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Health & Welfare Plans Newsletter

May 3, 2023

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[Guidance Overview]

CMS Releases 2024 Medicare Part D Benefit Parameters

"Plan sponsors that want to confirm their prescription drug coverage is creditable or want to remain qualified for the employer retiree drug subsidy will have to determine if their 2024 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage, which may require a closer look this year due to improvements in the Medicare Part D program brought about by the Inflation Reduction Act of 2022."  MORE >>


[Guidance Overview]

Preparing for the End of the COVID-19 Emergency: HDHPs and HSAs

"[I]ndividuals covered by an HDHP may continue to contribute to an HSA following the end of the PHE. COVID-19 vaccinations also continue to be considered preventive care under Section 223 of the Code for purposes of determining whether a health plan is an HDHP."  MORE >>

McDermott Will & Emery

First Circuit Holds Blue Cross Was Not a Fiduciary When It Allegedly Overpaid, Repriced, and Mishandled Benefit Claims

"The court was unpersuaded by the arguments of the Fund and its amici (including the [DOL]) that finding Blue Cross to be a nonfiduciary would lead to anticompetitive practices that concededly could harm plans and their participants ... Thus, based on ERISA's far from pellucid statutory definition of fiduciary, the First Circuit allowed Blue Cross to evade fiduciary responsibility to the tune of $1.4 million in plan losses caused by its ... medical claims pricing and payment practices." [Mass. Laborers' Health & Welfare Fund v. Blue Cross Blue Shield of Mass., No. 22-1317 (1st Cir. Apr. 25, 2023)]  MORE >>

Kantor & Kantor LLC

ACA Preventive Services Ruling: Insights and Key Takeaways for Plan Sponsors

"Many employers and insurers are opting to wait out the appeals process before considering whether to make changes to their health plans' coverage of recommended preventive services, ... [T]he appellate court will be called upon to address a host of complex legal issues and, when deciding those issues, will have the views of not only the parties in the case but also from an array of interested third parties who will file briefs attempting to influence the outcome of the appeal." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

BenefitsPro; free registration required

New Data on No Surprises Act Arbitration Cases Show Providers Are Faring Well Amid Systemic Challenges

"Print Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system.... [T]he arbitration criteria are meant to place providers and insurers on roughly equal footing in dispute resolution, thus giving insurers motivation to include more providers in their networks. Over time, that should help reduce the flood of disputes in the IDR portal."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Your EAP May Be Subject to ERISA

"It is common for EAP providers to fail to recognize an EAP as an ERISA benefit plan.... Often, the service agreement with the EAP does not address claims, fiduciary status, and COBRA responsibilities."  MORE >>

Haynes and Boone, LLP

Third-Party Administration 101: Answering Employer Questions About TPAs

"Third-Party Administrators (TPAs) are important components of self-funded employer health plans.... [1] What is a third-party administrator? ... [2] What are the benefits of a third-party administrator?.... [3] How do you select a third-party administrator?.... [4] Will transitioning to a health plan with a TPA be disruptive?"  MORE >>


Managing Mental Health with an FSA or HSA

"[1] Don't forgo clinical services.... [2] Take steps to manage anxiety.... [3] Improve sleep.... [4] Explore complementary approaches.... [5] Try pressure therapy."  MORE >>

Health E-Commerce, via PRWeb

Florida Lawmakers Approve Restrictions on Pharmacy Benefit Managers

"[The bill] includes: [1] Increasing the Office of Insurance Regulation's authority over PBMs ... [2] Largely preventing a practice known as 'spread pricing' ... [3] Placing restrictions on PBMs that have affiliated pharmacy businesses.... [4] Preventing PBMs from requiring patients to receive prescriptions by mail."  MORE >>

wusf Public Media

Benefits in General

[Guidance Overview]

Reform of Family Attribution Rules Under SECURE 2.0

"[R]evised family attribution rules under [SECURE 2.0], effective for plan years after December 31, 2023, will permit businesses owned separately by spouses to provide benefits to their respective employees without necessarily having to count the employees of the other spouse.... [F]amily-owned entities ... should understand how the Act may alter the employee populations counted for qualified retirement plans and also for identifying Applicable Large Employer status under the health insurance mandate of the [ACA]."  MORE >>

KLB Benefits Law Group

Employee Benefits Jobs

View job as Defined Contribution Consultant
            for AimPoint Pension Group

Defined Contribution Consultant

AimPoint Pension Group


View job as Defined Contribution Consultant for AimPoint Pension Group

Press Releases

RFP for Consulting Services to the California Retirement Savings Board


Transamerica Names Oriana Freidenberg to Lead Customer Experience and Marketing for Life Insurance and Annuities


Health-E Commerce Offers Tips for Using Tax-Free Healthcare Funds to Protect Mental Wellbeing

Health E-Commerce

Strongpoint Partners Announces Partnership with Retirement Planners and Administrators

Strongpoint Partners

Webcasts and Conferences
(Health & Welfare Plans)

New Drugs for Weight Loss: What Plan Sponsors Need to Know

May 24, 2023 WEBINAR


Employee Benefits: Current and Future Trends

June 7, 2023 WEBINAR

Conference of Consulting Actuaries

Last Issue's Most Popular Items

Autism Health Plan Exclusions and Limitations May Trigger MHPAEA Liabilities

Solutions Law Press

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


Fiduciary Litigation Update, May 2023


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

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