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Health & Welfare Plans Newsletter

May 8, 2023

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[Guidance Overview]

COBRA for the Health FSA

"The health FSA is a group health plan subject to COBRA. However, COBRA coverage is available only for underspent accounts and only through the end of the plan year of the qualifying event. The exception is where the health FSA offers the carryover, COBRA continues to be available for the full (typically 18-month) maximum coverage period."  MORE >>


District Court Applies De Novo Review After Finding Insurer Failed to Strictly Adhere to ERISA Claims Procedure Regs

"[The court found] that First Reliance failed to 'strictly adhere' to ERISA claims procedure regulations because it [1] failed to consult with an appropriately qualified health care professional on appeal; [2] failed to afford Plaintiff the opportunity to respond to a physician addendum report; and [3] exceeded all possible deadlines on appeal." [Rhodes v. First Reliance Standard Life Ins. Co., No. 22-5264 (S.D.N.Y. Apr. 26, 2023)]  MORE >>

Roberts Disability Law

Senate Hearing on Mental Health Network Adequacy: Could Employer Plans Be Next?

"[A report focused on Medicare Advantage plans] found 33% of mental health provider listings were inaccurate, had non-working numbers, or the provider did not return calls.... [O]ther reports have found similar problems with employer plan provider directories and appointment access.... [C]ommittee members made it clear they plan to incorporate changes similar to those contemplated for Medicare and Medicaid plans to the commercial market, when possible."  MORE >>

HR Policy Association [HRPA]

Plan Sponsors Prepare for End of COVID-19 Public Health Emergency and National Emergency

"Most respondents (46%) indicated that they would not continue coverage for OTC COVID-19 tests and testing-related services.... Twenty-one percent of respondents said they are going to cover testing and testing-related services indefinitely, whereas 14% indicated they would only continue coverage for a certain period of time.... 19% of respondents stated they have yet to decide whether they are going to cover testing once the PHE is lifted."  MORE >>


Cost-Saving Strategies to Optimize Your Fully Insured Health Plan

"[1] Participating insurance policies ... [2] Tiered network plans ... [3] Value-based insurance design ... [4] The elimination of out-of-network benefits."  MORE >>


All-Payer Claims Databases: Should Self-Funded Employers Participate?

"APCDs serve as a way for employers, consumers, legislators, and various stakeholders to examine healthcare spending and utilization by analyzing claims data across payers, providers and plan designs. This can lead to greater transparency, improved preventive measures, and cost-saving decision-making for all stakeholders involved."  MORE >>


Immunizations Remain a Critical Part of Workforce Health Strategy

"While 76% agreed that keeping up-to-date based on current COVID guidelines is core to their immunization strategies going forward, 81% agreed that the pandemic has increased the urgency of focusing on all vaccinations for employees and their families 96% of respondents agreed that employee engagement in primary care was a critical health strategy to improve immunization uptake 81% believe that employers are a trusted source for vaccine information compared to 62% for health plans"  MORE >>

National Alliance of Healthcare Purchaser Coalitions

The Incidence of the ACA's Dependent Coverage Mandate

"Economic theory and empirical studies conclude that the cost of voluntary employer-sponsored health insurance falls on employees.... [The authors find that] incidence falls mainly on households where the newly-eligible child is the youngest in the household. Second, ... the incidence of the mandate falls mainly on the highest income households. Finally, [the authors] find that the mandate leads to increased commuting time for parents of newly-eligible dependents."  MORE >>

National Bureau of Economic Research [NBER]; purchase may be required for full document


We All Needlessly Overpay 225% for Healthcare

"[P]rivate payers pay a national average of 224% of Medicare and as high as 600% of a hospital's cost in a state like California.... If you have more than about 250 employees, you should evaluate whether you can opt out of this fraud entirely, say goodbye to your insurers, and move to a reference-based pricing (RBP) system whereby you pay some reasonable margin over the Medicare price."  MORE >>

Craig Gottwals, via Substack; free registration may be required

Benefits in General

[Guidance Overview]

IRS 2022-2023 Priority Guidance Plan: Third Quarter Update (PDF)

32 pages; employee benefits items begin on page 4.  MORE >>

Internal Revenue Service [IRS]

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Last Issue's Most Popular Items

IRS Reconfirms Prohibition, Consequences of Health FSA and DCAP Substantiation Shortcuts

Thomson Reuters / EBIA

New Life Insurer Settlement with DOL: Employers Could Be at Risk (PDF)


Can a Telehealth-Only Plan Continue After the End of the COVID-19 Emergency?

Thomson Reuters / EBIA

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

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