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Health & Welfare Plans Newsletter

September 25, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

HHS Proposed Regs Would Set IDR Administrative Fees and IDR Arbitrator Fee Ranges

"Issued in response to a court decision striking down aspects of the Departments' regulations, the proposed regulations would (among other things) set the administrative fee amount and IDR arbitrator fee ranges for single and batched disputes through notice-and-comment rulemaking."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

HHS Sets New Administrative Fee to Be Paid by Parties in No Surprises Act Independent Dispute Resolution Cases

"In the newly proposed rule, the departments committed to using a notice-and-comment period in setting the fee ... Future changes to the fee could happen more often than annually, the proposed rule states, but likewise would be subject to notice-and-comment procedures.... The departments have completed work on a yet-to-be-published separate rule related to the IDR process. That rule ... could set up a more rigorous process for keeping ineligible cases out of the portal."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

[Guidance Overview]

New York City Publishes Final Amendments to Earned Safe and Sick Time Rules

"On September 15, 2023, the New York City Department of Consumer and Worker Protection released final amendments to the New York City Earned Safe and Sick Time Act (ESSTA) Rules. Importantly, there are several ESSTA topics that are impacted by the final amended Rules, including employer size, employee eligibility, notice requirements, documentation standards, payment of sick/safe time, and written ESSTA policy requirements."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

New York City Amends Safe and Sick Time Regs

"The changes clarify coverage issues for telecommuters and hybrid employees, employer headcount and coverage thresholds, and advance notice and documentation requirements. Additionally, the changes clarify employers' responsibility to report accrual, usage, and balance information to employees on a paystub or employee-accessible electronic system."  MORE >>


Cigna Hit with Second Class Action Suit Over Claims Automation Software

"Cigna is facing a second class action lawsuit over the health insurer's use of software to automate claims processing. The lawsuit ... alleges Cigna's 'procedure-to-diagnosis' or PxDx software reviewed and denied customer claims in batches without a medical professional reviewing those decisions. Cigna faces an almost identical lawsuit in California that was filed earlier this summer. The payer defends the technology as a standard review process similar to those used by other insurers." [Van Pelt v. Cigna, No. 23-1135 (D. Conn. complaint filed Aug. 25, 2023)]  MORE >>


Embedded Deductibles and OOPMs

"As compared to aggregate deductibles, embedded deductibles ease the cost burden on individuals when family deductibles are high. The benefits of embedded deductibles for employees translate to increased costs for plans, as plans pay more when participants pay less. Embedded [out-of-pocket maximums (OOPMs)] work in much the same way.... However, unlike embedded deductibles, embedded OOPMs are required unless the plan has an aggregate OOPM less than the individual OOPM.... The interactions of these rules can be boiled down to three basic principles."  MORE >>

HUB International

New Jersey Now Requires Abortion Coverage for All State-Regulated Insurance Plans

"All state-regulated health insurance plans must now provide coverage for abortions with the exception of nonprofit religious employers who seek permission to opt-out, the New Jersey Department of Banking and Insurance announced ... The impact of the mandate will be limited because it will only apply to the insurance market regulated by the state, and the majority of people in New Jersey are covered by federally regulated, self-insured plans operated by their employers."  MORE >>

MSN News


The Cost Shift, the Health Care Ecosystem, and Commercial Prices

"Going forward, commercial insurance payments will have a profound impact on the nature, size, and adequacy of the hospital and physician delivery system. Inadequate Medicare and Medicaid funding and other relevant market factors must be considered in commercial pricing decisions.... A more complete understanding of the delivery system impact of key input cost driver impacts will provide important insight to policy makers who will be asked to balance affordability with access to health care services."  MORE >>

Health Affairs Forefront

Employee Benefits Jobs

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ESOP Administrator

Blue Ridge ESOP Associates


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            for Nova 401(k) Associates

Defined Contribution Account Manager

Nova 401(k) Associates


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Last Issue's Most Popular Items

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Morgan Lewis

State Paid Family Leave Law Updates


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

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