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Health & Welfare Plans Newsletter

March 15, 2023

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

Text of CMS Notice: Reduced Coinsurance for Certain Part B Rebatable Drugs Under the Medicare Prescription Drug Inflation Rebate Program (PDF)

"For the time period of April 1 to June 30, 2023, 27 Part B rebatable drugs have an adjusted coinsurance rate based on the inflation-adjusted payment amount. People with Traditional Medicare and Medicare Advantage who use these drugs may, depending on other health coverage they may have, pay a reduced amount for their coinsurance during this specific quarter." [Also available: Fact Sheet on Medicare Prescription Drug Inflation Rebate Program Part B Rebatable Drug Coinsurance Reduction, and Guidance on Inflation Rebates in Medicare.]  MORE >>

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

[Guidance Overview]

Health Coverage for Temps and Interns

"The ACA employer mandate generally requires that ALEs offer coverage to full-time temps or interns in the same manner as regular full-time hires to avoid potential penalties. However, employers frequently take advantage of cost-saving strategies such as utilizing the ACA's limited non-assessment period to delay the offer of coverage to the first day of the fourth full calendar month of employment."  MORE >>


[Guidance Overview]

Tri-Agencies Release Guidance for Group Health Plan 'No Gag Clause' Attestations

"The Departments clarify that gag clauses include restrictions on the disclosure of provider rates regardless of whether the TPA considers them 'proprietary,' or provisions that allow access to provider-specific cost and quality-of-care information only at a TPA's discretion. In addition, provisions that indirectly operate to restrict access to or disclosure of applicable information violate the prohibition on gag clauses -- even if they don't expressly restrict disclosure."  MORE >>


[Guidance Overview]

State Laws Limit Vacation Forfeitures

"For employers voluntarily providing paid vacation, state wage-and-hour laws often fail to specify whether the employer must pay out unused accrued vacation on employment separation or can implement a use-it-or-lose-it policy that requires forfeiture of vacation not used by a specified date ... [R]ecent developments in Colorado and Maine illustrate the mix of court rulings and state laws that employers must track when crafting vacation policies."  MORE >>


[Guidance Overview]

What Health Plan Sponsors Need to Know About the End of the COVID-19 Emergency Declarations

"In general, after May 11, 2023, group health plans will no longer be required to cover testing, preventive services, and vaccines for COVID-19 without cost-sharing. However, the requirement under the CARES Act that non-grandfathered group health plans must cover in-network preventive services and vaccines for COVID-19 is not tied to the ending of the PHE."  MORE >>

Miller Johnson

[Guidance Overview]

Illinois Mandates Paid Leave 'For Any Purpose' Effective January 1, 2024

"[T]he Act does not preempt the Chicago Minimum Wage and Paid Sick Leave Ordinance or the Cook County Earned Sick Leave Ordinance, and employers that provide employees with paid sick leave in compliance with the Chicago or Cook County ordinances will not be required to provide an additional 40 hours of paid leave. However, the Act does apply to employers with Chicago or Cook County-based employees who are not currently covered by those ordinances."  MORE >>

Morgan Lewis

[Guidance Overview]

Illinois Adopts Mandatory Paid Leave

"[C]overed employees accrue one hour of paid leave for every 40 hours worked, for up to a total of 40 hours earned in any designated 12-month period. Employers may also satisfy the paid time off requirement by granting, or 'frontloading,' all 40 hours of paid leave at the beginning of the designated benefit year. Employees must be permitted to carry over up to 40 hours of unused paid leave to the next benefit year, except where an employer frontloads the full 40 hours."  MORE >>

Duane Morris LLP

Ninth Circuit Rules Plan Participants Have No Standing to Challenge Alleged Misconduct of Multi-Employer Benefit Manager

"The court noted that RingCentral made all decisions regarding which benefits would be offered to employees, and what contributions would be required for those benefits. Plaintiffs were required to establish a connection between Sequoia's actions and their contributions, but RingCentral's intermediary actions broke that connection ... The Ninth Circuit then turned to plaintiffs' second standing theory, which was that they retained an equitable ownership interest in the Tech Benefits Program's trust fund ... The court held that this argument ran afoul of the Supreme Court's decision in Thole." [Winsor v. Sequoia Benefits & Ins. Servs., LLC, No. 21-16992 (9th Cir. Mar. 8, 2023)]  MORE >>

Kantor & Kantor LLC

The ERISA Industry Committee Refiles Motion for Summary Judgment in NJ Warn Act Lawsuit

"Nearly three years ago, ERIC challenged amendments to the New Jersey WARN Act that would impose a series of requirements forcing employers in every industry to create ongoing administrative systems affecting severance benefits. Because these requirements violate [ERISA], ERIC filed suit to prevent overreach by the State and invalidate the amended law." [The ERISA Industry Committee v. Asaro-Angelo, No. 20-10094 (D.N.J. motion filed Mar. 14, 2023)]  MORE >>

The ERISA Industry Committee [ERIC]

Budget Proposal Includes Substantial Amounts for Implementation and Enforcement of No Surprises Act and Mental Health Parity Requirements

"President Biden's proposed 2024 budget includes substantial additional amounts for continued funding of the implementation and enforcement of the No Surprises Act (NSA) and the transparency laws passed along with the NSA, including prohibitions on gag clauses regarding price and quality information, the required disclosure of indirect compensation for brokers and consultants with respect to employer-sponsored health plans, required reporting on pharmacy benefits and drug costs, and enforcement of the mental health parity comparison requirements."  MORE >>

Manatt, Phelps & Phillips, LLP

Federal Employees Can Expect to See Improved Fertility Coverage in 2024

"Carriers are required to [1] provide coverage of artificial insemination ... [2] cover drugs associated with artificial insemination procedures ... [3] cover the cost of In Vitro Fertilization (IVF)-related drugs for three cycles annually.... These 2024 changes represent an expansion of fertility benefits compared to what was available this year."  MORE >>

Government Executive

Employee Benefits Jobs

View job as Actuarial Services Manager
            for FuturePlan, by Ascensus

Actuarial Services Manager

FuturePlan, by Ascensus


View job as Actuarial Services Manager for FuturePlan, by Ascensus

View job as Retirement Plan Consultant (Cash Balance)
            for FuturePlan, by Ascensus

Retirement Plan Consultant (Cash Balance)

FuturePlan, by Ascensus


View job as Retirement Plan Consultant (Cash Balance) for FuturePlan, by Ascensus

View job as Actuarial Consultant
            for Nyhart, part of FuturePlan by Ascensus

Actuarial Consultant

Nyhart, part of FuturePlan by Ascensus


View job as Actuarial Consultant for Nyhart, part of FuturePlan by Ascensus

View job as Financial Services Representative
            for The Standard

Financial Services Representative

The Standard


View job as Financial Services Representative for The Standard

Press Releases

iJoin Taps Benjamin Thomason to Guide Its Rapidly Growing Partner Channels


Federal Court Orders Defunct Milwaukee Info Technology Company, President to Restore $18k Withheld from Employees for Medical Plan

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

The Wagner Law Group Ranked Among the Largest Women-Owned Businesses in Massachusetts

The Wagner Law Group P.C.

Ameritas Joins the Retirement Advisor Council

Retirement Advisor Council

Last Issue's Most Popular Items

Gag Clause Compliance Attestation Requirements for Plan Sponsors

Sherman Howard

Health Plans Must Submit Gag Clause Attestations by Dec. 31, 2023


Medicaid Redetermination and Its Impact on Employer Medical Plans


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

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