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Health & Welfare Plans Newsletter

July 6, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

MHPAEA Opt-Out Ends for Nonfederal Government Plans

"Self-funded state and local government employee group health plans that previously opted out of the Mental Health Parity and Addiction Equity Act (MHPAEA) will need to prepare to comply with parity requirements, just as private employers' health plans already do. A provision in the 2023 Consolidated Appropriations Act eliminates the mental health parity opt-out, and affected plans may see a fairly significant cost increase."  MORE >>


[Guidance Overview]

Determining COBRA Election and Payment Deadlines at the End of the COVID-19 Outbreak Period (PDF)

"If a participant experiences a qualifying event and is provided a COBRA election notice on or before July 10, 2023, the individual's 60-day period to elect COBRA begins to run on July 10, 2023 (making the deadline September 8, 2023).... Although not expressly addressed, it appears that if a qualifying event occurs on or before July 10, 2023, and the COBRA election notice is provided after that date, the COBRA election deadline would be measured from the provision of the notice."  MORE >>

Thomson Reuters / EBIA

District Court Orders Reevaluation of Child's Residential Treatment Claim Denial (PDF)

" This decision reaffirms the importance of demonstrating that the plan has engaged with treating providers' opinions when denying claims based on medical necessity. And while the participant's mental health parity claims were thus far unsuccessful, compliance with the mental health parity requirements is a focus of agency enforcement and should be a priority for plans." [D.B. v. United Healthcare Ins. Co., No. 21-0098 (D. Utah Jun. 1, 2023)]  MORE >>

Thomson Reuters / EBIA

Employer Lawsuits Against Health Plan Administrators Are Heating Up

"Lawsuits by employers against insurers that administer employer health plans are beginning to mount, and workers could soon join the fray with litigation against employer-sponsored health plans.... [A] major point of contention is the alleged failure of plan administrators to provide employer plans with claims data."  MORE >>

Bloomberg Law

Association Health Plans Get Assist

"A push to allow small businesses and self-employed business owners to join together in large groups to buy health insurance is seeing early success, despite concerns it could skirt Obamacare protections. Republican members of Congress have moved a bill through the House that would boost association health plans, which are group health plans covering small employers and self-employed individuals in the same or different industries."  MORE >>

Bloomberg Law

2022 Stop-Loss Stats and Health Plan Design Considerations

"71% of all stop-loss claims came from 10 procedures; over the last four years, 37% of claims came from the top three procedures ... Ideas to consider: [1] A cancer navigation program and a focus on specific cancer procedures that can be performed through bundled (fixed) costs. [2] Treatments, like dialysis infusion, done at home versus a medical facility ... [3] Ensuring access to detailed claims data to assess new strategies."  MORE >>


Affordable Health Insurance Options for Small Employers

"A recent survey of small-business leaders found that their top four most important health care issues are cost-related, with 28 percent saying that rising health insurance costs could impact their ability to offer health care benefits.... [1] ACA Marketplace tax credits ... [2] New Health Reimbursement Arrangements ... [3] Expanded tax credits for family members."  MORE >>


New York City Council Introduces Amendment to Paid Sick Leave Law

"Under a bill introduced at the New York City Council meeting on June 22, 2023, New York City employers would be required to allow employees to accrue up to 80 hours of personal time off that can be used for any reason, in addition to the sick and safe leave such employers already must provide employees under the New York City Paid Sick and Safe Leave Law."  MORE >>

Davis Wright Tremaine LLP

HHS Investigation of Snooping Security Guards Results in $240,000 Settlement

"This resolution agreement illustrates the importance of evaluating the roles of all workforce members to determine which individuals should have access to PHI, and which ones should not. The HHS press release cautions that data breaches by current and former workforce members impermissibly accessing PHI is a recurring issue for HIPAA covered entities."  MORE >>

Thomson Reuters / EBIA

Benefits in General

District Court Acknowledges the 'Fiduciary Exception's' Applicability to ERISA Communications -- with a Twist

"[D]efendant's former Chief Digital Officer sued for severance benefits after he was terminated. Not surprisingly, he pointed to the fiduciary exception that generally applies in ERISA cases. But the court carefully analyzed the severance plan, and concluded that ... the plan's status as a 'top-hat plan' meant that under ERISA the fiduciary exception did not apply." [Kramer v. American Electric Power Executive Severance Plan, No. 21-5501 (S.D. Ohio Apr. 13, 2023)]  MORE >>


Employee Benefits Jobs

View job as Plan Administrator
            for Atlantic Pension Services Inc.

Plan Administrator

Atlantic Pension Services Inc.

Remote / Kennett Square PA / DE / MD / NJ / TN

View job as Plan Administrator for Atlantic Pension Services Inc.

View job as Compliance Analyst
            for Guideline

Compliance Analyst


CA / CO / FL / MA / MD / ME / NC / NY / TX / WA

Selected New Discussions

Experience-Rated Plans

"I am not an expert in Form 5500 but I am very curious about one question here: I thought all large groups (>50 enrollees) are experience-rated to some extent (premiums depending on their past claims). But why most Form 5500 Schedule A filings are nonexperience-rated? Is this an option that employers can choose? If yes, what kind of employers are more likely to file as nonexperience-rated?"

BenefitsLink Message Boards

Press Releases

CBIZ Acquires American Pension Advisors

CBIZ, Inc.

Webcasts and Conferences
(Health & Welfare Plans)

Best Practices Conference: Building Community with Employee Benefits

September 20, 2023 in MA

New England Employee Benefits Council [NEEBC]

ERISA Basics National Institute 2023


American Bar Association Joint Committee on Employee Benefits [JCEB]

2023 Fall Virtual Policy Conference


ERIC [ERISA Industry Committee]

Last Issue's Most Popular Items

The Pregnant Workers Fairness Act: What Plan Sponsors Need to Know

International Foundation of Employee Benefit Plans [IFEBP]

Maine Poised to Enact Sweeping Paid Family and Medical Leave Law


Health Insurance Caught in a New Pickle

International Foundation of Employee Benefit Plans [IFEBP]

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

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