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Health & Welfare Plans Newsletter

April 26, 2023

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Text of CMS Proposed Regs Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children's Health Insurance Programs

23 pages. "This proposed rule would make several clarifications and update the definitions currently used to determine whether a consumer is eligible to enroll in a Qualified Health Plan (QHP) through an Exchange; a Basic Health Program (BHP), in States that elect to operate a BHP; and for some State Medicaid and Children's Health Insurance Programs (CHIPs)."  MORE >>

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

[Guidance Overview]

Preventive Care in a Post-Braidwood World: Agencies Release Guidance on Preventive Services Coverage Requirements

"[N]on-grandfathered group health plans are still required to cover items and services recommended by the USPSTF before March 23, 2010. In addition, the Braidwood decision did not invalidate preventive services requirements deriving from the ACIP recommendations or HRSA guidelines, so non-grandfathered plans must continue to cover those items and services as well. What is left unanswered in the Departments' guidance is Braidwood's impact on USPSTF recommendations that were issued before March 23, 2010, but have been modified since that date."  MORE >>


[Guidance Overview]

Exceptional Usefulness and Quality icon Breaking Up Is Hard to Do: The End of the COVID Mandates and Outbreak Period Extensions

"Plan sponsors opting for a reversal of the additional previously mandated benefits should review all plan communications related to announcements about coverage for COVID-19 diagnosis, treatment, and preventive services ... If duration was not communicated, or if the notice was issued in an earlier plan year, then the participants need to be notified within a 'reasonable time' in advance of the reversal.... Plan sponsors that are considering extending deadlines beyond what is required by the end of the Outbreak Period should discuss with insurers and stop-loss carriers."  MORE >>

Alston & Bird

Fourth Circuit Warns: Be Careful How You End Things

"[T]he Fourth Circuit found that a unanimous written consent adopted by a plan sponsor's board of directors was insufficient to terminate the company's severance plan, because the plan's governing document required that plan amendments be 'in writing by the Human Resources department.' " [Messer v. Bristol Compressors Int'l, LLC, No. 21-2363 (4th Cir. Apr. 3, 2023; unpub.)]  MORE >>

Haynes and Boone, LLP

House HELP Subommittee Hearing: Reducing Health Care Costs for Working Americans and Their Families

Links to video, statement of Chairman Rep. Bob Good (R-VA), and statements by witnesses [1] Mrs. Tracy Watts, Mercer; [2] Ms. Marcie Strouse, Capitol Benefits Group; [3] Ms. Sabrina Corlette, J.D., Georgetown University"s Health Policy Institute; and [4] Mr. Joel White, Council for Affordable Health Coverage (CAHC)."  MORE >>

Committee on Education and the Workforce, U.S. House of Representatives

More Than Half of Surveyed Companies Find ACA Compliance Burdensome

"More than half (55%) said employee misclassification is the most common potential problem when it comes to ACA compliance. And 1 in 4 respondents said they had been audited by the IRS for potential non-compliance.... 3% of respondents said their ACA compliance requirement were overly burdensome, 21% said the requirement were somewhat burdensome, and 27% said the requirements were not burdensome."  MORE >>

BenefitsPro; free registration required

PBM Best Practices: Is Your Point Solution on Point?

"As the cost of healthcare continues to increase, employers, plan sponsors, and health plans are looking for cost containment strategies.... This white paper is intended to support decision-making processes for evaluating and implementing point solutions. It includes a discussion of the various financial arrangements common to point solutions, and the advantages, disadvantages, and customer considerations for each type of arrangement."  MORE >>


Benefits in General

Exceptional Usefulness and Quality icon Individual Arbitration of ERISA Breach of Fiduciary Duty Claims: Is It Possible And, If So, Is It Worth It?

"[T]he seemingly instinctive desire to pursue individual arbitration in lieu of class litigation may need to be reevaluated.... [A]rbitration of ERISA fiduciary breach claims may still emerge as a useful tool to the defense bar, but the focus may need to shift away from arbitration as a means to avoid altogether the prospects of class action litigation, and in favor of crafting arbitration agreements that will make such litigation more manageable."  MORE >>

Proskauer, via JDSupra

Employee Benefits Jobs

View job as Defined Benefit Administrator
            for Corvus Pension Actuaries, LLC

Defined Benefit Administrator

Corvus Pension Actuaries, LLC


View job as Defined Benefit Administrator for Corvus Pension Actuaries, LLC

View job as Product Specialist
            for PensionPro Software

Product Specialist

PensionPro Software


View job as Product Specialist for PensionPro Software

Press Releases

Ohio Chamber Health Benefit Program Partners with AndHealth to Expand Employee Access to Specialty Care

Ohio Chamber Health Benefit Program [OCHBP]

Better Wealth Management for Everyone: OneDigital Chooses Pontera to Help Clients with Their 401(k)s


Business Group on Health Announces Winners of Best Employers: Excellence in Health and Well-Being Award

Business Group on Health

Webcasts and Conferences
(Health & Welfare Plans)

Self-Funded vs. Fully Insured



The COVID-19 Emergencies Are Ending. What Does That Mean for Health Plans?

April 25, 2023 PODCAST


Recent HIPAA Violation Settlements from OCR


NFP Corp.

Know Your Health & Welfare Plan Fiduciary Responsibilities: Avoiding Liability and Penalties

May 18, 2023 in NY

Worldwide Employee Benefits Network [WEB] - New York Chapter

Last Issue's Most Popular Items

End of COVID-19 Emergencies: Impact on Employee Benefit Plans


Understanding Recent Litigation on Medication Abortion: A Guide for Health Plan Sponsors


HSAs: Avoiding ERISA Status While Still Providing a Strong Benefit


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

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