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Health & Welfare Plans Newsletter

March 29, 2023


[Guidance Overview]

Prohibition of Gag Clauses: Attestation Guidance for Employers

"The first Gag Clause Prohibition Compliance Attestation (GCPCA) submission is due December 31, 2023, and will cover the period of December 27, 2020, through the date of the attestation. Subsequent GCPCA submissions are due by December 31st of each year thereafter. Group health plans can satisfy their reporting obligations by having third parties, such as carriers or third-party administrators (TPAs), submit the attestation on their behalf."  MORE >>


A Progress Check on Hospital Price Transparency

"[CMS] looked at whether hospitals had met their obligation to post price information online in two key formats: a 'shoppable' list of at least 300 services for consumers, and a comprehensive machine-readable file that incorporates all the services for which the hospital has standard charges.... CMS found that 70% of hospitals published both lists in 2022. An additional 12% published one or the other. By contrast, the agency's previous progress assessment in 2021 found that just 27% of 235 hospitals had both types of lists."  MORE >>

Kaiser Health News

FMLA May Protect Leave Request at Start of Pandemic

"An employee with a sick child who was denied remote work at the start of the COVID-19 pandemic may have brought viable [FMLA] claims against her employer.... The 6th Circuit noted that the plaintiff never actually took FMLA leave, but only made a request for leave. Thus, the court found, the question was whether she had a right to inquire about and request leave even if it turned out that she was not entitled to such leave." [Milman v. Fieger & Fieger PC, No. 21-2685 (6th Cir. Jan. 25, 2023)]  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

State Insurance Regulators Resume Effort to Clean Up Misleading Health Ads

"TV commercials featuring celebrity endorsers urging viewers to call a toll-free number to sign up for Medicare Advantage plans, and advertising selling short-term, or 'skinny' health plans, that are not compliant with the [ACA] are two of the best-known examples of improper health plan marketing, state insurance regulators have said."  MORE >>

The Implicit (Un)Healthy Life Expectancy Used for Pricing Long-Term Care Insurance and Life Care Annuities

"[The authors] find several weaknesses that highlight the difficulty involved in building the biometric data sets needed to make an actuarially fair valuation of the premiums for LTCI and LCAs. [They] also verify the existence of the so-called 'male-female health-survival paradox', i.e. the fact that women have greater longevity than men but are also likely to spend proportionally more time in some state of dependence, irrespective of the initial health state."  MORE >>

Carlos Vidal-MeliĆ”, Manuel Ventura-Marco and Anne M. Garvey, via SSRN


Protecting Employer-Sponsored Health Care Plans for Maryland Employers

"Some of the protections and benefits that will be gutted by HB 357/SB 898 include eliminating discounts for co-pays, which employers use to drive down costs by encouraging patients to visit pharmacies or utilize mail-order prescription services that sell drugs at lower prices. This legislation also ... [eliminates] the protections that control costs for specialty prescription drugs or when purchasing prescription drugs from a specialty pharmacy.... [If] this legislation passes, Maryland lawmakers will increase costs throughout the health care supply chain."  MORE >>

The Daily Record

Benefits in General

[Guidance Overview]

IRS Requires Most Employee Benefit Plans to File Forms Electronically

"The final regulations: [1] reduce the 250-return filing threshold to generally require electronic filing by filers of 10 or more returns in a calendar year.... [2] require filers to aggregate almost all information return types covered by the regulation to determine whether a filer meets the 10-return threshold ... [3] permit waivers for filers that would experience hardship in complying with the e-filing requirements.... [T]he hardship waiver is not applicable to Form 5500 filings."  MORE >>

The Wagner Law Group

Press Releases

The Standard to Acquire Life and Disability Business from Elevance Health; Companies Announce Future Distribution Partnership

The Standard

Oscar Health Announces Appointment of Healthcare Veteran Mark Bertolini to CEO; Co-Founder and CEO Mario Schlosser Transitions to President of Technology

Oscar Health

The Hartford Renames Accidental Death and Dismemberment Insurance to Enhance Consumer Understanding

The Hartford

Last Issue's Most Popular Items

The End of the COVID-19 Emergency: Mental Health Parity

McDermott Will & Emery

Prescription Drug Data Collection (RxDC) Reporting Instructions: Section 204 Data Submission Instructions for the 2022 Reference Year (PDF)

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

Can Employers Provide Surrogacy Benefits on a Tax-Favored Basis?

Willis Towers Watson

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

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