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Health & Welfare Plans Newsletter

September 28, 2023

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[Official Guidance]

Text of Agency FAQs Part 61: Transparency in Coverage (PDF)

"Q1: In light of the interim final rules issued in November 2021 implementing the prescription drug reporting requirements of the CAA and the collection of the required information from plans and issuers, do the Departments still intend to consider through separate notice and comment rulemaking whether the prescription drug machine-readable file requirements remain appropriate? Not at this time.... Q2: Will the Departments continue to maintain an 'enforcement safe harbor' as described in FAQs Part 53? Not at this time."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of HRSA Request for Comments on Draft Recommendation to Update the Agency-Supported Women's Preventive Services Guideline Relating to Screening for Urinary Incontinence

"This draft recommendation has been developed through a cooperative agreement, known as the Women's Preventive Services Initiative (WPSI), with the American College of Obstetricians and Gynecologists (ACOG), through which they convene health professionals to develop draft recommendations. Under applicable law, non-grandfathered group health plans and health insurance issuers must include coverage, without cost sharing, for certain preventive services, including those provided for in the HRSA-supported Guidelines."  MORE >>

Health Resources and Services Administration (HRSA), U. S. Department of Health and Human Services

[Official Guidance]

Draft of 2023 IRS Instructions for Forms 1094-B and 1095-B: Health Coverage (PDF)

Sep. 27, 2023. "What's New: The electronic filing threshold for information returns required to be filed on or after January 1, 2024, has been decreased to 10 or more returns."  MORE >>

Internal Revenue Service [IRS]

[Official Guidance]

Draft of 2023 Instructions for IRS Forms 1094-C and 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)

Sep. 27, 2023. "What's New:  The electronic-filing threshold for information returns required to be filed on or after January 1, 2024, has been decreased to 10 or more returns."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

IRS Reduces 2024 Affordability Percentage

"IRS Rev. Proc. 2023-29 set the lowest affordability percentage since the implementation of the ACA, following a three-year trend of reduction.... Under the FPL safe harbor, the employee contribution cannot exceed 8.39% of the FPL, which for 2024 in the mainland United States is $14,580 annually, or $101.94 per month (down from $103.28 per month in 2023). Employers that set employee contributions based on the exact FPL safe harbor dollar amount will need to reduce the required employee contribution for the 2024 plan year."  MORE >>

Williams Mullen

No Surprises Act Update: Litigation Developments, Enforcement Trends, Agency Guidance and Future Rulemakings

"The No Surprises Act (NSA) has been in effect since January 2022, and has faced litigation ever since from healthcare providers. States and federal agencies are also examining surprise billing and consumer protection laws related to some provisions of the NSA. [The authors] review the state of NSA litigation, oversight activities, and rulemaking and guidance as we approach Q4 2023, and share [their] views on what lies ahead for healthcare providers."  MORE >>

McDermott Will & Emery

These Employers Took on Healthcare Costs, and the Fight Got Nasty

"A bruising battle over hospital costs in Indiana previews a growing trend: Employers are sick of the ever-rising price of healthcare, and they are ready to do something about it.... A drive for legislation ... turned into a brawl. An employer-backed group targeted patients' phones with digital ads about high prices when they visited hospitals. Hospitals warned of cuts to crucial medical services and government price fixing. There was cursing. The resulting law, passed ... with bipartisan support, contained significant actions for tackling high healthcare costs."  MORE >>

The Wall Street Journal; subscription may be required

Federal Workers Will Pay 7.7% More Towards Health Insurance Premiums in 2024

"On average, federal workers enrolled in 'self-only' plans will pay an additional $8.05 per biweekly pay period, while feds in 'self plus one' insurance plans will pay $16.73 more next year. Federal employees enrolled in family coverage will pay an average of $21.16 per pay period in 2024."  MORE >>

Government Executive


PCMA v. Mulready: Did ERISA Do a 180?

"In upholding the Arkansas state law in [Rutledge], the Supreme Court held that Arkansas' law was 'a mere cost regulation that did not have an impermissible connection with ERISA plans.' ... [T]he Mulready decision reinforces the idea that states may not force ERISA plans to adopt administrative, network, benefit design, or substantive coverage requirements. The holding in Mulready provides examples of impermissible state regulation of PBMs under the framework provided in Rutledge." [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]  MORE >>

MZQ Consulting, LLC


The No Surprises Act: Hoping for an End to the Surprises

"[It] is clear that [HHS, DOL and] Treasury have lost their way. The United States District Court for the Eastern District of Texas has consistently agreed with providers and ruled against the Departments ... The [No Surprises Act] had a simple premise. Figuring out how to implement it has been a procedural nightmare. The Departments must go back to the basics and do what is in the best interest of all parties, but, most importantly, assure that the patients receive the quality healthcare that our system is designed to provide them."  MORE >>



House Bills Expanding HSAs Would Boost High-Income Tax Breaks, Not Affordability of Care

"Data show that the benefits of HSAs skew heavily toward people with high incomes. An analysis of 2017 IRS data found that tax returns exceeding $500,000 in adjusted gross income were the most likely to report individual HSA contributions, and returns between $200,000 and $1 million were the most likely to report employer contributions."  MORE >>

Center on Budget and Policy Priorities

Benefits in General

Cybersecurity's Role in Plan Governance

"The responsibility for ensuring the safety of [employee benefit plan] participants’ data and monetary assets has shifted from the computer department to the human resources suite. HR managers face a two-part challenge. The first is the need to have a working knowledge of the risks facing their EBPs from internal sources and service providers. Second is the capability to detect any data security intrusions that strike plan vendors as they occur."  MORE >>

Roland Criss

Employee Benefits Jobs

View job as Business Advisor, Retirement Specialist
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Business Advisor, Retirement Specialist


Fargo ND / Hybrid

View job as Business Advisor, Retirement Specialist for Alerus

Selected New Discussions

Closing Existing FSA and Opening New FSA in Order to Change Plan Year

"We have an existing FSA plan with a plan year of 4/1-3/31, which is the same time line for our health plans' plan year. We merged (acquired) w/ another company earlier this year, and they have a Jan. 1-Dec. 31 plan year for their health plans, and didn't have an FSA. Our company has decided to restructure the plans so company wide the plan year would be Jan. 1-Dec. 31 for all offices, with the same plan year and enrollment periods for all health & dental, and FSA. Questions I have are:

  1. If we close the FSA plan by Dec. 31, this year, do we have to notify staff? If so, how soon? Is there a blackout period?
  2. If we close FSA by Dec. 31, some employees have fully utilized their Health Care FSA balances already, so the company would lose the missed premium that the employee would have normally contributed during the Jan-Feb-Mar payrolls. Is this correct? Can we ask them to contribute those funds they would have normally contributed in Jan/Feb/Mar?
  3. To avoid any more of the situation in above #2, are we allowed to ASK employees to only use up to the amount they would have contributed through Dec. 31? Or is this unlawful?
  4. For employees who have the Dependent Care FSA, and were anticipating using the full amount, will now be cut short by 3 months. Can they contribute a higher amount? Is this change-over of the plan year possibly considered a QLE/Qualifying Event? Any information would be greatly appreciated!'

BenefitsLink Message Boards

Press Releases

Virgin Pulse and HealthComp Announce Intent to Merge to Create Comprehensive Employer Health Platform

Virgin Pulse

Webcasts and Conferences
(Health & Welfare Plans)

Student Loan Repayment Benefits

October 18, 2023 WEBINAR


HSAs: Top 10 Wrap-up (2023 Edition)

November 2, 2023 WEBINAR


Last Issue's Most Popular Items

CRS Report: Paid Family and Medical Leave in the United States

Congressional Research Service [CRS]

A Mental Health Parity Win for Plaintiffs in Utah and Further Proof of a Turning Tide

Kantor & Kantor

Healthcare Benefits Offered at the Top U.S. Companies


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

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