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Health & Welfare Plans Newsletter

October 27, 2023

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

Gag Clause Prohibitions in ERISA, the Internal Revenue Code and the Public Health Service Act

"Plans and issuers subject to these gag clause prohibitions are required to submit an annual attestation here, with the first due Dec. 31, 2023, and on each Dec. 31 thereafter.... The FAQ sheet ... includes helpful examples of what constitutes a gag clause. One such example ... makes clear that a provision giving a TPA discretion over the plan's access is considered a gag clause[.]"  MORE >>

Stevens & Lee

[Guidance Overview]

Surprise Billing Arbitrations (Partially) Restart After Litigation

"[FAQs Part 62 focus] on calculating the qualifying payment amount (QPA) under the No Surprises Act. The agencies also issued guidance about the phased reopening of the federal independent dispute resolution (IDR, or arbitration) portal following its recurring operational suspensions, and a variety of ongoing regulatory legal challenges. It's notably apparent that this new FAQ expresses both the government's response to, and opposition to, the recent decision in Texas Medical Association v. HHS."  MORE >>

HUB International

[Guidance Overview]

Roundup of State Accrued Paid Leave Mandates

"As of October 2023, 15 states ... and Washington, DC, have comprehensive laws that mandate paid sick leave. Illinois, Maine and Nevada have laws requiring accrued paid time off that can be used for any reason. More than ever, the number of these laws creates a compliance imperative for employers, especially those with workplaces in multiple states."  MORE >>


Emergency Room Spending, Price, and Use Trends 2012-2021

"The average price for an [emergency room Evaluation and Management (E&M)] visit increased by 73% between 2012 and 2021.... [F]rom 2012 to 2021 ... ER E&M spending per person increased 55%.... ER E&M spending growth was largely driven by higher severity visits. Per-person spending on the highest severity ER E&M visit rose 135%, with price increasing 56% and use increasing 50%."  MORE >>

Health Care Cost Institute

Why Drug Companies Don't Want to Sell Allergy Medicines and Bandages Anymore

"French drug giant Sanofi ... plans to spin off its consumer-health business, which includes well-known brands like allergy medicine Allegra and the pain treatments IcyHot and Aspercreme. The drugmaker is the latest -- after rivals Johnson & Johnson, Pfizer and GSK -- to hive off its division selling over-the-counter medicines and other retail products to focus on more commercially lucrative but scientifically riskier prescription drugs."  MORE >>

MSN News

Pharmacy Benefit Manager Pricing and Spread Pricing for High-Utilization Generic Drugs

"In 2021, Medicare Part D spent $11.8 billion for 690 million claims ... representing 5.5% of all Part D spending ($216 billion) in 2021. The $22.50 was distributed as follows: $9.18 (40.8%) represents PBM gross profit; $3.87 (17.2%), pharmacy gross profit; $2.71 (12.0%), wholesaler gross profit; and $6.73 (29.9%), manufacturer revenue."  MORE >>

JAMA Health Forum

Access to Employment-Based Health Benefits System Continues to Grow

"In 2017, the overall percentage of private-sector employers offering health benefits increased for the first time in nearly a decade.... In 2022, nearly 81 percent of workers employed by private-sector employers were eligible for health benefits.... Smaller establishments have shown more variability in offer rates."  MORE >>

Employee Benefit Research Institute [EBRI]


U.S. Chamber Comment Letter to Agencies on Proposed Rules for MHPAEA Requirements

"[T]he Chamber is deeply concerned with many of the dramatic and unimplementable new requirements included in the Proposed Rules. There are five particularly concerning proposed regulatory elements which the Chamber urges the Departments to reconsider and offers recommendations for revisions in the Final Rules. [1] New 3-Part test for NQTL parity: Problematic Part 1 and Problematic Part 3. [2] New 'meaningful benefit' requirement. [3] New fiduciary certification mandate. [4] Unilateral power to prohibit plan operations. [5] Problematic applicability date."  MORE >>

U.S. Chamber of Commerce

Benefits in General

[Guidance Overview]

Illinois and New Jersey Regulate Pay and Benefits of Temporary Workers

"[Illinois HB 2862 provides that,] if a temporary laborer is assigned to work for a third party client for more than 90 calendar days (non-consecutive), the temporary laborer must be paid at least the same rate of pay as the lowest paid comparable, directly hired employee, and provided equivalent benefits.... New Jersey also aims to provide covered temporary workers with equal pay and benefits to directly hired employees.... [G]uidance on determining whether benefits are comparable is very much needed."  MORE >>

HUB International

Employee Benefits Jobs

View job as Relationship Manager
            for Compass Retirement Consulting Group, Inc./Compass 360, LLC

Relationship Manager

Compass Retirement Consulting Group, Inc./Compass 360, LLC

Remote / NH / Hybrid

View job as Relationship Manager for Compass Retirement Consulting Group, Inc./Compass 360, LLC

View job as 401(k) Administrator
            for Blue Ridge ESOP Associates

401(k) Administrator

Blue Ridge ESOP Associates


View job as 401(k) Administrator for Blue Ridge ESOP Associates

View job as Regional Sales Director
            for AmericanTCS

Regional Sales Director


Remote / Butler PA / AL / AR / IA / IL / IN / KS / KY / LA / MN / MO / MS / ND / NE / OK / SD / TN / TX

View job as Regional Sales Director for AmericanTCS

Press Releases

Judge Appoints Independent Fiduciary to Distribute $781k in Assets to Participants in Defunct Michigan Company's Retirement Plan

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Webcasts and Conferences
(Health & Welfare Plans)

Guidance on State and Local Paid Sick Leave Laws, Part 11: A Decade of Paid Sick Leave Law Change


Seyfarth Shaw LLP

Last Issue's Most Popular Items

OIG Notice to EBSA of Upcoming Audit of EBSA Enforcement of Mental Health Parity (PDF)

Office of Inspector General, U.S. Department of Labor [DOL]

Can Employers Use a 'Sampling' Approach to Review Health FSA and DCAP Claims? (PDF)

Thomson Reuters / EBIA

Minnesota's New Paid Sick and Safe Leave Law

Ogletree Deakins

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

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