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Health & Welfare Plans Newsletter

September 11, 2023

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[Guidance Overview]

Will Your Employees' Health Care Premiums Be Affordable in 2024?

"[A]ssuming an employee household income of $40,000, in 2023 the maximum premium for at least one employee-only coverage option would have been $304 per month. Assuming the same income, the maximum in 2024 would be $279.67 per month. If the employer in this example keeps the lowest cost employee-only option at $304 per month for 2024, then it will be vulnerable to penalties for not offering affordable coverage."  MORE >>

KLB Benefits Law Group

Is Employment-Related Group Insurance Financing of Expensive Gene Therapies Threatened in the United States?

"[The authors] provide a conceptual framework and empirical evidence to support the proposition that, at present, private group insurance financing of cost-effective gene therapies is not only feasible and competitively necessary in the labor market for employers regardless of group size, but also that currently the number of U.S. workers in small firms who might be stressed by very high-priced claims is a tiny fraction of the group market for genetic treatments"  MORE >>

Health Affairs Scholar

Ending Pay for PBM Performance: Consequences for Prescription Drug Prices, Utilization, and Government Spending

"Proposed 'delinking' legislation would prohibit Pharmacy Benefit Managers (PBMs) from being remunerated based on the rebates and discounts they negotiate for drug insurance plans serving Medicare beneficiaries. This policy would significantly change drug pricing and utilization and shift billions of dollars annually from patients and taxpayers to drug manufacturers and retail pharmacy companies. Annual federal spending on Medicare Part D premiums would increase $3 billion to $10 billion plus any concomitant increase in Medicare subsidies for out-of-pocket expenses."  MORE >>

National Bureau of Economic Research [NBER]; purchase may be required for full document

UnitedHealthcare-Prisma Health Lawsuit Highlights Rising Tensions in Payer-Provider Negotiations

"Inflationary pressures are putting strain on contract negotiations between payers and providers as the two sides work to iron out deals in a challenging financial climate. Many contracts that were agreed upon before the economy experienced record inflation are now coming to an end, but tensions are higher as providers and insurers battle over new terms."  MORE >>

HealthLeaders Media

Expanding Existing Bereavement Leave Policies to Account for Fertility Related Losses

"Some states and cities have already mandated bereavement leave recognizing fertility loss. Illinois law, for example, provides up to two [2] weeks of unpaid bereavement leave both in connection with the death of a family member and following losses associated with certain pregnancy, fertility, surrogacy and adoption-related events. But these laws are few and far between leaving private employers to decide whether, and how, to acknowledge fertility loss in their bereavement leave policies."  MORE >>


HHS Office for Civil Rights Settles with L.A. Care Health Plan Over Potential HIPAA Security Rule Violations

"The potential violations in this case included: [1] failure to conduct an accurate and thorough risk analysis to determine risks and vulnerabilities to ePHI across the organization, [2] failure to implement security measures sufficient to reduce risks and vulnerabilities to ePHI to a reasonable and appropriate level, [3] failure to implement sufficient procedures to regularly review records of information system activity, [4] failure to perform a periodic technical and nontechnical evaluation in response to environmental or operational changes affecting the security of ePHI, and [5] failure to implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use ePHI."  MORE >>

U.S. Department of Health and Human Services [HHS]

Benefits in General

Damages Available for ERISA Benefits Lawsuits

"[If] you are pursuing a benefits claim under an ERISA-governed plan, you cannot seek any other damages besides the benefits due under your plan, as well as an award of pre-judgment interest and/or attorneys' fees, at the discretion of the court. Unlike ordinary insurance litigation, extra-contractual bad faith damages are unavailable under ERISA.... Equitable relief may be sought when a claim for benefits is not available under the plan's terms, or in addition to a claim for benefits, so long as the alleged injury and/or requested relief is not duplicative. "  MORE >>

DeBofsky Law

Employee Benefits Jobs

View job as Retirement Plan Consultant/Administrator
            for Compass Retirement Consulting Group, Inc.

Retirement Plan Consultant/Administrator

Compass Retirement Consulting Group, Inc.

Remote / NH

View job as Retirement Plan Consultant/Administrator for Compass Retirement Consulting Group, Inc.

Press Releases

Groom Named to WBJ’s Largest Law Firms in Greater Washington List

Groom Law Group

OneDigital Named to the Atlanta Business Chronicle's Top Employee Benefits and Compensation Companies List


Marco Diaz of News Corp Named to Board of Business Group on Health

Business Group on Health Announces Release of AI Capabilities to Its Plan Data Intelligence Tool


Last Issue's Most Popular Items

DOL Enforces Tobacco Surcharge and Missing Participant Requirements

Miller & Chevalier

Illinois Enacts Pre-Tax Commuter Benefits Requirement

Jackson Lewis P.C.

Tenth Circuit Overturns Claim Denial Because of Failure to Follow Claims Procedures

The Wagner Law Group

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

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