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Health & Welfare Plans Newsletter

October 3, 2023

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[Guidance Overview]

Exceptional Usefulness and Quality icon Gag Clause Prohibition Compliance Attestation Due December 31

"The removal of gag clauses from medical and pharmacy contracts is [the plan sponsor's] responsibility and should include a thorough review of BAA's and NDA's [the plan has] in place with medical and pharmacy carriers. Although the CAA-2021 amends ERISA laws, public sector employers must also attest that all gag clauses are removed from contracts to give unfettered access to data to make more informed healthcare decisions."  MORE >>


[Guidance Overview]

Departments Roll Back Enforcement Discretion in New Guidance on Transparency in Coverage Rules.

"As originally enacted, the TiC Final Rules require group health plans and health insurance issuers to disclose on a public website in-network negotiated rates and historical net prices for covered prescription drugs.... [FAQ Part 61] provides that enforcement of the rule will now be exercised on a case-by-case basis ... The Departments have [also] clarified that enforcement of the requirement to disclose certain rates as dollar amounts is a fact-specific determination exercised on a case-by-case basis, rather than a blanket safe harbor."  MORE >>

Bricker Graydon

[Guidance Overview]

Departments Propose Another Increase to IDR Fee; Will It Stick?

"The new proposed fees of $150 (from $50) will take effect on January 1, 2024, after a notice and comment period.... This rule comes as a relief to both payors and providers who have been waiting to hear when the Federal IDR Process will restart after the portal has been partially paused due to recent litigation."  MORE >>

Foley & Lardner LLP

[Guidance Overview]

Retiree Medical Coverage: Just Get the COBRA Waiver

"Many employers incorrectly assume they do not have to offer COBRA at retirement if they offer a retiree medical plan or a retiree health reimbursement arrangement (HRA), but the calculus is not that simple. Whether there is a requirement to offer COBRA and if so, to whom and when, depends on a number of factors[.]"  MORE >>

Verrill Dana LLP

[Guidance Overview]

Managing State Individual Healthcare Mandates

"Typically, states have a different definition of who is considered a resident and who needs to be reported for purposes of their state individual mandates. Additionally, states can have their own unique reporting deadlines, acceptable data formats and methods for submitting data.... As of September 2023, the states with their own mandates include Massachusetts, California, New Jersey, Rhode Island, Vermont and Washington, D.C."  MORE >>



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Sponsored by BRI Network

[Guidance Overview]

New York City Clarifies Employer Obligations Under Paid Safe and Sick Time Law

"The amended regulations, which take effect October 15, better align with the ordinance's 2020 amendments and provide additional clarifications of employer obligations."  MORE >>


[Guidance Overview]

Massachusetts Updates Paid Family and Medical Leave Contribution Rates, Maximum Weekly Benefits for 2024

"The benefit contribution rate for employers has been increased to .88% of eligible wages.... The maximum weekly benefit amount will be $1,144.90 per week."  MORE >>

Jackson Lewis P.C.

DOL Settlement Warns Insurers, Plans to Timely Decide Insurability in ERISA-Covered Life, Disability and Other Plans

"The investigation found that United denied numerous claims based on a participant's failure to provide evidence of insurability, after accepting premiums for years without determining if insurability requirements were satisfied.... In light of this, and a prior similar enforcement action against another insurer in 2022, all sponsors, fiduciaries, administrators, and insurers of ERISA-covered group life, disability, or other insurance programs requiring insurability should verify the timeliness of insurability determinations made by their programs currently, and within the applicable statute of limitation period for claims"  MORE >>

Solutions Law Press

HHS Moves Forward with Medicare Drug Price Negotiations

"[A]ll 10 drug companies whose drugs were selected for price negotiation with Medicare for the first cycle of the program have decided to participate in those negotiations.... These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023 ... Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs."  MORE >>

U.S. Department of Health and Human Services [HHS]

Benefits in General

Approaches, Considerations and the Steps to Launch an Education Financing Offering (PDF)

10 pages. " Depending on the commitment an employer is willing and able to make, and the needs of its employees, while balancing all benefit considerations, there are two primary approaches employers can use to address student loan debt, as well as a few expanded approaches an organization should consider."  MORE >>


Benefits for a Multigenerational Workforce: Meeting the Needs of Different Age Groups

"In today's dynamic work environment, one of the most complex challenges faced by employers is managing a multigenerational workforce.... One way to bridge this gap is through the strategic design of employee benefits packages that cater to an age diverse population.... Before you construct a new benefits strategy, it's essential to understand the key preferences of each generation."  MORE >>

Assured Partners

Employee Benefits Jobs

View job as Retirement Services Analyst
            for Sacramento County Employees' Retirement System

Retirement Services Analyst

Sacramento County Employees' Retirement System

Sacramento CA

View job as Retirement Services Analyst for Sacramento County Employees' Retirement System

Selected New Discussions

Prevailing Wage Credit for HRA Audit Expenses

"A construction company subject to prevailing wage laws sponsors an HRA funded via a trust. Contributions are made to the trust for each hour worked, and the trust reimburses participants when they incur medical expenses. The trust also pays Plan audit fees and legal expenses. The question is whether the company can take full prevailing wage credit for all contributions to the trust if a portion of those contributions are used to pay Plan audit fees and legal expenses rather than provide direct reimbursement benefits."

BenefitsLink Message Boards

Press Releases

Guideline Launches New Starter Plan, Making 401(k)s Even More Accessible for Millions of People


Mineral Adds Select Health to Embed HR and Compliance Solutions in Employer-Sponsored Health Plans


Ceridian to Become Dayforce


Webcasts and Conferences
(Health & Welfare Plans)

Employer Compliance Guide to the CAA's No Gag Clause and Attestation Requirements


NFP Corp.

End of the Year Health and Welfare Benefit Plan Checklist

October 18, 2023 WEBINAR

Miller Johnson

HSAs and Medicare

November 14, 2023 WEBINAR


Another Look at Bias

November 15, 2023 WEBINAR

Conference of Consulting Actuaries

Last Issue's Most Popular Items

House Ways and Means Committee Approves Legislation to Dramatically Expand HSA Limits

American Retirement Association [ARA]

The Proposed MHPAEA Regs' Meaning of Terms: Processes, Strategies, Evidentiary Standards and Other Factors

McDermott Will & Emery

Medicare Part D Prescription Drug Rebates: Possible Impact of the Inflation Reduction Act


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

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