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Health & Welfare Plans Newsletter

September 13, 2023

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[Guidance Overview]

Exceptional Usefulness and Quality icon DOL Guidance on Mental Health Parity: Proposed Rules for NQTL Comparative Analyses

"[1] Lack of plan-specific information creates compliance challenges ... [2] What does Mental Health Parity mean? ... [3] EBSA reports some enforcement progress ... [4] New rules seek to provide clarity, improve compliance ... [5] Focus on outcomes data ... [6] Other Proposed Rule/Enforcement Report highlights ... [7] Where plan sponsors can start coming into compliance."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]


2024 Onsite Employee Health Clinics Summit (February 1 - 2, 2024; Scottsdale, AZ)

The Leading Forum on Building & Expanding On-Site Health Clinics – Incorporating Strategies that Reduce Costs, Ensure Employee Satisfaction and Positively Impact Patient Behavior

Sponsored by World Conference Forum

[Guidance Overview]

The 'Meaningful Benefit' Requirement Under the MHPAEA

"The proposed regulations add a requirement that plans and issuers must provide 'meaningful benefits' for the treatment of MH/SUD disorders or conditions. While the term 'meaningful benefit' is not defined, the proposed regulations offer two examples ... The Departments invite comments on how to define 'meaningful benefits' and on whether there might be other potential alternatives."  MORE >>

McDermott Will & Emery

[Guidance Overview]

Illinois Employers Required to Provide Public Transit Benefits in 2024

"The act applies to employers with at least fifty full-time employees working in certain geographic areas in Illinois that offer a public transit system operated by the Regional Transportation Authority. Beginning January 1, 2024, employers will need to provide the benefit to all full-time employees after 120 days of employment. The transit benefit must comply with federal rules for qualified transportation fringe benefits."  MORE >>

Ogletree Deakins

[Guidance Overview]

Maine Paid Family and Medical Leave Overview (PDF)

21 presentation slides. "Maine has enacted a paid family and medical leave program. Contributions will start in 2025, and benefits will become available in 2026."  MORE >>


Tenth Circuit Holds Denial of Minor’s Residential Treatment Claims Was Abuse of Discretion

"The district court and the Tenth Circuit determined that when the defendants denied the plaintiffs' claims, they failed to provide the plaintiffs with an explanation of what plaintiffs needed to perfect the claims at issue until it was too late in the process.... [T]he defendants asserted that they had internal notes that established the basis for their decisions; however, the Tenth Circuit determined that ERISA requires a meaningful dialogue between the plan and the claimant and that the information in those notes was never provided or relayed to the plaintiffs during the claim process, denying the plaintiffs the opportunity to engage with that information." [P. v. United Healthcare Ins. Co., No. 21-4129 (10th Cir. Aug. 15, 2023)]  MORE >>


Fourth Circuit Attempts to Clarify the Scope of ERISA’s Equitable Relief in Heart Transplant Case

"In the end, the Supreme Court's cases discussing ERISA Section 502(a)(3) are certainly unsatisfying, and it is not surprising that the panel diverged on how to interpret them properly. The majority believes it has synthesized the proper approach ... As the dissent points out, however, that approach runs afoul of not only Amara but prior opinions from the Fourth Circuit, and thus the majority may have overstepped its bounds." [Rose v. PSA Airlines, Inc., No. 21-2207 (4th Cir. Sep. 11, 2023)]  MORE >>

Kantor & Kantor

Tobacco Surcharge and Incorrect Claims Processing Lead to DOL Lawsuit and Civil Penalties

"[T]he takeaway here is that employers should ensure that any documentation or directions given to their service providers is consistent with the benefits booklets or certificates of coverage produced by such service providers. As this case demonstrates, the employer, in its capacity as the plan administrator, is ultimately liable for ensuring the plan's claims administration is in accordance with the terms of the plan." [Su v. Flying Food Group, LLC, No. 23-6583 (N.D. Ill. proposed consent order filed Aug. 30, 2023)]  MORE >>

Haynes and Boone, LLP

Top ACA Coverage and Reporting Pitfalls and How to Avoid Them

"[1] Your 1095-C forms were printed after the IRS deadline.... [2] You switched ACA compliance vendors or HRIS software vendors and don't have the historical information you need to respond to an IRS penalty notice.... [3] You received a Letter 226J and your finance department was surprised to find out that the company owes over $1 million.... [4] Your organization didn't offer coverage to variable-hour employees who measured as eligible.... [5] You acquired a new company and couldn't merge the ACA data.... [6] You submitted your organization's ACA filing to the IRS but there were errors.... [7] There's turnover in your HR team and you lost the resources that manage ACA reporting.... [8] Your ACA filing to the IRS was rejected."  MORE >>


As Student Loan Payments Resume, Here's How Employers Can Help

"Employees will likely seek help in the months ahead due to the re-emergence of student debt servicing.... [K]ey actions employers can take right now: [1] Inventory all available resources first, particularly if they are already included in the broader benefit plan.... [2] Understand how these various benefits can help, how they may interact across platforms and what service gaps and resources still exist.... [3] Consider tuition assistance programs and student loan assistance programs."  MORE >>

BenefitsPro; free registration required

Inflection Point: The Transformative Promise of AI in Insurance and Beyond (PDF)

14 pages. "Artificial intelligence is revolutionizing the business landscape faster than technology media can track it. ... [This report provides a] broad overview of the AI space -- from major investments to consumer sentiment to the ethical implications of the technology. [It then examines] specific ways in which generative AI can deliver unprecedented advances in the insurance industry."  MORE >>


Employee Benefits Jobs

View job as 401(k) Administrator
            for Blue Ridge ESOP Associates

401(k) Administrator

Blue Ridge ESOP Associates


View job as 401(k) Administrator for Blue Ridge ESOP Associates

Press Releases

Cohen and Buckmann Elevates New Partner: Zahava Blumenthal

Cohen & Buckmann P.C.

DOL Recovers $22.5M from Trustee for Stock Overpayment by RV Rental Company's Employee Stock Ownership Plan

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

GoodRx and MedImpact Announce Program to Ensure Seamless Access to Affordable Prescriptions


Webcasts and Conferences
(Health & Welfare Plans)

Healthcare's Final Frontier: Navigating the Wild West of RBP with Industry Renegades


Craig Gottwals

New Mental Health Parity Regulations: Putting Some Meat on the Bones

October 18, 2023 WEBINAR

Worldwide Employee Benefits Network [WEB]

Last Issue's Most Popular Items

Update Those Severance Agreements

Kaufman & Canoles

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

Solutions Law Press

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


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

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