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Health & Welfare Plans Newsletter

May 18, 2023

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

Back to Normal: Ending COVID-19 Tolling of COBRA Deadlines

"Plan administrators should review prior communications sent to qualified beneficiaries regarding the tolling of COBRA election and premium payment periods and provide updated communications to the extent necessary. Given that deadlines are calculated on an individual basis, a general notice describing the end of the COVID-19 pandemic and the impact on COBRA deadlines may be preferable in some situations ... Administrative processes should also be reviewed and adjusted ... to avoid unintentionally extending COBRA deadlines beyond the end of the COVID-19 emergency."  MORE >>

HR Daily Advisor

[Guidance Overview]

Is a Telehealth Benefit Subject to ERISA?

"If your arrangement is a voluntary employee-pay-all telehealth benefit offered by a third party, with employer involvement limited as set forth in the safe harbor, it would not be an ERISA plan. If it does not meet all the requirements of the safe harbor, it will be an ERISA plan and must comply with the generally applicable rules ... As a group health plan, a telehealth plan raises legal issues aside from ERISA's applicability, including considerations under COBRA, HIPAA, and coverage mandates[.]"  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Florida Enacts Comprehensive Regulation of Pharmacy Benefit Plans

"Florida's Prescription Drug Reform Act, ... aims to enhance drug pricing transparency, define relationships and contract requirements between PBMs and pharmacy benefit plans and/or network pharmacies, and enact protections for pharmaceutical consumers. The Florida Department of Financial Services is expected to develop rules to implement the new laws."  MORE >>

Holland & Knight

Fifth Circuit Stay Reinstates Preventive Services Mandate -- for Now

"[P]lan sponsors should remember that the Fifth Circuit administrative stay is not a decision on the merits of the underlying case. ... [T]he Fifth Circuit pressed pause on the district court order so that the pre-Braidwood preventive services mandate would remain intact for now while the case proceeds." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023); No. 23-10326 (5th Cir. motion for stay granted May 15, 2023]  MORE >>


Tenth Circuit Affirms District Court Decision Requiring Substantial Changes to Health Plan Denial Letters

"The Tenth Circuit's decision means that health plan administrators cannot rely on compliance with ERISA's claims procedure regulations to establish that the plan engaged in a 'meaningful dialogue' with claimants in addressing an administrative appeal from a determination that particular services were not medically necessary." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023)]  MORE >>

Troutman Pepper

District Court Finds Severance Agreement Not a Substitute for COBRA Compliance

"The court determined that while the severance agreement provided the employee with initial notice that she had rights under COBRA, it did not indicate whether the employee received the additional information or if the employer timely processed the employee's request for continued coverage. Thus, the court denied the employer's motion to dismiss, allowing the COBRA claim to proceed to trial." [Davis v. World Ins. Assocs., LLC, 2023 WL 2665727 (D.N.J. Mar. 28, 2023)]  MORE >>

Thomson Reuters / EBIA

Coverage of Medications Used for Weight Loss: What Employers Need to Know

"An increase in prescriptions and the overall expense of these drugs has prompted insurance plans and self-insured groups to consider whether providing coverage for these medications is sustainable. Besides cost, sponsors need to consider the long-term efficacy and potential side effects of these medications."  MORE >>


FTC Expands Probe Into Pharmacy Benefit Managers to GPOs

"The [FTC] is expanding its probe into pharmacy benefit managers by issuing compulsory orders to two group purchasing organizations [GPOs] that negotiate rebates on behalf of PBMs.... Caremark, Express Scripts and Optum account for 80% of the PBM market, and all three are integrated with large national health plans: Aetna, Cigna and UnitedHealthcare, respectively. These massive companies also own GPOs, providers, data analytics and more."  MORE >>


Key Moments from Ways and Means Committee Hearing on Health Care Price Transparency

"Witnesses shared their firsthand experience of using price transparency to benefit patients seeking care or small businesses sponsoring insurance for their employees.... [O]ne in four hospitals are estimated to be in compliance with [the] price transparency rules and only four hospitals out of 6,000 nationwide have ever been fined for noncompliance."  MORE >>

Committee on Ways and Means, U.S. House of Representatives

Hospital Price Transparency Updates Include Stricter Enforcement, New Fines and Pending Legislation

"Among the changes outlined in a [CMS] fact sheet is implementation of a firm 90-day window for coming into full compliance from the time CMS issues a request for a corrective action plan (CAP).... Hospitals also can expect penalties to become routine for failing either to submit a CAP within 45 days or to come into compliance within 90 days of the CAP request."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

State Paid Leave: Help for Women Caring for Spouses

"Nationwide, about 8 percent of working wives whose husbands develop a medical problem quit their jobs ... But in the researchers' comparison of California, New Jersey and New York with states that do not offer family paid leave, the wives who live in states with paid leave programs are substantially less likely to leave a job to care for home or family after the spouse goes to the emergency room or winds up in the hospital."  MORE >>

Center for Retirement Research at Boston College

Benefits in General

[Guidance Overview]

Applying the ERISA Controlled Group and Affiliated Service Group Rules in the Health Care Industry

"The friendly-PC model involves a professional service corporation (PSC) conducting a medical practice in affiliation with a management services organization (MSO).... Although the friendly-PC model may be a solution to the corporate practice of medicine doctrine, it can create unintended consequences for employee benefit plans sponsored by the PSC and MSO."  MORE >>

Foley & Lardner LLP

Employee Benefits Jobs

View job as Vice President of National Accounts and Advisory Enterprise Sales
            for Vestwell

Vice President of National Accounts and Advisory Enterprise Sales


Remote / NY

View job as Vice President of National Accounts and Advisory Enterprise Sales for Vestwell

View job as Regional Vice President
            for Vestwell

Regional Vice President


Remote / NY

View job as Regional Vice President for Vestwell

View job as Retirement Plan Consultant
            for SetAway, LLC

Retirement Plan Consultant

SetAway, LLC

Remote / Bedford NH / CT / MA / ME / RI / VT / Hybrid

View job as Retirement Plan Consultant for SetAway, LLC

View job as Retirement Analyst / Senior Retirement Analyst
            for Montgomery County, MD Government - Montgomery County Employee Retirement Plans

Retirement Analyst / Senior Retirement Analyst

Montgomery County, MD Government - Montgomery County Employee Retirement Plans

Rockville MD

View job as Retirement Analyst / Senior Retirement Analyst for Montgomery County, MD Government - Montgomery County Employee Retirement Plans

Selected New Discussions

Mid-Year Refund of YTD Wellness Program Surcharge

"A wellness program imposes a surcharge on tobacco users who do not complete a tobacco cessation course. If a person completes the requirements to have the surcharge removed mid-year, could the surcharge that has already been paid during the current plan year be refunded? I'm thinking that would be an impermissible, retroactive election change. Prospectively, the surcharge could be removed and the participant's election automatically decreased assuming it's an insignificant change in cost. Any thoughts on the refund of the surcharge previously charged during the year?"

BenefitsLink Message Boards

Press Releases

Found Launches 'Found for Business,' a Clinically Comprehensive Obesity Care Program for Employers


Endeavor Law Launches to Meet the Needs of Financial Services Firms

Endeavor Law

NFP Appoints Joel Shapiro President of Its Retirement Division

NFP Corp.

Income Lab, the Retirement Income Management Software Provider, Launches Revolutionary and Timely Retirement Stress Test Tool for Financial Advisors

Income Lab

Webcasts and Conferences
(Health & Welfare Plans)

The Skinny on Obesity Drugs In Your Health Plan

June 7, 2023 WEBINAR

Ballard Spahr LLP

Last Issue's Most Popular Items

IRS Announces 2024 Limits for HSAs, HDHPs and Excepted Benefit HRAs

McDermott Will & Emery

The Section 125 Tag-Along Rule


Assessing Your Health Plan's Service Provider Compensation

Morgan Lewis

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

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