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Health & Welfare Plans Newsletter

February 1, 2023

5 New Job Opportunities 5 New Job Opportunities


[Official Guidance]

Statement of Administration Policy Establishing the End of COVID-19 Declared Emergencies (PDF)

"The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, respectively. At present, the Administration's plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the Administration's previous commitments to give at least 60 days' notice prior to termination of the PHE."  MORE >>

Executive Office of the President

[Official Guidance]

Text of IRS Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans (PDF)

"For use in preparing 2022 returns.... What's New: [1] Telehealth and other remote care services.... [2] Health FSA contribution and carryover for 2023.... [3] Insulin products.... [4] Health FSA contribution and carryover for 2022.... [5] Home testing for COVID-19 and personal protective equipment for preventing spread of COVID-19... [6] Surprise billing for emergency services or air ambulance services."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Preparing ERISA Plans for the End of the COVID-19 Emergency Periods

"As the Public Health Emergency ends, plan sponsors should review coverage of COVID-19 and related costs to determine how the plan will cover such costs going forward. Plan sponsors should also consider whether any continued coverage may cause parity problems under [MHPAEA].... When the national emergency period ends on May 11, 2023, the 60-day clock will begin counting down toward the end of the Outbreak Period. At the end of the Outbreak Period, the extended [COBRA] deadlines will revert to their pre-emergency timeframes."  MORE >>

Michael Best

[Guidance Overview]

Rule Proposes Removing Moral Exemption to Contraception Mandate

"Under a new proposed rule, fewer employers would be able to decline to provide employees health care coverage for birth control. [HHS], [DOL] and Department of the Treasury issued the proposed rule on Jan. 30 to remove the moral exemption under [ACA] regulations. The religious exemption would remain in place."  MORE >>

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

[Guidance Overview]

Final Regs Issued by Massachusetts Department of Family and Medical Leave: Health Plan Coverage During Leave

"The 2023 Regulations provide new options and flexibility for employers to meet the MAPFML requirement to provide health insurance coverage during leave. However, some questions remain[.]"  MORE >>


Ninth Circuit Once Again Reverses District Court Ruling Requiring Reprocessing of Mental Health Claims

"The Ninth Circuit has reversed a district court's ruling that a health insurer violated [ERISA] by using claims processing guidelines that were more restrictive than generally accepted standards of care ... to adjudicate mental health and substance use disorder (MH/SUD) claims ... [concluding] that the district court erred by treating claims reprocessing as a stand-alone remedy under ERISA. The Ninth Circuit's decision withdraws and replaces another Ninth Circuit decision in this litigation from March 2022." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]  MORE >>

Thomson Reuters Practical Law

Ninth Circuit Doubles Down on Prior Decision Negating Class Action Against UnitedHealthcare

"[T]he Ninth Circuit stated that ERISA's benefit claim provision (29 U.S.C. Section 1132(a)(1)(B)) only provides a right to 'recover benefits or to enforce or clarify rights under the plan.' Thus, reprocessing, which entails 'a remand to the administrator for reevaluation' is not a proper remedy under this provision, and is only 'a means to the ultimate remedy,' i.e., the payment of benefits. As a result, the court ruled that the district court violated the Rules Enabling Act by creating a substantive right not authorized in ERISA[.]" [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]  MORE >>

Kantor & Kantor LLC

District Court Allows ERISA Claims Alleging Incomplete Communications with Beneficiary to Proceed

"Lisa Erban applied for life insurance benefits as the beneficiary after her husband died ... She claims the defendants breached their fiduciary duty when they denied her benefits because they failed to inform her that she could continue her husband's life insurance benefits by continuing to pay premiums and that they did not completely inform her about the deadline to convert her husband's plan. The federal judge denied the defendant's motion to dismiss, finding Erban stated a plausible claim that the defendants breached their fiduciary duty in light of her husband's illness." [Erban v. Tufts Medical Center Physicians Org., Inc., No. 22-11193 (D. Mass Jan. 23, 2023)]  MORE >>; free registration required

ERISA Litigation Trends: Out-of-Network Payments and COVID-19 Testing Reimbursement

"[In] the coming year, plans .plans should be mindful of preserving the defensive privileges surrounding pricing methodology.... [I]nsurers and plans should anticipate that the outcome of many cases in 2023 will be decided on how much evidence providers gain through discovery and how clear (or unclear) plan language on pricing is.... [S]ome courts are allowing providers' claims [involving COVID-19 reimbursement] to proceed by reasoning that if a provider has standing to sue under ERISA by virtue of a plan beneficiary's assignment of benefits, then a plan may have breached an ERISA plan's terms in its failure to reimburse certain COVID-19 testing claims."  MORE >>

ReedSmith, via Lexology; free registration required

Who Is Caring for WA Cares? Benefit or Burden?

"A revised actuarial report published on October 20, 2022, now shows WA Cares is expected to be able to pay benefits through the first 75 years of operation. However, should modeling assumptions change, the report provides the WA Cares tax could require an increase from .58 percent to 1.23 percent of wages to cover benefit expenditures."  MORE >>

Davis Wright Tremaine LLP

Employee Benefits Jobs

View job as Retirement Plan Documents Specialist
            for Loren D. Stark Company

Retirement Plan Documents Specialist

Loren D. Stark Company


View job as Retirement Plan Documents Specialist for Loren D. Stark Company

View job as Retirement Plan Administrator (TPA)
            for Retirement Plan Consultants

Retirement Plan Administrator (TPA)

Retirement Plan Consultants


View job as Retirement Plan Administrator (TPA) for Retirement Plan Consultants

View job as Welfare Plan Counsel
            for Littler Mendelson P.C.

Welfare Plan Counsel

Littler Mendelson P.C.


View job as Retirement Plan Onboarding Coordinator
            for The Finway Group

Retirement Plan Onboarding Coordinator

The Finway Group

Remote / West Des Moines IA

View job as Retirement Plan Onboarding Coordinator for The Finway Group

View job as Regional Sales Director
            for Ameritas

Regional Sales Director


Remote / MN / ND / SD / WI

View job as Regional Sales Director for Ameritas

Press Releases

Milliman Wins Three Benefits Communication Graphic Design Awards for National Client Campaigns


Morningstar Investment Management and PAi's ESG Pooled Employer Plan Goes Live

Morningstar, Inc.

Pentegra Named One of New York's Best and Brightest Companies to Work For


The SPARK Institute Elects New Governing Board

SPARK Institute

Webcasts and Conferences
(Health & Welfare Plans)

HSAs: Advanced

March 14, 2023 WEBINAR


Last Issue's Most Popular Items

The DOL's 2023 Regulatory Agenda: New Rules for 401(k)s and Group Health Plans

Treasury & Risk; free registration required

Coming to Illinois in 2024: Paid Leave for Any Reason

Foley & Lardner LLP

A New Normal? Omnibus Bill Extends High Deductible Health Plan Telehealth Safe Harbor


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

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