as Contract Shifts

"Share to Facebook Share to Twitter Share to Email App Share to Print Share to More North Carolina State Health Plan officials are researching the differences between the provider networks for Aetna and Blue Cross and Blue Shield of North Carolina as they prepare for a shift in management of the health insurance plan. State Treasurer Dale Folwell.... said he expects administration costs to go down as the plan moves to a new third-party administrator for the first time in 40 years."  MORE >>

Cashed Check Costs United Healthcare More Than $2 Million

"United Healthcare ... had sought a refund of more than $2 million after claiming that an audit showed that it had overpaid Low-T Physicians Service ... Following a review and negotiations, the Low-T groups offered to settle for $24,665.... At trial, United Healthcare's general counsel and investigator said they were not aware of the settlement offer until after the check was deposited.... Evidence showed that the ... associate general counsel for United Healthcare who had been communicating with Low-T ... should have received the letter six days before the check was cashed. After a deposition, he found the letter in his files." [United Healthcare of Texas, Inc. v. Low-T Physicians Services, PLLC, No. 02-22-00170 (Ct. App. Tex. Jan. 5, 2023)]  MORE >>

American Bar Association

Benefits in General

What's in Store for Employee Benefits and Total Rewards in 2023?

"Employers continue to absorb healthcare premiums and other costs.... Virtual primary care will continue to take off as the next generation of telehealth.... Companies may need to manage through significant change as they right-size their organization in line with current market conditions.... Employers continue to reduce expenses in defined contribution plans.... The pace of defined benefit plan terminations increases.... Pension plan sponsors begin to implement income distribution options in their defined contribution plans."  MORE >>


Employee Benefits Jobs

View job as Experienced Defined Benefit Plan Administrator
            for MGKS

Experienced Defined Benefit Plan Administrator


Remote / Phoenix AZ

View job as Experienced Defined Benefit Plan Administrator for MGKS

View job as Retirement Plan Administrator
            for Metro Benefits, Inc.

Retirement Plan Administrator

Metro Benefits, Inc.

Remote / Pittsburgh PA

View job as Senior Attorney, ERISA
            for The Standard

Senior Attorney, ERISA

The Standard


View job as Senior Attorney, ERISA for The Standard

View job as Retirement Plan Administrator
            for The Finway Group

Retirement Plan Administrator

The Finway Group

Remote / West Des Moines IA / IL / KS / MN / MO / ND / NE / SD / WV

View job as Retirement Plan Administrator for The Finway Group

View job as Regional Sales Director
            for July Business Services

Regional Sales Director

July Business Services

Remote / Waco TX

View job as Regional Sales Director for July Business Services

Selected New Discussions

Non-ALE with ICHRA Required to File 1094-B and 1095-Bs?

"My understanding is that non-ALEs offering an ICHRA are supposed to file 1094-B and 1095-Bs. Other than the 'because it's the law' and 'there could be substantial penalties if your failure is discovered' is any real purpose served by such filings? Thanks"

BenefitsLink Message Boards

Leave of Absence and Medical Flex Spending Account Catch Up Contributions

"If an employee chooses to catch-up on their medical FSA contributions upon their return from leave and they do not have enough pays to complete the catch-up contributions prior to year end, can the employer post the remaining contributions due as post-tax contributions and take the remaining amount due in the following calendar year?"

BenefitsLink Message Boards

Press Releases

GOSHRM Wins Two Awards for Community Impact on Opioid Crisis

Greater Orlando Society for Human Resource Management [GOSHRM]

PSCA's 2022 Nonqualified Plan Survey Is Now Available

PSCA [Plan Sponsor Council of America]

Andrew Forgrave, Enrolled Actuary at Pinnacle Plan Design, Promoted to Partner

Pinnacle Plan Design

Webcasts and Conferences
(Health & Welfare Plans)

Mental Health Forum

January 24, 2023 in FL

Greater Orlando Society for Human Resource Management [GOSHRM]

Litigating Out-of-Network Provider Claims

April 11, 2023 WEBINAR

Jackson Lewis LLP

Last Issue's Most Popular Items

Recent Developments for Health and Welfare Plans

Kutak Rock LLP

Complying with Various State Individual Health Care Mandates


2023 Benefit Basics for Pension and Health and Welfare Plans

Willis Towers Watson

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

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