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Health & Welfare Plans Newsletter

September 12, 2023

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[Guidance Overview]

Reminder: Distribute Medical Loss Ratio (MLR) Rebates This Year

"Total MLR reimbursements are projected to be $1.1 billion in 2023, which is about the same level as last year.... If employees contributed to the total premium, then a portion of the MLR rebate will be considered to be an ERISA plan asset and can only be used to benefit those participants, not the employer."  MORE >>

OneDigital

[Guidance Overview]

Maine Law Requires Paid Family and Medical Leave

"Maine is the second state in 2023 to adopt a paid family and medical leave (PFML) program. Contributions are initially set at 1.0% of wages up to the Social Security taxable wage base and are evenly split between employers and employees, with an exception for certain small employers. Contributions will start in 2025; benefits will become available in 2026."  MORE >>

Mercer

[Guidance Overview]

San Francisco Health Care Security Ordinance: New Expenditure Rates for 2024

"What covered employers must do: [1] Calculate and make the required Health Care Expenditures on behalf of their Covered Employees [as shown in a chart] ... [2] Maintain records of their Health Care Expenditures; [3] Post the SFHCSO poster ... in all workplaces with Covered Employees and distribute a copy to remote Covered Employees; and [4] Submit the SFHCSO Annual Reporting Form ... by April 30, 2024."  MORE >>

Davis Wright Tremaine LLP

Text of Fourth Circuit Opinion Partially Reviving ERISA Suit Over Denial of Benefits for Heart Transplant (PDF)

32 pages. "[T]he district court did not consider whether Rose plausibly alleged facts that would support relief that was 'typically' available in equity.... [O]ne such remedy is based on the defendant's unjust enrichment. But the question remains whether Rose has plausibly alleged facts that would entitle her to such relief by alleging [1] that a defendant was unjustly enriched by interfering with Kyree's rights and [2] that the fruits of that unjust enrichment remain in the defendant's possession or can be traced to other assets.... [We] remand for the district court to decide in the first instance whether Rose has met this burden for each defendant." [Rose v. PSA Airlines, Inc., No. 21-2207 (4th Cir. Sep. 11, 2023)]  MORE >>

U.S. Court of Appeals for the Fourth Circuit

Litigation Over Death Benefits Puts Spotlight on Plan's Domestic Partner Procedures

"In litigation involving competing claims to an employee's death benefits, a district court rejected an alleged domestic partner's attempt to demonstrate a domestic partnership using a declaration submitted after the death of the other purported domestic partner (the decedent-employee). The court therefore concluded that the employee's minor child was entitled to the death benefits." [Zaharopoulos v. Taylor, No. 22-348 (M.D. Ga. Sept. 6, 2023)]  MORE >>

Thomson Reuters Practical Law

Evaluating Changes to Health Insurer Desktop Websites

"While member site changes accounted for 37% of the total website changes, 69% of high-significance updates were behind the login About a third of firms made 10 or more changes on the member site ... Tools & Digital Resources accounted for a quarter of all high- and medium-significance changes ... Notable changes pertained to: [1] Chatbots ... [2] Cost estimator tools ... [3] Quote tools ... [4] Provider locator tools."  MORE >>

Corporate Insight

Update Those Severance Agreements

"Since the start of this year, the [NLRB] has been quite active in adopting and promulgating principles of law that affect even the nonunion workplace.... Perhaps the most important of these pronouncements, because it will find application virtually every day, is the board's stance on what kind of releases an employer may seek or obtain from a resigning or terminated employee in a severance agreement."  MORE >>

Kaufman & Canoles

$1.3 Million Health Plan HIPAA Resolution Reminds Health Plan Sponsors, Fiduciaries and Vendors to Manage Cybersecurity Compliance and Risks

"Record-setting HIPAA resolution payments along with recurrent warnings issued by OCR urging health plans and other HIPAA covered entities to guard their electronic systems and electronic protected health information against various hacking, malware and other cybersecurity threats send a clear message to health plans and other HIPAA-regulated covered entities and business associates to constantly monitor and reconfirm the adequacy of their own HIPAA privacy, security, breach notification and other procedures and protections or be prepared to face similar sanctions from OCR. "  MORE >>

Solutions Law Press

Here’s Your Disaster-Ready Employee Benefits Checklist

"Establish emergency leave and flexible work arrangements ... Implement an employee assistance program ... Provide employee support networks ... Stay in touch with your carrier ... Educate your employees on their coverage ... Create a communication plan."  MORE >>

Corporate Synergies

[Opinion]

Fixed Indemnity Plans Offer Great Value for Millions of Hardworking Americans

"Millions of American businesses and their employees value the additional protection offered by fixed indemnity and specified disease plans, which cover costs not covered by traditional major medical insurance. That's the take-away from a new survey of health insurance providers who offer these plans to employers.... The survey was released in concert with AHIP's comment letter on the proposed rules and request for information on these supplemental health insurance products."  MORE >>

America's Health Insurance Plans [AHIP]

[Opinion]

American Council of Life Insurers (ACLI) Tells Agencies to Keep Supplemental Benefits Out of Proposed Federal Regs

"ACLI's [comment letter to HHS, EBSA and IRS] emphasizes that the proposed regulation would eliminate many valuable benefits that people rely on to protect their finances. These benefits supplement, but are not a form of, primary medical coverage. They are distinct from short-term, limited duration insurance discussed in the agencies' proposal and therefore should be excluded from the final regulation.... Also see ACLI's letter to Treasury and IRS on the proposal's tax implications[.]"  MORE >>

American Council of Life Insurers [ACLI]

[Opinion]

American Academy of Actuaries Comment Letter to HHS Re Proposed Regs for Short-Term, Limited-Duration Insurance (PDF)

"[H]ealth needs may exceed the scope of major medical coverage.... [The] segmentation of health coverage (into major medical coverage, short-term coverage, critical illness coverage, etc.) helps the market address the full scope of consumer coverage needs while maintaining actuarially appropriate risk pools.... To ensure market stability, regulators should consider this balance when approving overlapping coverages that compete for the same consumers."  MORE >>

American Academy of Actuaries

Employee Benefits Jobs

View job as Sales Consultant
            for Great Lakes Pension Associates, Inc.

Sales Consultant

Great Lakes Pension Associates, Inc.

Remote / MI

View job as Sales Consultant for Great Lakes Pension Associates, Inc.

Selected New Discussions

Coordination of 529 and 127

"Any insight on how a 529 and 127 plan would coordinate with each other? Code 529 talks about coordination with ESA and American Opportunity and Lifetime Learning credits, but nothing re: 127 plans."

BenefitsLink Message Boards

Press Releases

New Report Shows Employers Making Progress on Workplace Mental Health; However, Women, People of Color, Working Parents, and Remote Workers Say Support and Culture Are Lacking

LifeSpeak Inc.

The Standard Engages with NFP to Launch Pooled Employer Plan Solution

The Standard

Inaugural ‘State of Weight Care’ Report Reveals Employers are Grappling with How to Navigate Obesity Coverage

Found

Aflac Is the First Insurance Carrier Approved to Provide Voluntary Paid Family Leave Insurance in Virginia

Aflac

New Report From PeopleKeep Highlights Employers' Robust Use of ICHRAs to Cover Higher-Tier Health Insurance Plans

PeopleKeep

MedCity News and Quantum Health Launch New Healthcare Benefit Consultant Sentiment Index: Predicts Point Solution Consolidation and Employer Need for Integration

MedCity News

National Association of Plan Advisors to Launch New Research, Data Arm

National Association of Plan Advisors [NAPA]

Webcasts and Conferences
(Health & Welfare Plans)

Updates in Employee Benefits

September 20, 2023 WEBINAR

Constangy, Brooks, Smith & Prophete, LLP

Captives, Coalitions & ICHRAs (oh my!)

October 26, 2023 WEBINAR

EPIC

Last Issue's Most Popular Items

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

KLB Benefits Law Group

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

Health Affairs Scholar

Damages Available for ERISA Benefits Lawsuits

DeBofsky Law

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

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