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Health & Welfare Plans Newsletter

October 12, 2023

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Text of Agencies' Request for Information: Coverage of Over-the-Counter Preventive Services

"[Treasury, DOL and HHS] are issuing this RFI to gather input from the public regarding the potential benefits and costs of requiring non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover OTC preventive items and services without cost sharing and without a prescription by a health care provider; seek comment on any potential challenges associated with providing such coverage; understand whether and how providing such coverage would benefit consumers; and assess any potential burden that plans and issuers would face if required to provide such coverage."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

Compliance and Policy Issues for Health Benefits and Family/Sick Leave in 2024

"Issues in the spotlight include preparing for sweeping new mental health parity rules proposed for 2025, ongoing compliance with numerous group health plan transparency requirements, and efforts to rein in healthcare and prescription drug costs. Employers must also contend with the growing patchwork of state rules, particularly ones targeting prescription drug pricing and paid family/sick leave.... This GRIST summarizes expected 2024 compliance and policy developments affecting health and leave benefits and suggests action steps for employers."  MORE >>


[Guidance Overview]

Agencies Request Comments on Plan Coverage of OTC Products Without Rx for ACA Preventive Services

"Plan sponsors may wish to comment on the RFI, particularly with respect to the operational considerations associated with covering an ACA OTC drug with no prescription. Issues could include increased administrative costs in setting up direct coverage of OTC ACA services as well as additional claims procedures for reimbursement. As with the coverage of OTC COVID-19 tests, group health plans would need the ability to take reasonable steps to assure medical management and prevent, detect, and address fraud and abuse."  MORE >>


[Guidance Overview]

Upcoming Deadline icon October 14 Is Deadline for Medicare Part D Notice of Creditable (Or Non-Creditable) Coverage

"[T]here are five instances in which such notice must be provided: [1] Prior to an individual's initial enrollment period for Part D; [2] Prior to the effective date of enrollment in your company's prescription drug coverage; [3] Upon any change in your plan's creditable status; [4] Prior to the annual election period for Part D (which begins each October 15); and [5]Upon the individual's request."  MORE >>

Fraser Trebilcock

[Guidance Overview]

Important Change to ACA Electronic Reporting

"Beginning in 2024, almost all employers will need to file their [ACA] forms electronically. Previously, employers were required to file electronically only if they were filing 250 or more of a specific form, such as the Form 1095-C. Now, employers must file their ACA forms electronically if they are required to file at least 10 'information returns' during the calendar year. In addition, partnerships with more than 100 partners must file their ACA forms electronically."  MORE >>

Venable LLP

[Guidance Overview]

CMS Finalizes Regs Addressing Penalties for MSP Reporting Violations (PDF)

"[F]or group health plans, responsible reporting entities (RREs) -- typically insurers or third-party administrators (TPAs) -- are required to report information to CMS about individuals who are both entitled to Medicare and covered under a group health plan.... While relatively few employers are RREs, employers that are group health plan sponsors may be asked to assist their insurers or TPAs in compiling information about participants in their plans. With enforcement activity on the rise and soon to be enhanced by penalty imposition, employers' cooperation will be vital in ensuring RRE compliance."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

Chaotic Re-Opening for No Surprises Act IDR Process

"As of October 6, 2023, the IDR portal is open for the initiation of new single disputes, including single disputes involving bundled payment arrangements. The portal remains temporarily unavailable to initiate new disputes involving air ambulance services as well as batched disputes for air ambulance and non-air ambulance items and services. IDR portal functionalities related to previously initiated batched disputes are also unavailable. The Departments recommend that disputing parties continue open negotiations in accordance with required timeframes. Those impacted by the temporary suspension of the IDR program will get more time to submit and respond to new disputes[.]"  MORE >>

Miller & Chevalier

[Guidance Overview]

California Establishes New Leave for Reproductive Loss

"Senate Bill 848 makes it an unlawful employment practice for an employer to refuse to grant an eligible employee's request to take up to five days of leave following a reproductive loss event.... The law limits the amount of reproductive loss leave to a maximum of 20 days within a 12-month period."  MORE >>


[Guidance Overview]

California Increases Paid Sick Leave Entitlements

"Effective January 1, 2024, employers must comply with the increased paid sick leave entitlements as well as changes to usage restrictions. The amended statute also requires that employers comply with new timing requirements for issuing paid sick leave when using an alternative accrual method." [Chart provides side-by-side comparison of current and 2024 requirements.]  MORE >>

Morgan Lewis

Maximizing Benefits for the Single Employee

"In a 2022 study ... 87% of respondents across all family types agreed or strongly agreed with the statement: 'Working parents have more benefits.' Work culture may also telegraph that flexible working, pay raises, and promotions are more important for employees with children than those without, creating a glass ceiling to career progression."  MORE >>


Employee Benefits Jobs

View job as Loans and Distribution Specialist
            for AimPoint Pension

Loans and Distribution Specialist

AimPoint Pension


View job as Loans and Distribution Specialist for AimPoint Pension

View job as Retirement Plan Consultant/Administrator
            for Compass Retirement Consulting Group, Inc.

Retirement Plan Consultant/Administrator

Compass Retirement Consulting Group, Inc.

Remote / NH

View job as Retirement Plan Consultant/Administrator for Compass Retirement Consulting Group, Inc.

Webcasts and Conferences
(Health & Welfare Plans)

Preparing for Year-End and a Look Ahead for Plan Sponsors


Groom Law Group

Last Issue's Most Popular Items

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

Snell & Wilmer L.L.P.

Business Associate Agreements: What Plan Sponsors Need to Know

MZQ Consulting, LLC

Communicating About HSAs to Pre-Retirees

Willis Towers Watson

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

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