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Health & Welfare Plans Newsletter

May 15, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

2024 Parameters for Medicare Part D Credible Coverage

"CMS has released the following 2024 parameters for the standard Medicare Part D prescription drug benefit: [1] Deductible: $545 (up from $505 in 2023); [2] Initial coverage limit: $5,030 (up from $4,660); [3] Out-of-pocket threshold: $8,000 (up from $7,400); [4] Total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are not eligible for the coverage gap discount program: $11,477.39 (up from $10,516.25 in 2023); and [5] Estimated total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are eligible for the coverage gap discount program: $12,447.11 (up from $11,206.28)."  MORE >>

HUB International

[Guidance Overview]

Puerto Rico Five-Day Paid Leave for COVID-19 Ends as Governor Ends Related State of Emergency

"[E]mployers are no longer required to provide to non-exempt employees who have or are suspected of having COVID-19 the five-day special paid leave due to emergencies declared by the Government of Puerto Rico[.]"  MORE >>

Jackson Lewis P.C.

Eighth Circuit: Claims Appeals Procedures Must be in Formal Plan Documents

"The insurer conceded that the plan documentation (including the plan document and the summary plan description) did not provide for any internal review or appeal procedures that a covered participant may or must exhaust following a denial of a claim for plan benefits. However, it argued that the ERISA lawsuit is nonetheless barred because the spouse failed to exhaust the administrative remedies described in the denial letter. The Court disagreed, stating that the spouse is not subject to the exhaustion requirement because the written plan documents do not provide for, or describe, any appeal or review procedures for her to exhaust. The Court noted that the denial letter was not part of the plan documentation." [Yates v. Symetra Life Insurance Company, No. 22-1093 (8th Cir. Feb. 23, 2023)]  MORE >>

The Wagner Law Group

Some Employers Unsure If They Will Cover Preventive Care

"Though 72% of employers [surveyed] said they expect to continue covering preventive services, 22% revealed they do not know whether they will provide coverage and 6% said they'll be more selective."  MORE >>

HealthLeaders Media

Vermont Paid Family and Medical Leave Won't Pass This Year. Now What?

"While it is very possible this law will pass in the 2024 legislative session, it is still a good time to get a better understanding of what the current legislation is, what lawmakers are proposing, and how this interacts with other employee benefits. Here are the most frequently asked questions ... as well as ... background on this legislation and what it might mean for your business."  MORE >>


The Great Equalizer: Medicare and the Geography of Consumer Financial Strain

"[The authors] estimate the effect of universal health insurance at age 65 -- when most Americans become eligible for Medicare -- at the national, state, and local level. [They] find a 30 percent reduction in debt collections -- and a two-thirds reduction in the geographic variation in collections -- with limited effects on other financial outcomes."  MORE >>

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


Surprise Does Not Equal Unexpected When It Comes to Medical Bills

"20% [of survey respondents] said they or their family have received an unexpected medical bill and 22% were charged over $1,000. The survey points to the complexity and weaknesses of the NSA ... Rising facility fees are not being accounted for and protected against under the federal NSA legislation.... The best response to the NSA is still an approach that is both strategic and compliance oriented."  MORE >>


Benefits in General

Dear Plan Sponsor, Where Can I Find You?

"When plan participants and/or governmental agencies, such as the DOL or IRS, cannot easily locate the plan sponsor it can be a recipe for disaster.... Often, third party service providers will prepare the initial drafts of summary plan descriptions and Plan Filings. It is imperative that, in reviewing these drafts, plan sponsors focus on the addresses included -- not only to confirm that they are correct, but to ensure that they are as specific as they should be."  MORE >>

Haynes and Boone, LLP

Employee Benefits Jobs

View job as Regional Sales Consultant
            for Prime Pensions, Inc.

Regional Sales Consultant

Prime Pensions, Inc.

Remote / Florham Park NJ

View job as Regional Sales Consultant for Prime Pensions, Inc.

View job as Senior Defined Contribution Account Manager
            for Nova 401(k) Associates

Senior Defined Contribution Account Manager

Nova 401(k) Associates


View job as Senior Defined Contribution Account Manager for Nova 401(k) Associates

Press Releases

Local Firm Provides Alternative to Colorado SecureSavings

Castle Rock Investment Company

Milliman Hires Ryan Falls to Expand Statewide Public Pension Work


Last Issue's Most Popular Items

Dependent Care FSAs: Expenses Eligible for Reimbursement

Willis Towers Watson

Retiring Early? a Guide to Health Insurance Options


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

Thomson Reuters / EBIA

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