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Health & Welfare Plans Newsletter

February 24, 2023

3 New Job Opportunities 3 New Job Opportunities


[Official Guidance]

Text of Agency FAQs Part 57: Prohibition on Gag Clauses on Price and Quality Information in Provider Agreements (PDF)

13 Q&As."Q1: What is a 'gag clause'? ... Q5: What is the due date for the Gag Clause Prohibition Compliance Attestation? ... Q6: What is the due date for the Gag Clause Prohibition Compliance Attestation [GCPCA]? ... Q7: How should plans and issuers submit an attestation? ... Q8: Which entities are required to submit a [GCPCA]? ... Q9: Can another entity, such as a pharmacy benefit manager (PBM), managed behavioral health organization, TPA, or other service provider attest on behalf of a self-insured group health plan or a health insurance issuer? ... Q10: Can an issuer that both offers group health insurance and acts as a TPA for self-insured group health plans submit a single [GCPCA] on behalf of itself, its fully-insured group health plan policyholders, and its self-insured group health plan clients?" [Also available: Instructions for submitting the GCPCA (PDF); User Manual for submitting the GCPCA (PDF); and GCPCA Reporting Entity Template (XLSM)]  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

Upcoming Deadline icon The Clock Is Ticking: HIPAA Small Breach Notifications Due March 1

"[E]ntities providing OCR breach notification may consider: [1] Designating a person within the reporting entity who will be responsible ... [2] Preparing the contents of the notification in advance.... [3] Printing out and retaining a 'receipt' of the filing of the notification ... [4] Verifying that the entity has appropriate documentation in place ... [5] Being prepared. Notifications may spur investigations and compliance reviews by OCR."  MORE >>

Davis Wright Tremaine LLP

[Guidance Overview]

HHS Issues Updated National Medical Support Notice and Instructions

"HHS's Office of Child Support Enforcement has released an updated version of the National Medical Support Notice (NMSN) with changes to both Parts A and B. An NMSN is a standardized medical child support order that is used by state child support enforcement agencies to obtain group health coverage for children."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

CMS Delays Final Regs Addressing Penalties for MSP Reporting Violations

"CMS has extended by one year its deadline for publishing final regulations that would specify how and when it will impose civil money penalties for violations of the Medicare Secondary Payer (MSP) reporting requirements....  CMS justifies the one-year extension by explaining that public listening sessions about the proposed rule raised additional concerns that need to be researched prior to publishing the final rule."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

DOL Provides Resources to Help Employees Understand FMLA Protections, Benefits

"As part of its ongoing efforts to empower workers to use FMLA-protected leave, the department's Wage and Hour Division has launched a webpage and updated resources to help workers seeking to take time off from work to care for a family member. The site includes ... [1] A guide on how to talk to your employer about taking job protected FMLA leave. [2] Updated fact sheets on using FMLA leave when your family member has a serious health condition, must respond to military service duties, or must care for an adult child with a disability. [3] FAQs on taking FMLA leave and other resources for family caregivers to navigate their responsibilities."  MORE >>

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]


2023 CCA Healthcare Meeting A Virtual Event for Health Actuaries April 11 & 13

Earn up to 13.5 CE hours during this 2-day, virtual meeting! Choose from 8 sessions covering a range of healthcare topics. Registration includes the webinar, The 3Ms and the Ties That Bind Federal Healthcare Regulatory Direction. Learn more.

Sponsored by Conference of Consulting Actuaries [CCA]

Seventh Circuit Clarifies Evidentiary Standard Required to Discipline Employees for Abusing FMLA Leave

"[The Seventh Circuit held] that Vail did not raise the bar for FMLA-abuse investigations to require surveillance evidence before disciplining an employee for abusing FMLA leave. Instead, it held that because Husband presented no evidence that would suggest that FCA's suspicion was not genuine, summary judgment against Husband on the interference claim was appropriate." [Juday v. FCA US LLC, No. 21-1414 (7th Cir. Jan. 12, 2023)]  MORE >>


Eighth Circuit Addresses Exhaustion of Administrative Remedies and Accidental Heroin Overdose

"The court first held that an ERISA plan participant is not required to exhaust administrative remedies before filing suit when the written plan documents are silent on any review process or administrative remedies ... the court found that using heroin is not itself an intentionally self-inflicted injury. The overdose injury was unintentional. The court rejected Symetra's argument that the insured's purposeful act of using an illegal substance means that the injury stemming from the act was purposeful." [Yates v. Symetra Life Insurance Company, No. 22-1093 (8th Cir. Feb. 23, 2023)]  MORE >>

Roberts Disability Law

Financial Wellbeing and Implications of Rising Health Care Costs (PDF)

"[P]aying for health care was near the bottom of factors that impacted stress... Approximately one-third (32 percent) of respondents reported that premiums, deductibles, the cost of care, or prescriptions have increased in the last year. In contrast, two-thirds (65 percent) reported that health care costs have remained the same, while only 4 percent reported that they fell."  MORE >>

Employee Benefit Research Institute [EBRI]


A Question of Transparency

"When a broker says, 'We often get paid more by insurance companies than we charge you for those services,' is that being transparent? ... Most PBMs are willing to disclose that they make money on spread pricing ... Is this enough to be transparent? Do they need to reveal how much? ... Will new government-required reporting solve the transparency problem? ... [T]here's still enough complexity in the system to keep things opaque."  MORE >>

Chelko Center for Benefits Management

Benefits in General

[Guidance Overview]

IRS Issues Final Regulations Expanding Mandatory Electronic Filing of Information Returns

"The regulations, which were proposed in 2021 to implement statutory changes made by the Taxpayer First Act of 2019, establish lower thresholds for mandatory electronic filing of the following returns affecting employee benefit plans: [1] Form 1094 Series; Forms 1095-B and 1095-C; Form 1099 Series; and Form 5498 Series.... [2] Forms 5330 and 8955-SSA.... [3] Form 5500 Series."  MORE >>

Thomson Reuters / EBIA

Employee Benefits Jobs

View job as Defined Benefit Consultant
            for AimPoint Group

Defined Benefit Consultant

AimPoint Group


View job as Defined Benefit Consultant for AimPoint Group

View job as Retirement Plan Consultant
            for The MandMarblestone Group, llc

Retirement Plan Consultant

The MandMarblestone Group, llc

Remote / Philadelphia PA

View job as Retirement Plan Consultant for The MandMarblestone Group, llc

View job as Combined Plan Administrator
            for Maxus Plan Solutions

Combined Plan Administrator

Maxus Plan Solutions

Remote / Charlotte NC

View job as Combined Plan Administrator for Maxus Plan Solutions

Last Issue's Most Popular Items

ACA Coding Error Penalties Are Coming Soon

HUB International

Plan Sponsors: Prepare for the End of the COVID-19 Emergencies

Hunton Andrews Kurth LLP

Text of Final Forms Revisions: Annual Information Return/Reports (Form 5500 and 5500-SF)

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; and Pension Benefit Guaranty Corporation [PBGC]

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

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