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Health & Welfare Plans Newsletter

October 11, 2023

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Text of CMS Bulletin: Evaluation of EDGE Data Submissions for the 2023 Benefit Year (PDF)

17 pages. "[CMS] issues annual guidance describing the thresholds it will use ... to evaluate the sufficiency of EDGE server data for a given benefit year, including the format and timeline for baseline data submission. [This bulletin describes] the operational processes and metrics for when and how CMS intends to evaluate the sufficiency of data in terms of the 'quantity' and 'quality' of an issuer's EDGE server data submissions for benefit year (BY) 2023"  MORE >>

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

[Guidance Overview]

2023 End-of-Year Plan Sponsor 'To Do' Lists: Health and Welfare Plans

"[In 2024] employers will focus their compliance efforts on: [1] further implementing Consolidated Appropriations Act, 2021 (CAA) requirements; [2] updating fiduciary practices for health and welfare plans; [3] complying with the Mental Health Parity and Addiction Equity Act of 2008 ('MHPAEA') and tracking its proposed changes; [4] considering abortion-related plan design changes; and finally, [5] if any action items remain, winding down COVID-19 related group health plan changes."  MORE >>

Snell & Wilmer L.L.P.

[Guidance Overview]

Departments Partially Reopen Surprise Billing IDR Portal and Temporarily Extend Certain IDR Deadlines

"The Departments [had] suspended federal IDR process operations in August 2023 after two district court decisions that vacated portions of the NSA's regulations implementing and related guidance. Besides reopening the IDR process (in part), the Departments also temporarily extended certain deadlines involving the IDR process."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Business Associate Agreements: What Plan Sponsors Need to Know

"The Privacy Rule addresses using and disclosing individuals’ health information, more commonly known as protected health information or PHI. ... As part of that protection, all Covered Entities are required to have a signed Business Associate Agreement (BAA). What is this document, who does it apply to, and is it necessary?"  MORE >>

MZQ Consulting, LLC

[Guidance Overview]

California's Expanded Paid Sick Leave

"[E]ffective January 1, 2024 ... [1] Employers must annually provide five days/40 hours of paid sick leave (PSL) to employees (increased from the current three days/24 hours).... [2] Employers may cap total PSL accruals at 10 days/80 hours (increased from the current six days/40 hours). [3] Employers may limit the amount of accrued PSL employees may carry over annually to five days/40 hours (increased from the current three days/24 hours)."  MORE >>

Shaw Law Group

[Guidance Overview]

California Officially Expands Statewide Paid Sick Leave Law

"The law remains silent as to requiring documentation for use of paid sick leave, which signals that documentation should not be required when an employee is using their five days or 40 hours of paid sick leave protected by California law."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

Massachusetts Paid Family and Medical Leave Update

"[F]or employers with private plan exemptions, if your plan is insured, your insurer will be releasing a new contribution rate for CY2024 in the next several weeks. This rate may be different than the State's public plan option. Employers with private plans are allowed to require employees to contribute to the cost of coverage, provided that costs for employees are no greater than their costs would be if they were participating in the State's public plan."  MORE >>


Group Health Plans: Prepare to Comply with Additional Machine-Readable File Requirements

"A new DOL FAQ announced the end of two nonenforcement policies related to the machine-readable files required to be posted under the DOL's Transparency in Coverage rules.... Employers may want to contact their service providers to ensure appropriate processes are being developed to prepare and post the prescription drug machine-readable file."  MORE >>

Haynes and Boone, LLP

Survey Identifies Employer Top Health and Wellbeing Priorities

"[1] Company costs: 69%; [2] Mental health and emotional wellbeing: 63%; [3] Employee experience: 40%; [4] Communication: 38%; [5] Diversity, equity and inclusion: 37%; [6] Employee affordability: 34%."  MORE >>

Willis Towers Watson

October Is Breast Cancer Awareness Month: Four-Step Plan for Employer Action (PDF)

"Breast cancer has the highest treatment cost of any cancer. In 2020, the treatment cost for breast cancer was three times that of lung cancer, the second most expensive cancer.5 Employers shoulder a large portion of the direct and indirect medical costs, including absenteeism, presenteeism and disability."  MORE >>

Brown & Brown, Inc.

Communicating About HSAs to Pre-Retirees

"It's important to consider the unique needs of the pre-retiree population as retirement age draws near.... [1] Encourage employees to consider catch-up contributions.... [2] Tell employees they must take action before they are enrolled in Medicare.... [3] Remind employees what happens to their HSA balance once they stop contributing."  MORE >>

Willis Towers Watson

Walmart Expands Online Healthcare Benefits for U.S. Employees

"Walmart said it has partnered with virtual healthcare services provider Included Health to expand its online primary care services, which are already available in 21 states. The expansion comes months after Walmart announced plans to open new healthcare centers in the U.S. next year, as the company looks to expand its footing in the industry."  MORE >>

Reuters; free registration may be required

Benefits in General

Empowerment Through Benefits: Nurturing Employee Financial Health

"Nearly three-quarters of employees surveyed expressed a real desire for financial guidance ...  ... [E]mployers can implement programs such as financial coaching. They can and should include everything from information on financial literacy and counseling to planning assistance, savings programs, and debt mitigation strategies. One-on-one support with a specialist, including the option for regular check-ins to support financial wellness throughout employee careers, is also a huge plus."  MORE >>

HR Daily Advisor

Employee Benefits Jobs

View job as Actuarial Consultant
            for ERP Retirement Services

Actuarial Consultant

ERP Retirement Services

Remote / Melville NY / MO

View job as Actuarial Consultant for ERP Retirement Services

View job as Sr. Retirement Plan Reporting & Testing Analyst
            for SS&C

Sr. Retirement Plan Reporting & Testing Analyst



View job as Sr. Retirement Plan Reporting & Testing Analyst for SS&C

Selected New Discussions

No Surprises Act IDR Process

"A provider initiated the IDR process by notifying a TPA and not the plan or issuer of the dispute. The TPA never forwarded the notice. The plan only learned about the determination -- which was issued with only input from the provider -- a year later. Is it a valid determination?"

BenefitsLink Message Boards

Section 125 Permitted Election Changes Beyond 30 Days

"Other than SEPs (Medicaid/Chip), do you allow any PECs for adding a newborn beyond 30 days? I haven't gotten this question in a while but we have a plan with two requests -- one parent was admitted to an inpatient mental health facility right after the birth and one reportedly couldn't access the enrollment system (yet to be verified)."

BenefitsLink Message Boards

Press Releases

Pgim Announces Enhancements to Target Date Funds


Alera Group Retirement Plan Services Makes FiduciaryRx Platform Available Across National Footprint

Alera Group

Webcasts and Conferences
(Health & Welfare Plans)

Emerging Trends in ERISA Litigation

October 24, 2023 WEBINAR

Seyfarth Shaw LLP

Preparing For Health Care Costs in Retirement

October 24, 2023 WEBINAR


Aftermath of Dobbs: Key Issues for Employee Benefit Plans, Plan Sponsors, and Administrators

December 5, 2023 WEBINAR


Last Issue's Most Popular Items

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

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

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

Thomson Reuters Practical Law

ERISA Fiduciary Duties: An Old Dog with New Tricks?

Health Affairs Forefront

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

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