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Health & Welfare Plans Newsletter

February 17, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

HHS Suspends Surprise Medical Billing IDR Payment Determinations

"The CMS notice directs certified IDR entities to continue working through other parts of the IDR process as they wait for additional direction from the agencies. Presumably this means that disputing parties will still be able to submit notices of IDR initiation through the IDR portal, further exacerbating the growing backlog of disputes."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

DOL Releases Guidance on Telework and FMLA

"[Field Assistance Bulletin 2023-1] confirms that FLSA and FMLA requirements apply whether work is performed at a remote location or at a designated work site.... [A new opinion letter] clarifies that employee rights under the FMLA are distinct and separate from those under the Americans with Disabilities Act (ADA), and the requirements of each statute must be analyzed separately. Leave provided as a reasonable accommodation under the ADA, however, also may qualify as FMLA-protected leave."  MORE >>


[Guidance Overview]

What Are the Temporary Reporting Requirements for Air Ambulance Services, and When Do They Apply?

"Under the proposed regulations, the reporting requirements would apply to self-insured and insured group health plans and insurers, but not to health reimbursement arrangements, excepted benefits, and short-term, limited-duration insurance.... [T]he regulations have not yet been finalized, so it is unclear at this time when the first report will be required."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Upcoming Deadline icon Medicare Part D Creditable Coverage Disclosures Due to CMS March 1, 2023

"The disclosure requirement applies to all plan sponsors that provide prescription drug coverage to Part D-eligible individuals, even those that do not make prescription drug coverage available to retirees.... Individuals who will become Part D eligible after the start of the plan year should not be included in the count for that year. However, they must be provided a notice of creditable or non-creditable coverage prior to their initial Part D enrollment period."  MORE >>


[Guidance Overview]

What Are the ACA Requirements for Out-of-Pocket Maximums?

"The maximum annual limits on cost sharing that a group health plan can impose for 2023 is $9,100 for self-only coverage and $18,200 for family coverage ($9,450 and $18,900, respectively, for 2024).... Plans are not required to include premiums, balance billing amounts for non-network providers or spending for non-covered services. While the OOPM limit only applies to EHBs, many employers apply the OOPM limit to all in-network benefits to ease plan administration."  MORE >>

Willis Towers Watson

DOL Continues Active ERISA Enforcement and Focus on Cybersecurity, Including Health and Welfare Plans

"The DOL has started including these cybersecurity questions and inquiries in health and welfare plan investigations ... Plan sponsors of health and welfare plans should remember that compliance with [HIPAA] may not be enough -- and the DOL's cybersecurity guidance must also be considered."  MORE >>

Morgan Lewis

Senate Cast Skeptical Eye on PBMs: 'Why the Hell (Do) They Even Exist?'

"U.S. Senate Commerce Committee members on Thursday vented bipartisan confusion and frustration about the opaque, unregulated, and possibly anticompetitive practices of pharmacy benefits managers and their reputed role in driving up drug costs for consumers.... [The committee] met to discuss Pharmacy Benefit Manager Transparency Act of 2023 [S 127], a bill that would enhance state and federal oversight of PBMs."  MORE >>

HealthLeaders Media

New Medicare and Medicaid Demonstration Projects Focused on Addressing the Costs of Medications

"[T]he Center for Medicare & Medicaid Innovation (CMMI), the research arm of [CMS], will implement three demonstration models ... [1] generic medications used to treat common chronic conditions. [2] A Medicaid project focused on the emerging field of cell and gene therapies. [3] A Medicare Part B model that would reduce payments for medications approved via the [FDA] Accelerated Approval pathway while the sponsors generate evidence from confirmatory trials."  MORE >>

Faegre Drinker

Benefits in General

Labor Secretary Walsh Departing to Lead NHL Player Union

"U.S. Secretary of Labor Marty Walsh is resigning his cabinet post to become the next executive director of the NHL Players’ Association, according to the NHL and Department of Labor. The announcements confirmed reports of his departure that surfaced last week."  MORE >>


Employee Benefits Jobs

View job as Defined Benefit Plan Consultant / Actuarial Analyst
            for Sentinel Benefits & Financial Group

Defined Benefit Plan Consultant / Actuarial Analyst

Sentinel Benefits & Financial Group

Remote / Wakefield MA / MI / NY / Hybrid

View job as Defined Benefit Plan Consultant / Actuarial Analyst for Sentinel Benefits & Financial Group

View job as Retirement Sales Consultant
            for Leading Retirement Solutions

Retirement Sales Consultant

Leading Retirement Solutions


View job as Retirement Sales Consultant for Leading Retirement Solutions

Press Releases

Fraser Trebilcock Introduces ERISA Health and Welfare Plan Voluntary Audit Service

Fraser Trebilcock

Webcasts and Conferences
(Health & Welfare Plans)

Employee Benefit Issues When Making Workforce Reductions: Section 409A, 401(k) Plans, Health and Welfare Plans

April 12, 2023 WEBINAR


Last Issue's Most Popular Items

Compliance Considerations When Offering COBRA Subsidies


Federal Telehealth Flexibilities in Private Health Insurance During the COVID-19 Public Health Emergency

Congressional Research Service [CRS]

Dependent Care FSA Issues for Married Couples


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

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