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Health & Welfare Plans Newsletter

June 28, 2023

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

IRS Opines on the Tax Treatment of Employer Wellness Policies

"The arrangement described in [Chief Counsel Memorandum 202323006] is similar to other so-called 'double dipping' arrangements that the IRS has previously rejected. While varying in their design features and terminology, the latest iterations of these programs share certain features: reduction of employee salary or wages coupled with a restoration of the salary or wages and a claim of outsized payroll tax savings."  MORE >>

McDermott Will & Emery

[Guidance Overview]

COVID-19 Health Plan Relief Winds Down

14 pages. "This updated slide deck describes agency guidance on which COVID-19 coverage mandates expired once the public health emergency ended on May 11, and how to calculate key plan and participant deadlines before and after the outbreak period ends on July 10. The slides also describe employer actions that the agencies encourage but do not require, such as steps to lessen the impact of Medicaid redeterminations on employees and their families."  MORE >>


[Guidance Overview]

IRS Issues Guidance on HDHP Relief for COVID-19 Services and Preventive Care

"[C]alendar year HDHPs must subject COVID-19 testing and treatment to the deductible beginning with the 2025 plan year. This gives HDHPs more than a year to transition to applying the deductible to these services. However, non-calendar year HDHPs will have less time since the relief will only apply until the end of the 2023 plan year. This is because a 2024 non-calendar year plan year will end after December 31, 2024."  MORE >>

Groom Law Group

[Guidance Overview]

For HDHPs, IRS Confirms Pre-Deductible COVID-19 Testing Coverage Will End Next Year

"The IRS's recent guidance on COVID-19 testing and treatment marks another (time-limited) eligible expense that plan sponsors will need to track as they monitor the scope of permissible expenses that can be covered under an HDHP before a participant satisfies the IRS minimum deductible."  MORE >>


[Guidance Overview]

Mandatory Overtime Impacts FMLA Compliance

"[DOL Opinion Letter FMLA2023-1-A confirms] that employees can use intermittent FMLA leave when they can't work required overtime hours due to an FMLA-qualifying reason. This leave can be taken on an hour-by-hour basis."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

[Guidance Overview]

IRS Provides Guidance on Substantiation of FSA Claims

"[T]he IRS Office of Chief Counsel issued a memorandum on the FSA claims substantiation process and described situations when substantiation is sufficient and when it is not.... Employers that are renewing contracts for FSA administration with a TPA, implementing FSAs with TPA services or changing TPAs should review the TPA's claims substantiation procedures and contract language for legal compliance with all applicable laws and tax-favored status under section 125."  MORE >>

Willis Towers Watson

Court Upholds Employer's Decision to Terminate Multiple Employees Who Filed Similar FMLA Claims

"The company's vice president explained that he pulled the trigger on the terminations based on suspected fraud, and the employees provided nothing to show that was not the real reason for the decision.... [T]he court noted that CSX did not notify the employees of their FMLA rights when they submitted their claim forms. But it also decided that they were not harmed by the omission; in fact, there was nothing to show they would have done anything differently had the notice been provided." [Adkins v. CSX Transportation, Inc., No. 21-2051 (4th Cir. June 16, 2023)]  MORE >>


Specialty Drug Coverage: Medical vs. Pharmacy Benefit

"Historically, physician administered specialty pharmaceuticals are covered by a patient's medical benefit and oral medications are covered by the pharmacy benefit. Increasingly, however, specialty pharmaceuticals are being covered by pharmaceutical benefit. Does this make a difference? Does medical vs. pharmacy coverage of drugs impact patient access?"  MORE >>

Healthcare Economist

How Often Do Health Insurers Say No to Patients? No One Knows

"When ProPublica set out to find information on insurers' denial rates, we hit a confounding series of roadblocks.... The minuscule amount of details available about denials robs consumers of a vital tool for comparing health plans.... The limited government data available suggests that, overall, insurers deny between 10% and 20% of the claims they receive. Aggregate numbers, however, shed no light on how denial rates may vary from plan to plan or across types of medical services."  MORE >>

MSN News

How HIPAA Fails: Insurance Companies Acquiring and Using PHI

"Although medical claim inflation hovers around four percent, insurance companies regularly demand annual rate increases ranging from eight to 12% with no justification whatsoever. They will not provide smaller employers with actual claim information because doing so allegedly would violate HIPAA. As it turns out, insurance companies are not concerned about HIPAA because it does not apply to them when negotiating plan prices with employers."  MORE >>

Hall Benefits Law

Employee Benefits Jobs

View job as TPA Administrator
            for Cetera Retirement Plan Specialists

TPA Administrator

Cetera Retirement Plan Specialists


View job as TPA Administrator for Cetera Retirement Plan Specialists

View job as Balance Forward Specialist
            for EPIC Retirement Plan Services

Balance Forward Specialist

EPIC Retirement Plan Services

Remote / Norwich NY

View job as Balance Forward Specialist for EPIC Retirement Plan Services

View job as Retirement Plans Compliance Analyst
            for The Standard

Retirement Plans Compliance Analyst

The Standard


View job as Retirement Plans Compliance Analyst for The Standard

View job as Manager, Client Service Management
            for American Trust Retirement

Manager, Client Service Management

American Trust Retirement


View job as Manager, Client Service Management for American Trust Retirement

Selected New Discussions

MEC Plan Requirements to Avoid 4980H(a) Penalty

"Does offering a group health plan that only offers preventive services allow an ALE to avoid the 4980H(a) penalty? The only definition of minimum essential coverage I can find is on the CMS website and states that a MEC plan includes 'employer-sponsored coverage.' Providers of preventive care only MEC plans argue that such plans satisfy an ALE's requirement to offer coverage and avoid the 4980H(a) penalty. I see how you could get to this conclusion based on the statute, but it doesn't seem consistent with the intent of the ACA employer mandate. Is there any guidance from the IRS or other agency on this?"

BenefitsLink Message Boards

Press Releases

10th Annual QKA Scholarship Program Announced by PenChecks, ARA

American Retirement Association [ARA]

Webcasts and Conferences
(Health & Welfare Plans)

Student Loan Repayment Benefits

July 19, 2023 WEBINAR


Hot Topics in Employee Benefits: What We’re Seeing, July 2023

July 19, 2023 WEBINAR

Morgan Lewis

Last Issue's Most Popular Items

Special Rule Allowing Reduced Cost COVID-19 Testing and Treatment for HSA Plans Sunsets Next Year; Sunset Does Not Apply to COVID-19 Vaccines


Addressing Pharmacy Benefit Management Misalignment (PDF)

National Alliance of Healthcare Purchaser Coalitions

Wellness Fixed-Indemnity: You Can’t Have Your Preventive Care and Tax-Free Indemnity Too

HUB International

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

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