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Health & Welfare Plans Newsletter

October 4, 2023

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

2024 ACA Considerations for Employers

"[1] IRS enforcement of ACA penalties has become much stricter.... [2] Electronic reporting will soon be required.... [3] Affordability threshold in 2024 is decreasing to 8.39 percent!.... [4] The 4980H penalties continue to increase."  MORE >>


[Guidance Overview]

Gag Clause Attestation Due by December 31

"[W]hether an employer needs to submit a GCPCA on behalf of some or all of the provider agreements associated with their health plan will depend on each of their vendor's willingness to do it for them. At a minimum, employers will need to take inventory of which health benefits are subject to the requirement, verify with their vendors that provider contracts are compliant, and determine who is submitting attestations."  MORE >>

Assured Partners

[Guidance Overview]

Administration Issues New Rule Governing Arbitration Fees and Takes First Step to Restarting Arbitration Process

"In addition to setting the non-refundable administrative fee, the proposed rule also describes the methodology to calculate that fee, as well as setting the potentially refundable IDRE fee ranges for future disputes, and outlining considerations used to develop those ranges.... [T]he Departments also recently announced that IDREs may resume processing single and bundled (but not batched) disputes that were submitted to the portal on or before August 3, 2023."  MORE >>

ArentFox Schiff LLP

[Guidance Overview]

Exceptional Usefulness and Quality icon The ACA Monthly Measurement Method

"The monthly measurement method is one of two alternative approaches permitted under the ACA for Applicable Large Employers (ALEs) to determine employees' ACA full-time status. Unlike the more complex look-back measurement method, the monthly measurement method adopts a relatively simple approach that treats employees as full-time for any given calendar month if they complete at least 130 hours of service."  MORE >>


Tenth Circuit Deviates from U.S. Supreme Court on State Regulation of Pharmacy Benefit Managers

"At the appellate level, PCMA argued, and the Tenth Circuit agreed, that Oklahoma's law violated ERISA by limiting the options employers could use to structure its benefits. By limiting or directing the ways in which employers could structure benefit plans, PCMA argued that the law's restrictions affected the governance of matters central to plan administration sufficient to trigger ERISA preemption under Rutledge." [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]   MORE >>

Duane Morris LLP

Reasons to Remember Your Business Associate Agreements This Fall

"[1] Ensure proper and timely notification of breaches and security incidents.... [2] Shift liability for breach-related costs.... [3] Pass requirements through to subcontractors.... [4] Be prepared for an audit.... [5] Assign responsibilities to the parties."  MORE >>


High U.S. Health Care Spending: Where Is It All Going?

"More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%), wages for physicians (~10%) and registered nurses (~5%), and medical machinery and equipment (less than 5%). Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending."  MORE >>

The Commonwealth Fund

Cost Control Options for Employers Facing Rising Health Insurance Premiums

"With large trend rates impacting renewal costs, employers should closely examine alternative funding options -- especially those where maximum costs are capped. Under these programs, the employer is not responsible for paying excessive amounts if these projected costs do not materialize, yet there is downside protection if they do. Captive Insurance programs can also mitigate individual client risk. Another alternative is using Individual Coverage Health Reimbursement Arrangements (ICHRAs)."  MORE >>


What Are Self-Funded Health Plans?

"Self-funded employers have a few things in common: ... [1] When self-funded employers have enough cash reserves to weather claims, they almost always come out ahead of what they'd pay an insurance company in premiums, especially in the long run.... [2] [M]ost companies that transition to self-funded insurance do so when they have between 100 -- 500 employees. Large companies with 500+ employees are likely already self-funded or have a good reason for staying fully funded."  MORE >>

Woodruff Sawyer

A Closer Look at 2024 Federal Employee Health Benefits Premiums

"Federal employees and annuitants will, on average, pay 7.7% more in FEHB premiums next year. OPM cites increased cost and use of prescription drugs, emergency room care, and outpatient care as the primary reasons for the increase in premiums.... [This article will describe] changes in popular plans, discuss which ones saw their premiums increase above and below the average, provide enrollment advice for two-person families, and discuss FEDVIP dental and vision plan premium changes."  MORE >>

Government Executive

Employee Benefits Jobs

View job as Actuary
            for TWG Benefits


TWG Benefits


View job as Actuary for TWG Benefits

View job as Sales Support Manager
            for Alerus

Sales Support Manager



View job as Sales Support Manager for Alerus

View job as Retirement Plan Consultant
            for Definiti

Retirement Plan Consultant



View job as Retirement Plan Consultant for Definiti

Press Releases

National Board for Health & Wellness Coaching Accredits ICARE's Recovery Coach Training (CPRC) for University of Wisconsin-Stevens Point

ICARE [International Center for Addiction and Recovery Education]

Webcasts and Conferences
(Health & Welfare Plans)

Deep Dive on Service Agreements

November 16, 2023 WEBINAR

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

Gag Clause Prohibition Compliance Attestation Due December 31


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

Bricker Graydon

Retiree Medical Coverage: Just Get the COBRA Waiver

Verrill Dana LLP

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

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