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Health & Welfare Plans Newsletter

March 13, 2023

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

Exceptional Usefulness and Quality icon Federal Requirements on Private Health Insurance Plans

34 pages. "Federal requirements on private health insurance may apply to large-group, small-group, self-insured, and/or non-group plans.... The selected requirements discussed in this report are grouped into the following categories: [1] Obtaining coverage ... [2] Keeping coverage.... [3] Health insurance premiums ... [4] Covered benefits ... [5] Enrollee cost sharing and plan payment for benefits ... [6] Health care provider interactions ... [7] Enrollee information and appeals ... [8] Federal and public reporting requirements[.]" [R45146 Mar. 9, 2023]  MORE >>

Congressional Research Service [CRS]

[Guidance Overview]

'Gag Clause' Prohibition Attestation Required by Year End

"[M]ost employers will not want to make this attestation themselves since the TPAs and ASOs will have the information on the gag clause requirements with respect to their networks.... Employers that want to take care of this themselves should consult the [CNS] instructions and user manual ... To the extent they are using a TPA or ASO, they will likely need to coordinate with that service provider and collect information from them regarding the filing."  MORE >>

HUB International

[Guidance Overview]

First Gag Clause Attestations Are Due by the End of 2023

"Self-insured plans may enter into written agreements with service providers to complete the attestation on their behalf, but the plan remains legally responsible for compliance.... Plans that fail to comply may face a civil penalty of up to $100 per day, adjusted annually, for each individual affected by a violation."  MORE >>


[Guidance Overview]

IRS Increases ACA Employer Mandate Penalties for 2024

"For the calendar year 2024, the A Penalty (IRC Section 4980H(a)) is $2,970 (which represents a $90 increase from 2023) and the B Penalty (IRC Section 4980H(b)) is $4,460 (which represents a $140 increase from 2023)."  MORE >>


[Guidance Overview]

Employee Benefits and Rights in Puerto Rico: What to Know Now That Law 41-2022 Has Been Declared Null and Void

"On March 3, 2023, the U.S. District Court for the District of Puerto Rico issued a decision declaring Law 41-2022 null and void, effectively reinstating the prior state of many of Puerto Rico's employment statutory entitlements. The decision will impact employees' statutory benefits and rights, including vacation pay and sick leave, meal periods, holiday bonuses, and statutory severance pay." [Financial Oversight and Management Bd. for Puerto Rico v. Urrutia No. 22-0063, 17 BK 3283-LTS (D. Puerto Rico  Mar. 3, 2023)]  MORE >>

Ogletree Deakins

UnitedHealth Beneficiaries Seek to Revive Case Over Mental Health Coverage

"In [the] renewed petition for rehearing, the plaintiffs said that the court should find that UBH must follow generally accepted standards for deciding medical necessity.... They noted that the federal government, multiple states and major medical associations had all weighed in on the plaintiffs' side." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. petition for rehearing filed Mar. 10, 2023)]  MORE >>

Reuters; free registration may be required

Restrict the Middleman? Quantitative Models of PBM Regulations and Their Consequences

55 pages. "The purpose of this paper is to help fill a gap between applied economics, where few economic models of the pharmaceutical industry so far even acknowledge that drug benefits are managed, and regulatory practice where new benefit-management regulations are now actively considered and implemented at both the federal and state levels."  MORE >>

National Bureau of Economic Research [NBER]; purchase may be required for full document

Senators Target 'Loopholes' in Insurer Price Transparency Rule

"Senators Maggie Hassan (D-NH) and Mike Braun (R-IN) wrote to CMS asking for changes to improve the payer price transparency rule. The changes include creating a standardizing reporting template, limiting file sizes, and requiring an organizational system and standardized labeling."  MORE >>

HealthLeaders Media


How Obamacare Doubles Your Cost for Preventive Care

"If you aren't a hyper-diligent health-bill-nazi, you're likely being double-billed now when your doctor's office keys in that you had a preventive exam as well as discussion, follow-up on, or evaluation of X. Where 'X' can be any ailment, bump, sore, cut, tick, twitch, stressor, or annoyance in your life.... To say that our system has been bureaucratized beyond recognition into some sort of Frankenstein monster of public-private plunder is an understatement."  MORE >>

Benefit Revolution


The Heat Is On, and Pharmacists are Thrilled. PBMs? Not So Much.

"Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Accountability, announced that his committee has launched an investigation into PBMs and their business practices.... Comer is asking for a lot of information about discount cards, rebates, contracts, and more.... Pharmacists and patients have known ... for a long time that PBMs evolved their business model long ago to benefit from higher prescription drug prices.... But attempts to change the pharmacy payment model will be met with intense lobbying pressure."  MORE >>

National Community Pharmacists Association [NCPA]

Employee Benefits Jobs

View job as Member Services Representative
            for DC Retirement Board

Member Services Representative

DC Retirement Board

Washington DC

View job as Member Services Representative for DC Retirement Board

View job as Retirement Analyst
            for DC Retirement Board

Retirement Analyst

DC Retirement Board

Washington DC

View job as Retirement Analyst for DC Retirement Board

View job as Senior Defined Contribution Account Manager
            for Nova 401(k) Associates

Senior Defined Contribution Account Manager

Nova 401(k) Associates


View job as Senior Defined Contribution Account Manager for Nova 401(k) Associates

View job as PSC (Participant Services Center) Manager
            for Definiti

PSC (Participant Services Center) Manager



View job as PSC (Participant Services Center) Manager for Definiti

Press Releases

Transamerica and Cetera Financial Group Debut New Group Retirement Plan Solution


Transamerica Bolsters Group Term Life Insurance Policies with Employee Assistance, Travel, and Identity Theft Services


Webcasts and Conferences
(Health & Welfare Plans)

Practical Strategies for Containing Pharmacy Costs

April 20, 2023 WEBINAR


2023 Annual Workshop

April 20, 2023 in FL

Florida West Coast Employee Benefits Council

Employee Benefits in Mergers and Acquisitions National Institute 2023

May 16, 2023 WEBINAR

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

What the End of the COVID-19 Pandemic Means for Employee Benefit Plan Deadlines and Coverage

Jackson Lewis P.C.

Volunteering for Trouble: The Nightmares Voluntary Benefits Often Bring

Benefit Revolution

Final Key Dates for Calendar Year 2023: Qualified Health Plan Data Submission and Certification, Rate Review, and Risk Adjustment (PDF)

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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

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