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Health & Welfare Plans Newsletter

September 29, 2023

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[Official Guidance]

Agencies Request Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies

"[HHS, DOL and the Treasury Department] are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information (RFI) solicits comment on access to a range of OTC items recommended by experts for preventive care that can be purchased without a prescription, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies."  MORE >>

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

[Official Guidance]

Text of IRS Notice 2023-69: Treatment of Amounts Paid to Section 170(C) Organizations Under Employer Leave-Based Donation Programs to Aid Victims of the Hawaii Wildfires (PDF)

"In response to the extreme need for charitable relief for victims of wildfires beginning on August 8, 2023, in the State of Hawaii, employers may have adopted or may be considering adopting leave-based donation programs. This notice provides guidance ... on the federal income and employment tax treatment of cash payments made by employers under leave-based donation programs for the relief of victims of the 2023 Hawaii Wildfires. This guidance is similar to the guidance ... regarding charitable relief following the September 11, 2001, terrorist attacks."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Which Individuals Are Entitled to a Medicare Part D Disclosure Notice? (PDF)

"A 'Part D eligible individual' is an individual who [1] is entitled to benefits under Medicare Part A or enrolled in Medicare Part B; and [2] lives in the service area of a Part D plan. Part D eligible individuals could include active employees, disabled employees, COBRA participants, retirees, and, importantly, covered spouses and dependents of any of the above.... Here are more details to help you determine who should receive a notice."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

'It Ain't Over 'Til It's Over': Don't Leave COVID-19 Out of Paid Time Off Considerations

"Despite the federal government declaring the end of the COVID-19 public health emergency (PHE) and national emergency, Mr. Berra's notable quotable applies to COVID-19 leave requirements in several parts of the country. A few jurisdictions prudently switched to a permanent standard for future state and/or federally declared PHEs. Here is a non-exhaustive summary of the remaining supplemental paid leave requirements for COVID-19 and future PHEs."  MORE >>


[Guidance Overview]

Minnesota Adopts Paid Sick and Safe Leave Requirement

"Minnesota joins 17 other states and Washington, DC, in requiring accrued paid leave for employees. Starting Jan. 1, 2024 ... all employers in the state [will be required] to provide up to 48 hours of earned sick and safe time (ESST) -- accrued at one hour for every 30 hours worked -- to eligible employees working in Minnesota."  MORE >>


The Time Has Come: Consider Adding a Welfare Plan Committee

"The stakes are getting higher for welfare plan administration and oversight: new legislation, increasing DOL scrutiny and audits, and participant breach of fiduciary duty litigation have drastically changed the welfare plan fiduciary landscape.... The higher stakes for welfare plan administration may mean a committee should oversee the welfare plan administration to make sure nothing falls through the cracks -- and to mitigate fiduciary risk and protect the company's Board or other management from fiduciary liability."  MORE >>

Holland & Hart LLP

Fiduciary Governance: Monitoring and Auditing Medical TPAs, Insurers, and Other Service Providers

"[1] Engage appropriate experts to help review service providers' compliance with contract terms and performance. [2] Negotiate and include detailed contract provisions related to audit rights and ongoing compliance check-ins with service providers. [3] Identify, retain, and contract with a qualified, independent auditing company that has specialized expertise in the area(s) to be audited. [4] Take corrective actions to address deficiencies and document those efforts."  MORE >>

Nixon Peabody LLP

Drugmakers Reluctantly Agree to Medicare Drug Price Negotiations, as Lawsuits Continue

"Merck, AstraZeneca, Bristol Myers Squibb and Boehringer Ingelheim have signed agreements to participate in the first round of Medicare drug price negotiations, while the remaining drugmakers have until Oct. 1 to decide."  MORE >>

BenefitsPro; free registration required

Uncertainty Persists for Bipartisan PBM, Transparency Reforms

"The bipartisan effort in Congress to lower healthcare costs through increased transparency and competition is facing some headwinds, though the depth of support for many reforms still gives them a good chance of becoming law this year.... Virtually all these reforms have strong backing from the plan sponsor community[.]"  MORE >>


Federal Subsidies for Health Insurance: 2023 to 2033

"In 2023, federal subsidies for health insurance minus certain related payments made to the federal government are estimated to be $1.8 trillion, or 7.0 percent of gross domestic product (GDP). In CBO and JCT's projections, those net subsidies grow substantially, reaching $3.3 trillion, or 8.3 percent of GDP, in 2033. Over the 2024-2033 period ... those subsidies total $25.0 trillion[.]"  MORE >>

Congressional Budget Office [CBO]

HHS Investigation of Health Plan Results in $1,300,000 HIPAA Settlement (PDF)

"HHS's Office of Civil Rights (OCR) has announced a resolution agreement with the nation's largest publicly operated health plan that provides benefits through state, federal, and commercial programs, settling potential violations of HIPAA found during two separate incidents. OCR opened the first investigation in January of 2016 based on an online media article about the health plan released in March of 2014, alleging that some members could see other members' PHI when logging onto the payment portal."   MORE >>

Thomson Reuters / EBIA

Benefits in General

[Official Guidance]

Text of EBSA Meeting Notice for ERISA Advisory Council

"[T]he 219th open meeting of the [ERISA Advisory Council] will be held via a teleconference on Monday, October 30, 2023.... The purpose of the open meeting is for the members of the ERISA Advisory Council to discuss potential recommendations for the Secretary of Labor on the following topics: [1] Long-Term Disability Benefits and Mental Health Disparity, and [2] Recordkeeping in the Electronic Age. Descriptions of [these] topics are available on the ERISA Advisory Council's web page[.]"  MORE >>

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

[Official Guidance]

Department of the Treasury 2023-2024 Priority Guidance Plan (PDF)

29 pages.  Employee benefits items begin on page 4.  MORE >>

U.S. Department of the Treasury and Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Actuarial Analyst
            for Nyhart, part of FuturePlan by Ascensus

Actuarial Analyst

Nyhart, part of FuturePlan by Ascensus


View job as Actuarial Analyst for Nyhart, part of FuturePlan by Ascensus

Press Releases

Federal Court Orders Louisville Technology Services Provider, Retirement Savings Plan to Repay $575k to Plan Participants

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

Former DOL Investigator Launches Antifraud Software for Retirement Plans

Participant I.D.

Webcasts and Conferences
(Health & Welfare Plans)

Polling of Non-Working Americans and the Importance of Paid Leave


Seyfarth Shaw LLP

Understanding PBM Reform: A Guide to Congress’s Proposals to Enact Federal PBM Reform Legislation

October 26, 2023 WEBINAR


MHPAEA in the Courts

November 14, 2023 WEBINAR

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

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

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

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

Internal Revenue Service [IRS]

Cybersecurity's Role in Plan Governance

Roland Criss

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

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