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Health & Welfare Plans Newsletter

September 6, 2023

3 New Job Opportunities 3 New Job Opportunities

 

[Guidance Overview]

Employers May Need to Lower Employees' Premiums to Keep Health Plans Affordable Under the ACA

"[The authors are] seeing an increased focus on ACA compliance and expect to see a ramp up in employer penalty notification. A failure to consider whether your plan is affordable when passing through any premium increases could result in an unintended penalty for each employee who enrolls in exchange coverage and qualifies for financial assistance."  MORE >>

Bricker Graydon

[Guidance Overview]

New Federal Rules Seek to Strengthen Mental Health Parity

"Although MHPAEA has been in effect for more than a decade now, regulators enforcing the law have often struggled to narrow the many gaps in access between MHSUD and medical/surgical benefits. One major driver of this has been the inability of regulators to effectively oversee insurer compliance with respect to NQTLs, especially network composition-related NQTLs. This proposed rule makes the NQTL standard more prescriptive and incorporates outcomes data, and if finalized ... would represent a significant step forward in MHPAEA enforcement."  MORE >>

Health Affairs Forefront

[Guidance Overview]

Upcoming Deadline icon Medicare Part D Notices Are Due Before Oct. 15, 2023 (PDF)

"Medicare Part D imposes disclosure requirements on employers with group health plans that provide prescription drug coverage to Medicare- eligible individuals. Plan sponsors must provide the annual Medicare Part D creditable coverage disclosure notices to individuals before Oct. 15, 2023. Model notices are available for employers to use."  MORE >>

Cowden Associates, Inc.

Don't Let ACA Penalties Tax Your Business

"During August 2023, a real-life illustration was shown highlighting how ACA requirements are not to be trifled with and the penalties are real.... [T]he IRS assessed exactions against Optimal Wireless for not providing adequate coverage to some employees.... [T]he U.S. Court of Appeals ruled against Optimal Wireless, agreeing with an earlier U.S. District Court ruling, that the exactions were a form of a tax and exempt from lawsuits ... Optimal Wireless is on the hook for the over $1.1 million in penalties to the IRS." [Optimal Wireless LLC v. IRS, No. 22-5121 (D.C. Cir. Aug. 8, 2023)]  MORE >>

Equifax

District Court Dismisses All But One of Employees' COBRA Election Notice Claims

"In litigation involving an employer's alleged notice violations under [COBRA], a district court rejected almost all of the employees' claims for why the notices were deficient. In the one claim that survived dismissal, an employee who was terminated in June 2020 alleged that the employer's COBRA election notice failed to state an enrollment deadline that accurately reflected COVID-19-related time extensions." [Bryant v. Walgreen Co., No. 23-1294 (N.D. Ill. Aug. 29, 2023)]  MORE >>

Thomson Reuters Practical Law

What Does Blue Shield of California's New Unbundled Pharmacy Model Mean to Employers?

"Blue Shield of California's recent decision to unbundle its pharmacy benefit program and work with multiple vendors ... wiped out $20 billion in market capitalization of the owners of the three largest pharmacy benefit managers within hours of the announcement.... This new model is a great opportunity [for employers] to request stronger guaranteed discounts, rebates, and even trend guarantees.... [E]mployers should request the right to audit these guarantees to ensure transparency and accountability."  MORE >>

EPIC

Medicare Negotiations Won't Keep Big Pharma from Making a Fortune

"To understand the extent to which decreased returns may impact innovation, [the authors] analyzed how much it costs on average to bring a drug to market and how much these companies have earned from the selected drugs since their launch. Not only are revenues enough to justify the investment in these particular drugs, they are enough to fund several more generations of pharmaceutical development. Lower negotiated prices are unlikely to deter further investment in similar medications."  MORE >>

Bloomberg; subscription may be required

GAO Report: CMS Should Monitor Effects of Rebates on Medicare Part D Plan Formularies and Beneficiary Spending

"[P]rivate companies that provide voluntary Medicare Part D prescription drug coverage received $48.6 billion in rebates from drug manufacturers in 2021. Three therapeutic drug classes accounted for 73 percent of rebates ... [R]ebates may ... lower Medicare drug spending ... However, rebates do not lower individual beneficiary payments for drugs ... GAO found payments by beneficiaries were more than plan sponsor payments, after accounting for rebates, for 79 of the 100 drugs receiving the most rebates." [GAO-23-105270]  MORE >>

U.S. Government Accountability Office [GAO]

Benefits in General

[Official Guidance]

IRS Announcement: South Carolina Taxpayers Impacted by Idalia Qualify for Tax Relief

"The [IRS] today announced tax relief for individuals and businesses affected by Idalia, anywhere in South Carolina. These taxpayers now have until Feb. 15, 2024, to file various federal individual and business tax returns and make tax payments.... All 46 counties in South Carolina qualify. Individuals and households that reside or have a business in these counties qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as TPA Retirement Plan Consultant DC & DB
            for Established TPA

TPA Retirement Plan Consultant DC & DB

Established TPA

Remote

View job as Senior DC Administrator and Team Leader
            for Prime Pensions Inc

Senior DC Administrator and Team Leader

Prime Pensions Inc

Remote

View job as Senior DC Administrator and Team Leader for Prime Pensions Inc

View job as Assistant General Counsel – Benefits Practice Group
            for Insperity

Assistant General Counsel – Benefits Practice Group

Insperity

Kingwood TX / Hybrid

View job as Assistant General Counsel – Benefits Practice Group for Insperity

Press Releases

José Jara Appointed Chair of ABA Employee Plans and Executive Compensation Group

Fox Rothschild LLP

DOL Files Suit Against Minnesota IT Company for Not Remitting Employee's Retirement Plan Contributions

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Zenith American Solutions Strengthens Its Executive Leadership with Appointment of Michele Rivas, EVP, Chief Legal Officer, and Keagan J. Kerr, EVP, Chief Human Resources Officer

Zenith American Solutions

Webcasts and Conferences
(Health & Welfare Plans)

No Surprises Act Compliance Assistance

September 14, 2023 WEBINAR

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Last Issue's Most Popular Items

Minimum Essential Coverage Reference Chart (PDF)

Center on Budget and Policy Priorities

How Lifestyle Savings Accounts Can Enhance Traditional Employee Benefit Offerings

Willis Towers Watson

In Misunderstanding Level-Funded Health Insurance Plans, Is the Administration Missing an Opportunity?

Health Affairs Forefront

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

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