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Health & Welfare Plans Newsletter

April 20, 2023

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

The End of the COVID-19 Public Health Emergency: New Deadlines for Group Health Plans

"This article provides [1] a recap of the deadlines, [2] rules of thumb for determining the deadlines, and [3] tables more specifically addressing some of the most common deadlines that arise. Plan administrators should review plan operations now and prepare to administer these shifting deadlines correctly to avert potential penalties and minimize avoidable claims exposure."  MORE >>


[Guidance Overview]

FAQs Provide Guidance on Preventive Care

"The FAQs confirm that the Departments view the court's ruling as applying only to A and B recommendations by the [USPTF]. The Departments encourage continued coverage of preventive care services that have been invalidated and plan to issue further guidance. High-deductible health plans may continue to treat preventive care services invalidated by the court's ruling as preventive care that is not subject to the required deductible." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

Ballard Spahr LLP

[Guidance Overview]

IRS Clarifies Ability to Reimburse Certain Programs Under HSAs, FSAs and HRAs

"Programs to treat a drug-related substance use disorder, programs to treat an alcohol use disorder, and smoking cessation programs qualify as medical care because the programs are considered treatment for a disease. However, therapy, nutritional counseling, and weight-loss programs will only be considered medical care if used to treat a specific disease (e.g. obesity). Programs for general health or wellbeing will not qualify as medical care."  MORE >>

Foley & Lardner LLP

[Guidance Overview]

Final 2024 Payment Rule, Part 2: Risk Adjustment

"This piece summarizes provisions related to the individual and small group market risk adjustment programs. The final payment notice largely continues existing risk adjustment policies, but HHS did finalize some policy changes, which largely (though not entirely) mirror those in the proposed rule."  MORE >>

Health Affairs Forefront

[Guidance Overview]

CMS Announces 2024 Medicare Part D Benefit Parameters Used for Creditable Coverage Disclosures

"CMS has released the following 2024 parameters for the defined standard Medicare Part D prescription drug benefit: [1] Deductible: $545 (up from $505 in 2023); [2] Initial coverage limit: $5,030 (up from $4,660 in 2023); [3] Out-of-pocket threshold: $8,000 (up from $7,400 in 2023); [4] Total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are not eligible for the coverage gap discount program: $11,477.39 (up from $10,516.25 in 2023); and [5] Estimated total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are eligible for the coverage gap discount program: $12,447.11 (up from $11,206.28 in 2023)." [Also available: CMS Fact Sheet]  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Upcoming Deadline icon Virginia Law Mandates Unpaid Organ Donor Leave

"When the law goes into effect on July 1, 2023, Virginia will join nearly 20 other states that require employers to provide medical donor leave.... Virginia employers with at least 50 employees must provide unpaid leave to organ donors, including bone barrow donors. Employees are eligible for this leave if they were employed by their current employer for at least 12 months prior and worked at least 1,250 hours in the preceding 12 months."  MORE >>

Jackson Lewis P.C.

Federal District Court's Ruling on ACA Preventive Care Eases Employer Burden, at Least for Now

"he ruling does not affect preventive care recommended by HRSA and ACIP. Additionally, many states mandate preventive care for fully insured group plans. The injunction took effect on March 30, 2023. Marketwide impacts could be felt when insurance contracts renew annually for the 2024 plan year." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

Ogletree Deakins

DOL Reaches Settlement with Prudential Insurance Company of America to Revise Life Insurance Practices That Denied Claims

"The [DOL] announced a settlement with the Prudential Insurance Company of America ... that will require the financial giant to revise its practices after a federal investigation found the ... company collected life insurance premiums from participants for extended periods, but then denied numerous claims after the participants died, citing the participants' failure to provide evidence of insurability when they applied for insurance."  MORE >>

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

Prudential Agrees to Group Life Claim Changes in DOL Settlement

"DOL officials say Prudential denied about 200 group life claims based on lack of evidence of insurability from 2017 through 2020. The company has agreed to limit evidence-of-insurability challenges to claims involving insureds who died within three months of starting to pay premiums. Officials say they would like to see all group life issuers limit challenges based on questions about evidence of insurability."  MORE >>



Are Insurers Weaponizing HIPAA Privacy Rules?

"The [HIPAA] Privacy Rule was designed to protect individuals' medical records and other personal health information. However, the latest practices by health insurance carriers raise serious concerns about how they circumvent these rules to maximize premiums.... Using third-party databases, risk adjustment models like the DCG, and other analytical tools by insurance carriers to inflate their underwriting decisions exploits a nefarious loophole that violates the spirit of HIPAA.... Contrast this unsavory practice to how those same carriers hide behind HIPAA privacy to shield a client's claim data while asking for the latest 12% increase."  MORE >>

Craig Gottwals, via BenefitsPro; free registration required

Benefits in General

[Guidance Overview]

Your Employee Benefit Plans May Need a Check Up: Nearing the End of the COVID-19 Public Health Emergency

"[E]mployers that do not want to risk having to do things like send COBRA notices for their employee assistance programs will want to take the COVID-related provisions out of those plans.... With the PHE came suspension (practically speaking) of required blackout notices; relaxed rules for distributions and loans from employee retirement accounts; permissible COVID-related distributions; and remote notarizations.... [It] is essential that employers check up on their plans to see if any COVID-related provisions that were placed into various benefit plans, including through the actions of insurers or other vendors, may now need to be removed."  MORE >>


Employee Benefits Jobs

View job as Implementation Specialist
            for Nova 401(k) Associates

Implementation Specialist

Nova 401(k) Associates


View job as Implementation Specialist for Nova 401(k) Associates

View job as Proposal Writer - Retirement RFP
            for The Standard

Proposal Writer - Retirement RFP

The Standard


View job as Proposal Writer - Retirement RFP for The Standard

View job as Actuarial Analyst
            for Metro Benefits, Inc

Actuarial Analyst

Metro Benefits, Inc

Remote / Pittsburgh PA

View job as Actuarial Analyst for Metro Benefits, Inc

View job as Retirement Plan Administrator
            for EPAB

Retirement Plan Administrator


Cherry Hill NJ / Hybrid

Press Releases

Robinson+Cole Continues Growth in New York with Addition of Partners in Capital Markets + Securities, Construction, and Managed Care + Employee Benefit Litigation


State Street Global Advisors, Global Trust Company, and Annexus Retirement Solutions Launch Target Date Series That Aims to Deliver Lifetime Income

State Street

Council Announces New Board Leadership

American Benefits Council

CEO Annette Guarisco Fildes of The ERISA Industry Committee Retires

ERIC [ERISA Industry Committee]

Quantum Health Joins With HPI and Employers Health Network to Offer New Healthcare Navigation and High-Performance Networks Platform to Self-Insured Employers

Quantum Health

aequum LLC Names Brandon Heusey as National Director of Sales

aequum LLC

Webcasts and Conferences
(Health & Welfare Plans)

Beyond Fully Insured: Self-Funding for Better Benefits



Last Issue's Most Popular Items

When, Oh When, Does the Outbreak Period End?

MZQ Consulting, LLC

Agencies Provide Guidance on Gag Clause Attestation


Courts Continue to Scrutinize ERISA Health Plan Benefit Denial Letters

Troutman Pepper, via Lexology; free registration required

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

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