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Health & Welfare Plans Newsletter

May 12, 2023

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

Continuing Coverage of COVID-19 Testing and Vaccines After Public Health Emergency Ends

"The agencies have encouraged plans to continue providing coverage for COVID-19 testing beyond the PHE at no cost to participants. However, plans may choose not to cover the tests or to cover them while imposing cost-sharing or out-of-network limitations. Unlike the diagnostic testing coverage requirement, the requirement to provide COVID-19 preventive services (vaccines) is not limited to the duration of the PHE."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Dependent Care FSAs: Expenses Eligible for Reimbursement

"Although some parents planned ahead for the cost of summer programs by signing up for a dependent care flexible spending account (FSA) at annual enrollment, they might not understand the ins and outs of how one works. For example, what is and is not covered? And when can participants be reimbursed for expenses?"  MORE >>

Willis Towers Watson

Seventh Circuit Affirms Discretion Over Who Gets Severance Benefits

"[T]he plan said an employee was not eligible unless they received a memo from a Vice President of Human Resources notifying them of their severance eligibility.... The employees argued that the requirement to receive an eligibility memo was merely ministerial and should be disregarded. The Seventh Circuit disagreed, holding that ERISA allows a severance plan to give the employer discretion over who will receive severance benefits." [Carlson v. Northrop Grumman Severance Plan & Northrop Grumman Corp., No. 22-1764 (7th Cir. May 8, 2023)]  MORE >>


Senate Panel Advances PBM Bill That Would Ban Spread Pricing

"The most contentious part of the PBM bill was a provision that would prevent these firms from deploying spread pricing models for their clients. In this model, a PBM would charge the insurer or plan sponsor more for a drug than it costs at the pharmacy and then pocket the difference.... [One provision] would direct the [DOL] to conduct a study into the fiduciary duties of PBMs that could be used to develop future legislation."  MORE >>


Agency Reports Show Surprise Billing IDR Volume Remains High

"Between April 15, 2022, and March 31, 2023, disputing parties initiated 334,828 disputes through the federal IDR portal, of which 122,781 were challenged as not eligible.... As of March 31, 2023, certified IDR entities made payment determinations in 42,158 disputes."  MORE >>

Thomson Reuters / EBIA

Retiring Early? a Guide to Health Insurance Options

"This article will: [1] Highlight the potential benefits of continuing your pre-retirement health care coverage through COBRA. [2] Explain why spouses with different health records may be better off buying health insurance separately. [3] Outline the tax credits and cost sharing reductions that may help you keep your health care premiums under control."  MORE >>



ERIC Applauds Senate Help Committee Advancement of Pharmacy Benefit Manager Reform Act

"While the bill [S 1339] does not apply fiduciary standards to PBMs in the same way that employer plan sponsors are required today to act in the best interests of the plan and its beneficiaries and to protect plan assets, ERIC is encouraged by support from Committee members for this policy[.]"  MORE >>

The ERISA Industry Committee [ERIC]


One in Three Dollars You Spend on Healthcare Is Squandered on Waste, Fraud or Abuse

"Investigators and experts speculate that up to 10% of all healthcare spending may be devoured solely by fraudulent schemes. While insurance companies assure the public of their vigilance in monitoring and protecting these funds, the stark reality is alarmingly different: fraudsters find easy access to this system, and convincing insurance companies to shut them down is an uphill battle."  MORE >>

Craig Gottwals, via Substack; free registration may be required

Employee Benefits Jobs

View job as Plan Health Consultant
            for Vestwell

Plan Health Consultant


Remote / NY

View job as Plan Health Consultant for Vestwell

View job as Relationship Manager
            for Executive Search - CPS Inc

Relationship Manager

Executive Search - CPS Inc

Remote / Irvine CA / New Orleans LA / Chicago IL / Lake Oswego OR / Aurora CO

View job as Enrolled Actuary
            for FuturePlan, by Ascensus

Enrolled Actuary

FuturePlan, by Ascensus

Remote / Chicago IL

View job as Enrolled Actuary for FuturePlan, by Ascensus

View job as Senior Retirement Benefits Analyst
            for Maryland-National Capital Park & Planning Commission Employees' Retirement System

Senior Retirement Benefits Analyst

Maryland-National Capital Park & Planning Commission Employees' Retirement System

Riverdale MD

View job as Senior Retirement Benefits Analyst for Maryland-National Capital Park & Planning Commission Employees' Retirement System

Last Issue's Most Popular Items

IRS Explains FSA Substantiation Rules

Groom Law Group

PCORI Deadline Is Just Around the Corner


PBMs, the Brokers Who Control Drug Prices, Finally Get Washington's Attention

KFF Health News

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

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