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Health & Welfare Plans Newsletter

May 2, 2023

2 New Job Opportunities 2 New Job Opportunities

 

[Official Guidance]

Text of CMS 2024 Final Letter to Issuers in the Federally-Facilitated Exchanges (PDF)

29 pages. "This 2024 Final Letter provides updates on operational and technical guidance for the 2024 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2024 Final Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs)."  MORE >>

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

[Guidance Overview]

Upcoming Deadline icon 2022 RxDC Reporting Due June 1, 2023

"The most recent instructions state that submissions can only be made through the HIOS system. Email submissions are no longer accepted. Employers that have yet to establish a HIOS account are encouraged to create one as soon as possible."  MORE >>

OneDigital

[Guidance Overview]

Preparing Employee Benefit Plans for the Emergency Exit

"Nongrandfathered plans must continue to cover COVID-19 vaccines obtained from in-network providers at no cost, as these were added as [ACA] preventive services by the CARES Act."  MORE >>

Eversheds Sutherland

[Guidance Overview]

IRS to Require Electronic Filing for ACA Reporting in 2024

"Starting in 2024, employers filing 10 or more returns in aggregate must file their Forms 1094-C and 1095-C electronically. This ends the option to file by paper for virtually all employers, and therefore employers will need to prepare to engage with an ACA reporting vendor to complete next year's filing via the IRS AIR system."  MORE >>

Newfront

Recovered Assets of Underfunded Group Health Plan Arrangement to Be Distributed to Participants, Employers and Medical Providers

"Health plan participants, employers and medical providers harmed by a [MEWA] operating in 36 states will begin to finally receive payments related to more than $54 million in unpaid health claims ... [T]he MEWA's court-appointed independent fiduciary [Receivership Management Inc. will] distribute more than $6.75 million in recovered assets ... [An] investigation by [EBSA] found fiduciary breaches by AEU Holdings, Black Wolf Consulting and Veritas PEO[.]" [Walsh v. AEU Benefits, LLC, No. 17-7931 (N.D. Ill. Mar. 28, 2023)]  MORE >>

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

Autism Health Plan Exclusions and Limitations May Trigger MHPAEA Liabilities

"[EBSA] has identified MHPAEA ... enforcement as a key priority in its current a fiscal year enforcement plan.... Although many diagnosticians and courts consider autism a neurological rather than psychological disorder, EBSA often interprets and enforces MHPAEA as applicable to Applied Behavior (ABA) therapy and other treatment for autism."  MORE >>

Solutions Law Press

How Payers Can Better Support Employers on Mental Health

"[J]ust 31% [of employers surveyed] are satisfied with network access for behavioral health care services. In addition, only 34% of employers said that their behavioral health care directors accurately reflected the providers available to their plan members."  MORE >>

FierceHealthcare

Pennsylvania Expands Insurance Coverage for Breast Cancer Screenings

"Insurers must cover the costs of breast cancer screenings for people at high risk of developing the disease under a new [Pennsylvania law] ... Advocates for health care access said the law ... is a positive, though limited, step toward making crucial medical tests more affordable. They urged further action in this vein, something that typically requires lawmakers to negotiate with the commonwealth's powerful health insurance industry."  MORE >>

WHYY

Proposal Would Expand California's Paid Sick Leave Mandate

"Under current law, eligible California employees are entitled to a minimum of twenty-four hours, or three days, of paid sick leave per year. SB 616 proposes to expand the entitlement to fifty-six hours, or seven days."  MORE >>

Ogletree Deakins

[Opinion]

New Weight Loss Meds: Panacea or Problem?

"[C]overage of these drugs may cost $500 per plan member per year (ALL plan members, not just per obese adult). This assumes only half of those clinically eligible use these drugs. So, let's say the drugs do provide the intended net benefits long term. Will the employer who made the investment be the same one to reap the rewards of a healthier employee?"  MORE >>

Chelko Center for Benefits Management

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Notice FL-2023-04, for Victims of Severe Storms, Tornadoes and Flooding in Florida

"Victims of severe storms, tornadoes and flooding in Florida from April 12 to April 14, 2023, now have until August 15, 2023, to file various individual and business tax returns and make tax payments ... [I]ndividuals and households ... that reside or have a business in Broward County qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Fiduciary Litigation Update, May 2023

"[1] 401(k) and 403(b) fee cases continue.... [2] No good deed goes unpunished: 1947 pension trust creates $38 million ERISA liability.... [3] Oops! Board action alone did not terminate severance plan.... [4] DOL weighs in on supplemental life insurance: evidence of insurability.... [5] Beneficiary/slayer denied retirement plan benefits."  MORE >>

CAPTRUST

Healthcare Costs for a Healthy 65-Year-Old Retiree Who Retires in 2023

"[A] healthy 65-year-old male retiree with [a Medicare Advantage plus Part D] plan will spend $134,000 for healthcare in his remaining lifetime (equating to $90,000 of savings in today's dollars), down from $137,000 in 2022. A 65-year-old female retiree with the same coverage will spend approximately $155,000 on healthcare expenses over the course of her lifetime ($100,000 in savings today), down from $158,000 in 2022."  MORE >>

Milliman

[Opinion]

Jury Trials in ERISA Cases: No Cause for Alarm

"[T]he increase in defense costs linked to the rise of jury trials in this context isn't just a question of the relative cost of conducting a jury trial relative to the cost of bench trials. Instead, it is driven by the fact that the possibility of jury trials is likely to increase the number of trials and the amount sought in settlement of these types of cases.... However, from a merits perspective, it is not entirely clear that jury trials in this context are by definition a bad thing."  MORE >>

Stephen Rosenberg, The Wagner Law Group

Employee Benefits Jobs

View job as Retirement Implementation Specialist
            for Alerus

Retirement Implementation Specialist

Alerus

Remote / MI / MN / ND

View job as Retirement Implementation Specialist for Alerus

View job as Associate Benefits Specialist
            for Air Line Pilots Association

Associate Benefits Specialist

Air Line Pilots Association

Atlanta GA

View job as Associate Benefits Specialist for Air Line Pilots Association

Selected New Discussions

Late Submission of DCFSA Claim to TPA

"Our plan document states a 3/31 cutoff for claims submission on DCFSA. We have an employee that has submitted $5000 in 2022 claims after the deadline. If we authorize the TPA to process the claims, how much liability are we creating for the organization? I hate creating policy exceptions, but also don't like seeing an employee lost out of $5000."

BenefitsLink Message Boards

Press Releases

USI Consulting Group Acquires Hooker & Holcombe

USI

RPAG joins the Retirement Advisor Council

Retirement Advisor Council

Webcasts and Conferences
(Health & Welfare Plans)

Student Loan Repayment Benefits

May 17, 2023 WEBINAR

Thrive

Nuts and Bolts of Payer-Provider Contracts

June 14, 2023 WEBINAR

Conference of Consulting Actuaries

Last Issue's Most Popular Items

Timeline of End Dates for Key Health-Related Flexibilities Provided Through COVID-19 Emergency Declarations, Legislation, and Administrative Actions

Henry J. Kaiser Family Foundation

All Good Things Must Come to an End: The Expiration of OCR's Enforcement Discretion

Akerman

New Bipartisan Senate PBM Bill Would Increase Transparency

HR Policy Association [HRPA]

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

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