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Health & Welfare Plans Newsletter

October 20, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

Fiduciary Governance: HIPAA and Cybersecurity Best Practices

"Plans considered 'covered entities' under HIPAA are subject to privacy and security rules governing individually identifiable health information. Plan sponsors must implement their plans' physical, administrative, and technical safeguards to protect e-PHI against cyberthreats. Fiduciaries should not stop at HIPAA-covered health data but should equally safeguard any personally identifiable information of employees in connection with their welfare benefit plans."  MORE >>

Nixon Peabody LLP

[Guidance Overview]

FAQs Issued on ACA Transparency in Coverage Requirements

"In the new FAQ guidance, the departments have determined there is no meaningful conflict between the RxDC reporting requirements and the TiC final rules. As a result, the TiC final rules' prescription drug machine-readable file requirement will be enforced, and the blanket enforcement safe harbor has been eliminated. Instead, the departments will exercise enforcement discretion on a case-by-case basis."  MORE >>

Willis Towers Watson

[Guidance Overview]

Transparency in Coverage Update: Status of Current Enforcement and Future Rulemaking

"[A]ll covered plans will need to move ahead with publishing machine-readable files with prescription drug cost information, but future guidance will be issued on the implementation timeline for those plans that have relied on the enforcement delay. Also, plans that use alternative reimbursement arrangements for in-network providers will no longer be able to use the safe harbor that was previously available for reporting in-network rates."  MORE >>

Slevin & Hart, P.C.

[Guidance Overview]

Florida Pharmacy Benefit Managers Must Be Licensed as Third-Party Administrators by January 1

"The TPA licensing process can take several months, especially if a significant number of applications are submitted at or around the same time.... [E]xisting PBMs that wish to continue providing PBM services after January 1, 2024, [should] submit the TPA licensing application materials as soon as possible because the Act includes significant penalties and public scrutiny for unlicensed activities."  MORE >>


[Guidance Overview]

When an Employee Fails to Return FMLA Medical Certification, Can an Employer Lawfully Terminate the Employee?

"If your goal is to exhaust an employee's FMLA allotment rather than issue discipline or terminate employment, then offering plenty of grace time is your game. When the employee provides certification -- whenever that is -- you simply designate all the absences as FMLA leave. The biggest issue you face is the employee who doesn't want FMLA leave to apply to his absence, so he simply refuses to provide certification, knowing that you won't discipline or terminate him for his failure to do so.... [Y]ou are not required to obtain medical certification to support the need for leave. You simply need sufficient facts to establish that the employee's leave is protected by FMLA."  MORE >>

FMLA Insights

[Guidance Overview]

Everything You Need to Know About Paid Family Leave in New York State

"New York State's Paid Family Leave Program provides paid leave to bond with a new child, care for a loved one with a serious health condition, or to help relieve family pressures when someone is called to active military service. New York Paid Family Leave Law applies to any employees of employers covered by the New York State Worker's Compensation Law, regardless of the size of the employer. Public employers may opt-in to the program."  MORE >>


[Guidance Overview]

Significant Paid Sick Leave Increases for California Employers

"The new law increases the annual accrual to 40 hours (five days), with an accrual cap of 80 hours.... California employers can also take this opportunity to confirm that their policies comply with the handful of California municipalities whose sick leave laws are still more generous than the State's paid sick leave law (including Los Angeles, San Francisco, San Diego, Emeryville, Berkeley, Santa Monica, and West Hollywood)."  MORE >>

Hunton Andrews Kurth LLP

U.S. Employers Target Healthcare Costs Mental Healthcare 2024

"[M]ore than two-thirds of U.S. employers (69%) are focused on managing healthcare plan costs. This follows a projected cost increase next year of 6.4%, compared with the average 6.0% increase employers are experiencing this year. Almost as many employers (63%) are focused on enhancing mental health and emotional wellbeing programs. Other priorities include employee experience (40%); communication (38%); diversity, equity and inclusion (37%); and employee affordability (34%)."  MORE >>

Willis Towers Watson

New Value-Based Obesity Care Provider Launches

"Founded on the belief that obesity care will only transform healthcare if it is part of the system, Ilant plans to partner with employers and payers.... It starts with identifying those who would most likely see clinical and financial value from treatment through a proprietary engine that analyzes claims data ... Then, Ilant matches individuals to the treatment most likely to drive outcomes and value best for them through an evidence-based algorithm that accounts for medical, behavioral and social determinants of health factors."  MORE >>


Benefits in General

[Official Guidance]

Text of IRS Final Regs: User Fees Relating to Enrolled Actuaries

"These final regulations amend existing regulations relating to user fees for enrolled actuaries. The final regulations increase both the enrollment and renewal of enrollment user fees for enrolled actuaries from $250 to $680."  MORE >>

Internal Revenue Service [IRS]

Employers Using Financial Wellbeing Programs to Increase Worker Satisfaction and Retention

"Benefits decision makers cited high costs of living as the top issue to address with financial wellness initiatives, supplanting retirement preparedness for the first time ever. While retirement preparedness remains an important area of focus for employers as the second-most cited area to address, issues such as health care costs, budgeting and money management and daily living expenses rounded out the top five, perhaps signaling an increase in employers' concern for their workers' day-to-day finances."  MORE >>

Employee Benefit Research Institute [EBRI]

Employee Benefits Jobs

View job as Employee Benefits Account Manager
            for U.S. Retirement & Benefits Partners

Employee Benefits Account Manager

U.S. Retirement & Benefits Partners

Rochester NY / Hybrid

View job as Employee Benefits Account Manager for U.S. Retirement & Benefits Partners

View job as Retirement Plan Services Manager
            for Kolinsky Wealth Management

Retirement Plan Services Manager

Kolinsky Wealth Management

Ramsey NJ

View job as Retirement Plan Services Manager for Kolinsky Wealth Management

Selected New Discussions

Welfare Plan Schedule A for Short Plan Year

"We will be filing a 5500 for a Welfare benefit plan with plan year of 4/1/22-3/31/23. The plan has more than 100 participants at the beginning of the plan year. The plan year is changing to 6/1/23-7/31/24 so a 5500 will need to be filed for the short plan year 4/1/23-5/31/23. We currently report 2 Schedule As. One is for the plan year and one is for the policy year 1/1/XX-12/31/XX. We will request a Schedule A from the insurance provider that uses the plan year. How do we phrase a request for Schedule A information from the insurance provider that uses a policy year of 1/1-12/31 since the short plan year is in the middle of the policy year? Or do we just use the same Schedule A that was reported on the 4/1/22-5/31/23 5500?"

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Last Issue's Most Popular Items

Text of Instructions for 2023 IRS Forms 1094-C and 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)

Internal Revenue Service [IRS]

What Are the Health Plan ID Card Transparency Requirements? (PDF)

Thomson Reuters / EBIA

PCORI Fee Amount Adjusted for 2024 (PDF)

Cowden Associates, Inc.

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

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