logo logo

Health & Welfare Plans Newsletter

March 16, 2023

3 New Job Opportunities 3 New Job Opportunities


[Official Guidance]

Text of CMS Guidance on Medicare Drug Price Negotiation Program: Initial Memorandum, Implementation for Initial Price Applicability Year 2026, and Solicitation of Comments (PDF)

91 pages. "This initial guidance describes how CMS intends to implement the Negotiation Program for initial price applicability year 2026, and specifies the requirements that will be applicable to manufacturers of Medicare Part D drugs that are selected for negotiation and the procedures that may be applicable to manufacturers of Medicare Part D drugs, Medicare Part D plans, and providers and suppliers (including retail pharmacies) that furnish Medicare Part D drugs." [Also available: Fact Sheet]  MORE >>

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

[Guidance Overview]

Coverage of COVID-19 Vaccines and the End of the COVID-19 Emergency

"Due to the ongoing requirements of the ACA, there will be minimal actions that employers need to take after the PHE ends regarding vaccine coverage. The primary changes are that ACIP-recommended COVID-19 vaccines should be covered immediately instead of after a 15-day hold period and that health plans can decide whether to apply cost sharing, prior authorization and medical management requirements to COVID-19 vaccines obtained from an out-of-network provider."  MORE >>

McDermott Will & Emery

[Guidance Overview]

Illinois Guarantees One Week of Paid Leave for All Workers

"[E]mployees are entitled to start using their paid leave 90 days following the commencement of their employment or 31 March 2024, whichever is later. The employee may use the paid leave for any purpose without fear of retaliation; the employee does not need to provide a reason to the employer, nor does the employee need to provide documentation or support for the paid leave."  MORE >>

K&L Gates

Eighth Circuit: Exhaustion of Administrative Remedies Not Required When Plan Documents Contain No Review Procedures

"This decision highlights the importance of providing claims procedures that are consistent with ERISA's requirements. As the appellate and trial courts noted, the plan document is at the center of ERISA. While it is generally acceptable and convenient to set forth a plan's claims procedures in a document that is separate from the formal plan document, it is crucial to expressly incorporate these procedures by reference -- otherwise they are not actually part of the plan." [Yates v. Symetra Life Insurance Company, No. 22-1093 (8th Cir. Feb. 23, 2023)]  MORE >>

Thomson Reuters / EBIA

Fourth Circuit Endorses Rule 52 for Resolving ERISA Benefit Claim Cases with Factual Disputes

"[T]he Fourth Circuit endorsed seeking judgment, not via summary judgment or a quasi-summary judgment procedure, but through Federal Rule of Civil Procedure 52 if the case involves de novo review of a benefit claim with factual disputes. Rule 52 allows a court to conduct a 'trial on the papers' and thus issue findings of fact and conclusions of law." [Tekmen v. Reliance Standard Life Ins. Co., No. 20-1510 (4th Cir. Dec. 16, 2022)]  MORE >>

Faegre Drinker

PBM Practices Receive Increased Federal Scrutiny

"On March 1, 2023, the House Committee on Oversight and Accountability launched an investigation into PBM practices.... Last year, the Federal Trade Commission (FTC) launched an investigation into the PBM industry, seeking information on the competitive impact of the contracting and business practices of the six largest PBMs.... Additionally, the OIG announced its intent to issue a report on whether States provide adequate oversight of Medicaid MCOs to ensure accountability over amounts paid for prescription drug benefits to PBMs."  MORE >>

Sheppard Mullin

HHS Reports to Congress on HIPAA Compliance and Breach Notifications

"The reports include important data from the HIPAA complaints investigated, highlight areas of noncompliance, and provide insights into trends such as cybersecurity readiness.... Regulated entities should be mindful that OCR opens compliance reviews to investigate all reported breaches affecting 500 or more individuals and may open compliance reviews into reported breaches affecting fewer than 500 individuals."  MORE >>

Thomson Reuters / EBIA

Employee Benefits Jobs

View job as Benefits Production Manager
            for IUOE Local No. 478 Employee Benefit Funds

Benefits Production Manager

IUOE Local No. 478 Employee Benefit Funds

Hamden CT

View job as Benefits Production Manager for IUOE Local No. 478 Employee Benefit Funds

View job as Retirement Plan Administrator
            for ERISA Services, Inc.

Retirement Plan Administrator

ERISA Services, Inc.


View job as Retirement Plan Administrator for ERISA Services, Inc.

View job as Retirement Plan Consultant
            for Retirement Recruiters - CPS, inc

Retirement Plan Consultant

Retirement Recruiters - CPS, inc

Remote / Chicago IL / CA / GA / MI / NE / NJ / PA / TX

Press Releases

NPPG's Acquisition of Oriental's Retirement Plan Record Keeping and Third- Party Administration Line of Business Expands Employee Benefit Services Outside of the Continental United States


IRI Honors Sammons' Bill Lowe as Champion of Retirement Security

Insured Retirement Institute [IRI]

IRI Announces Leadership and Chairman Award Recipients

Insured Retirement Institute [IRI]

OneDigital Expands Benefits and Retirement Presence With Addition of The Clear Group and 401K Resources


Webcasts and Conferences
(Health & Welfare Plans)

Group Health Plan Implications of the Termination of the COVID-19 Emergency Declarations


Miller Johnson

The End Is Near: Benefit Implications from Expiring COVID-19 Emergencies


NFP Corp.

Last Issue's Most Popular Items

Health Coverage for Temps and Interns


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


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

Miller Johnson

Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2023, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.