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Health & Welfare Plans Newsletter

May 22, 2023

3 New Job Opportunities 3 New Job Opportunities

 

[Guidance Overview]

Challenges for Health Plans: Gene Therapy Exclusions and Impending Rash of Special Enrollments

"With FDA approval of a number of gene therapy treatments, and more in the pipeline, plans can no longer rely on the experimental nature of these expensive treatments to exclude them from coverage.... [If] Medicaid or CHIP coverage ends for an employee or dependent on or before July 10, 2023, the employee will have until September 8, 2023 to exercise their HIPAA special enrollment right to enroll in the group health plan."  MORE >>

Vorys

[Guidance Overview]

ACA Preventive Care Coverage Requirements Remain Intact

"This post summarizes the ACA's preventive health services requirements, the Braidwood decision striking certain of them down and preventing their enforcement, the agencies' post-Braidwood FAQ guidance, the Fifth Circuit's temporary stay of the Braidwood ruling, and implications for patients, providers, and insurers." [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 >>

Zuckerman Spaeder LLP

District Courts Deny Motions to Seal Administrative Record and Pleadings in Two ERISA Disability Benefit Cases

"[A Florida district court] denied the motion to seal finding that Plaintiff did not offer any compelling justification ... The court found '[b]y filing this action seeking an award of long-term disability benefits, Plaintiff has placed his own medical condition squarely at issue.' ... [A California district court] reached the same conclusion, and offered a somewhat similar rationale." [Schramm v. Metropolitan Life Ins. Co., No. 23-0163 (M.D. Fla. May. 9, 2023); Dioquino v. United of Omaha Life Ins. Co., No. 20-0167 (S.D. Cal. Mar. 9, 2021)]  MORE >>

Roberts Disability Law

More Federal Action in the Pharmaceutical Sector as PBM Bill Advances in the Senate

"[T]he Pharmacy Benefit Manager Act (S 1339) reflects the overarching legislative push by members from both sides of the aisle and chambers of Congress to address drug pricing issues through federal fixes to the PBM framework. Further, Congress' efforts build on the momentum from the enactment of the high-profile Medicare prescription drug pricing provisions of the Inflation Reduction Act in 2022."  MORE >>

Health Law Advisor, Epstein Becker Green

Universal Paid Family and Medical Leave Bill Reintroduced

"[An] updated version of [this legislation would] create a permanent, national paid family and medical leave program (HR 3481 and S 1714).... The benefit would be paid for by a 0.2 percent payroll tax on employers and employees, based on the Medicare taxable wage base. The benefit would be administered through a new Office of Paid Family and Medical Leave within the Social Security Administration."  MORE >>

HR Policy Association [HRPA]

Exceptional Usefulness and Quality icon Tracking Telehealth Changes State-by-State in Response to COVID-19

Updated May 19, 2023. Descriptive list of current and proposed state and federal guidance, regulations, and legislation."  MORE >>

Manatt, Phelps & Phillips, LLP

Providers Score More Victories in First Year of NSA Arbitrations, But Claims Backlog Complicates Implementation

"In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions of the US Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments), and complicates the implementation of the NSA."  MORE >>

ArentFox Schiff LLP

Benefits in General

Employers Discuss Why They Use Vendor Search Consultants

"Some employers secure the support of a consultant to design, sort and score requests for proposals and requests for information, while others use consultants more narrowly for pricing or because they offer access to proprietary systems for evaluating benefit providers."  MORE >>

PLANSPONSOR; free registration may be required

Employee Benefits Jobs

View job as Business Development Director
            for AimPoint Pension Group

Business Development Director

AimPoint Pension Group

Remote / Pompano Beach FL

View job as Business Development Director for AimPoint Pension Group

View job as DC Plan Consultant/Administrator
            for Dynamic Pension Services, Inc.

DC Plan Consultant/Administrator

Dynamic Pension Services, Inc.

Remote / Dayton OH

View job as DC Plan Consultant/Administrator for Dynamic Pension Services, Inc.

View job as Retirement Plan Administrator
            for The Finway Group

Retirement Plan Administrator

The Finway Group

Remote / West Des Moines IA / IL / KS / MN / MO / ND / NE / SD / WV

View job as Retirement Plan Administrator for The Finway Group

Selected New Discussions

Cafeteria Plan Year with Different Underlying Policy Years

"Is there a preferred (or possible) method to selecting a cafeteria plan's plan year where the underlying benefit components do not all run on the same period (e.g., life insurance is on a 1/1-12/31 plan year, but medical/dental are on a 7/1-6/30 plan year)? Or would you need multiple plans?"

BenefitsLink Message Boards

Mistaken FSA Election and HSA Contributions

"During open enrollment, an (childless) employee elects HDHP coverage and therefore (implicitly) to receive the employer's HSA 'seed' contribution. Unfortunately, the employee also intended to enroll in the general purpose health FSA but instead enrolled in the dependent care FSA. The employer's systems obviously would not catch this error.

"Well into the year (the employer's cafeteria plan does not currently provide for a time limit of providing notification) and after the employer HSA 'seed' contribution was made, the employee notices the mistake and notifies the employer. Pursuant to IRS guidance, the employer corrects the mistake and converts all of the year's prior and subsequent FSA amounts to the health FSA.

"The change would certainly make all HSA contributions, including the 'seed' amounts, excess contributions. The employee can avoid the tax penalty if he or she takes a timely curative distribution. If the employee does so, the effect would be that he or she would get additional compensation from the employer but only as a result of the employee's mistake. Under these circumstances, can the employer ask the HSA custodian to return the 'seed' contribution to it? Under the HSA regulations, there are only limited circumstances when this can be done, most notably when the employer was never HSA-eligible. Here, the conversion means that in effect the employee was 'never' HSA-eligible but it was solely as a result of a change made mid-year."

BenefitsLink Message Boards

Webcasts and Conferences
(Health & Welfare Plans)

2023 High-Cost Claims and Injectable Drug Trends Analysis

RECORDED

Sun Life Financial

Last Issue's Most Popular Items

First Gag Clause Attestations Due December 31, 2023: What Group Health Plan Sponsors Need to Know

Hunton Andrews Kurth LLP

Preparing for the End of the COVID-19 Emergency: Deadline Tolling

McDermott Will & Emery

IRS Issues Guidelines Regarding Substantiation of Expenses for Cafeteria Plans

RSM US

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

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