logo logo

Health & Welfare Plans Newsletter

October 10, 2023

5 New Job Opportunities 5 New Job Opportunities


[Official Guidance]

Text of CMS Final Regs: Medicare Secondary Payer and Certain Civil Money Penalties

37 pages. "This final rule will specify how and when CMS must calculate and impose civil money penalties (CMPs) when group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) fail to meet their Medicare Secondary Payer (MSP) reporting obligations by failing to register and report as required by MSP reporting requirements. This final rule will also establish CMP amounts and circumstances under which CMPs will and will not be imposed."  MORE >>

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

[Guidance Overview]

Departments' Surprise Billing Guidance Addresses Court Vacatur of QPA-Related Rules

"Under [FAQs Part 62], plans and insurers must continue to make QPA disclosures with their initial payments (or payment denial notices) to OON providers, facilities, and air ambulance services providers. These disclosures (which were not vacated by the August 24 ruling) must be timely made on request from a provider or facility."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

IRS Lowers ACA Affordability Percentage for 2024

"The IRS lowered the threshold for 'affordable' employer coverage under the [ACA] for 2024 to 8.39% of an employee's household income, down from 9.12% in 2023. Employers should evaluate the effect of the revised affordability threshold percentage on health plan contributions and may need to consider lowering employees' contributions for the 2024 plan year. Non-compliance with the affordability threshold could lead to IRS-assessed penalties."  MORE >>

Hanson Bridgett LLP

[Guidance Overview]

The ACA Look-Back Measurement Method

"The look-back 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 relatively simple monthly measurement method, the look-back measurement method adopts a more complex web of measurement, administrative, and stability periods. Despite the added complexity, this look-back measurement method approach provides significant administrative advantages for ALEs with employee populations whose hours tend to fluctuate."  MORE >>


[Guidance Overview]

Important Changes to Massachusetts PFML Law

"Effective November 1, 2023, the Massachusetts Paid Family and Medical Leave (PFML) law will allow employees to supplement (i.e. 'top off') benefits received from the Commonwealth of Massachusetts with any available accrued paid leave (e.g., sick time, vacation, PTO, personal time, etc.). Employees still cannot be required to use accrued paid leave either before or while on PFML."  MORE >>


Ninth Circuit: Non-Provider Assignee Lacks Standing to Sue Insurance Carriers for Benefits Under ERISA

"In a short unpublished opinion, the court held that the district court did not err by dismissing Plaintiff's complaint under Rule 12(b)(6) because Plaintiff lacks derivative authority to sue under ERISA and Plaintiff failed to sufficiently plead ERISA claims." [ABC Services Group, Inc. v. Aetna Health and Life Ins. Co., No. 22-55631 (9th Cir. Oct. 6, 2023; unpub.)]  MORE >>

Roberts Disability Law

District Court Strikes Down HHS Drug Manufacturer Coupon Accumulation Choice

"The ruling may require plans to comply with the prior HHS rule that only permitted non­ grandfathered plans to exclude the value of a manufacturer's coupon from an individual's out-of-pocket maximum when there is a medically equivalent generic available and only if permitted by state law. Currently, approximately 20 states have laws that require that any payments made on a patient's behalf be applied toward the annual out-of-pocket cost-sharing requirements." [HIV and Hepatitis Policy Inst. v. HHS, No. 22-2604 (D.D.C. Sep. 29, 2023)]  MORE >>

Arthur J. Gallagher & Co.

Employer Plan Coverage of GLP-1 Medications for Weight Loss Could Nearly Double in 2024

"[W]hile 81% of human resource (HR) decision-makers feel that their employees would be interested, only 25% cover GLP-1s today.... 79% agree that GLP-1 coverage will help employees' health long term; 77% agree that GLP-1 coverage would make employees feel they get a better health insurance package."  MORE >>


HHS: Insurers Won't Be Penalized If They Don't Update Their No Surprises Act Qualifying Payment Amounts as Required

"Insurers have close to seven months, perhaps longer, before they'll face consequences for not abiding by a court ruling that struck down the current QPA methodology.... [HHS FAQs Part 62, issued on Oct. 6, state that the] administration will not enforce the court decision until at least May 1. The grace period could extend to Nov. 1, 2024, at the administration's discretion."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Survey Identifies Failures of Traditional Employer-Sponsored Health Insurance Plans

"Four in 10 working insured find their OOP costs so expensive they're dipping into their savings or taking on personal debt at staggering rates. 35% have deferred seeking medical care within the past year due to concerns about their ability to cover the associated costs, while, 50% of those with high deductible health plans reported instances in just the past three months where they needed healthcare but didn't receive it due to cost. 31% of respondents said they have some form of outstanding debt from their medical expenses (money that they owed for health care services they could not afford at the time), with 46% experiencing debt if their deductible is greater than $1,000."  MORE >>



ERISA Fiduciary Duties: An Old Dog with New Tricks?

"ERISA is commonly criticized as a hindrance to health care cost containment, as courts have interpreted its preemption clause to limit states' power to impose a wide range of health insurance reforms that affect employer-sponsored coverage. The obligations ERISA imposes on plan fiduciaries, however, may prove to be an important tool in enabling employers to become better stewards of health care dollars and help drive down spending."  MORE >>

Health Affairs Forefront

Employee Benefits Jobs

View job as Retirement Plan Administrator
            for Pension Inc.

Retirement Plan Administrator

Pension Inc.

Green Bay WI / Hybrid

View job as Retirement Plan Administrator for Pension Inc.

View job as DC Retirement Plan Consultant
            for EGPS

DC Retirement Plan Consultant



View job as DC Retirement Plan Consultant for EGPS

View job as DB Retirement Plan Consultant
            for EGPS

DB Retirement Plan Consultant


Remote / Franklin Square NY

View job as DB Retirement Plan Consultant for EGPS

View job as 3(16) Distribution Coordinator
            for ERISA Services, Inc.

3(16) Distribution Coordinator

ERISA Services, Inc.


View job as 3(16) Distribution Coordinator for ERISA Services, Inc.

View job as Retirement Plan Data Analyst - Seasonal
            for ERISA Services, Inc.

Retirement Plan Data Analyst - Seasonal

ERISA Services, Inc.


View job as Retirement Plan Data Analyst - Seasonal for ERISA Services, Inc.

Press Releases

Retirement Advisor Council Launches FinLitFuture$

Retirement Advisor Council

Webcasts and Conferences
(Health & Welfare Plans)

Game-Changing IRA - Revolutionizing Prescription Drug Pricing and Medicare Benefits


Epstein Becker & Green

Last Issue's Most Popular Items

Nondiscrimination Testing and Form 5500 Filing Obligations for Welfare Benefit Plans


District Court Ruling Calls Into Question Whether Plans and Issuers Can Count Drug Coupons Towards ACA Out-of-Pocket Limit

Groom Law Group

HHS Increases Civil Money Penalties for HIPAA Noncompliance, Effective October 6, 2023

Thomson Reuters Practical Law

Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2023, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.