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Health & Welfare Plans Newsletter

October 23, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

HHS Adjusts 2023 HIPAA, Certain ACA and MSP Monetary Penalties

"Though HHS rules directly impact health insurance issuers, employer plan sponsors may be indirectly affected by certain requirements: ... The maximum penalty for each failure by a health insurance issuer to provide SBCs to covered individuals increases to $1,362 (up from $1,264).... The maximum penalty for each failure by a health insurance issuer to comply with MLR reporting and rebate regulations increases to $136 (up from $126).... Penalties for violations of certain MSP rules [also] increase[.]"  MORE >>


[Guidance Overview]

New York City Amends Earned Safe and Sick Time Act Regs

"[The amended rules] provide clarification and guidance in areas employers often have questions about, including employee eligibility, employer size, notice and documentation requirements, and accruals ... [and] clarify employers' responsibility to report accrual, usage and balance information to employees on a paystub or accessible electronic system."  MORE >>


[Guidance Overview]

Starting November 1, Massachusetts Employees Can 'Top Off' Paid Family and Medical Leave Benefits

"Employees who apply for PFML benefits on or after November 1, 2023 will be permitted to use accrued paid leave to supplement the PFML benefits they receive from DFML. Employees will be allowed to opt to use accrued paid leave to supplement their PFML benefit up to a combined weekly sum equal to the amount of their Individual Average Weekly Wage (IAWW)."  MORE >>

Davis, Malm & D'Agostine P.C.

District Court Denies Cross-Motions on Standard of Review in Favor of Eleventh Circuit's Six-Step Framework for Evaluating ERISA Benefit Actions

"United of Omaha argued that the arbitrary and capricious standard of review applied strictly based on the plan's grant of discretionary authority to determine benefits eligibility. The Court also denied this motion finding that United of Omaha had not established that the Court could or should depart from the six-step framework." [Davis v. United of Omaha Life Ins. Co., No. 23-0057 (N.D. Ala. Oct. 17, 2023)]  MORE >>

Roberts Disability Law

How Proposed Mental Health Parity Regs Could Impact Access to Benefits

"[T]he employer community is concerned that the regulatory burden that is required to be compliant with the law will have [a detrimental] effect on increasing access to MH/SUD benefits ... [because] the proposed requirements are unworkable and efforts to even attempt to comply will be extremely costly. Some employers are even suggesting that the proposed requirements may force them to re-think the type and level of their plans' coverage of MH/SUD benefits."  MORE >>


Ozempic and Wegovy Don't Cost What You Think They Do

"The drugs' list prices are generally very different from the net prices, which companies receive after making secret deals with health insurers or the intermediaries known as pharmacy benefit managers.... A recent paper published by the American Enterprise Institute revealed that ... Wegovy's net price is about half of its list price, Ozempic's is nearly two-thirds lower and Mounjaro's net price is nearly 80 percent lower than its list price."  MORE >>

The New York Times; subscription required

Estimating the Cost of New Treatments for Diabetes and Obesity (PDF)

"[E]xisting research has incompletely characterized prices by focusing on only undiscounted list prices. [The authors] estimate that net prices received by drugmakers are 48 -- 78 percent lower than list prices. [They] document a large difference between net payments to manufacturers and the prices faced by some consumers who pay list prices[.]"  MORE >>

American Enterprise Institute

HSA and FSA Account Reminders for Year End

"[Employers can help employees] remember to not let their health and finances fall to the wayside, especially when it comes to their Health Savings Account (HSA) and Flexible Spending Account (FSA).... [1] The difference: HSA vs. FSA ... [2] Review their account balances ... [3] Understand their plan ... [4] Plan their medical expenses ... [5] Keep receipts and documentation ... [6] Use account tools ... [7] Communicate with their benefits team."  MORE >>

Assured Partners

Abortion Coverage Limited or Gone at 25% of Corporations

"KFF's 2023 annual survey found that 10% of large employers -- defined as those with at least 200 workers -- don't cover legal abortion care under their largest job-based health plan. An additional 18% said legal abortions are covered only in limited circumstances, such as when a pregnancy is the result of rape or incest, or endangers a person's life or health."  MORE >>

The Charlotte Post

Benefits in General

[Guidance Overview]

IRS Extends 2023 Form 5500 Filing Deadline for California Plans

"The California Franchise Tax Board (FTB) has also extended its deadline to conform to the IRS's extended deadline.... The IRS did not announce this latest deadline extension until the due date so many plan administrators may have already filed their Forms 5500. However, for those plan administrators who did not file their Forms 5500 by October 16, 2023, this short extension will come as a welcome relief."  MORE >>

Boutwell Fay LLP

Employee Benefits Jobs

View job as Manager, Retirement Plan Services Recordkeeping
            for 1st Source Bank

Manager, Retirement Plan Services Recordkeeping

1st Source Bank

South Bend IN

View job as Manager, Retirement Plan Services Recordkeeping for 1st Source Bank

View job as VP, Business Development
            for Segal

VP, Business Development


New York NY / Hybrid

View job as VP, Business Development for Segal

Press Releases

Pozek Named 2023 Winner of Thomas J. Finnegan III Educator’s Award

ASPPA [American Society of Pension Professionals & Actuaries]

Webcasts and Conferences
(Health & Welfare Plans)

Automating Payroll in the 2first Century and Cybersecurity

October 26, 2023 in CA

Western Pension & Benefits Council - Orange County Chapter

Last Issue's Most Popular Items

Fiduciary Governance: HIPAA and Cybersecurity Best Practices

Nixon Peabody LLP

FAQs Issued on ACA Transparency in Coverage Requirements

Willis Towers Watson

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

FMLA Insights

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

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