logo logo

Trusted Since 1995

Health & Welfare Plans Newsletter

November 14, 2023

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

Text of CMS Memo: Application of Pharmacy Price Concessions to the Negotiated Price at the Point of Sale Beginning January 1, 2024 (PDF)

"[CMS] is issuing this memorandum to highlight upcoming requirements regarding pharmacy price concessions effective January 1, 2024. [CMS reminds] Part D plan sponsors and/or their pharmacy benefit managers (PBMs) that CMS strongly encourages them to make necessary cash flow arrangements with network pharmacies in preparation for these upcoming changes."  MORE >>

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

[Guidance Overview]

Exceptional Usefulness and Quality icon Chicago Enacts New Paid Leave and Paid Sick Leave Ordinance for 2024

"With a total entitlement of up to 80 hours of paid time off per 12-month period, the new Ordinance is one of the most generous paid time off laws in the country and will likely require policy changes for all Chicago employers prior to the end of the year.... The Ordinance applies to all employers with employees in Illinois."  MORE >>


[Guidance Overview]

Chicago Enacts Novel Dual Paid Sick Leave / Paid Time Off Law

"As the Ordinance's December 31, 2023 effective date approaches ... [1] [E]mployers should immediately review their existing paid leave and paid sick leave policies to ensure they meet or exceed the Ordinance's requirements, and prepare any updates as needed. [2] Employers should also ensure that their payroll or other systems are prepared to identify employees' paid time off balances, as required by the Ordinance, in addition to issuing other required notices and policies."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

California Employees Entitled to Greater Paid Sick Leave Benefits Starting January 1

"SB 616 expands California's sick pay law in several important ways, including by increasing the amount of paid sick leave an employee is entitled to accrue from 24 hours/three days to 40 hours/five days (whichever is greater), increasing the accrual cap on paid sick leave, and extending coverage of the law to employees covered by a qualifying collective bargaining agreement."  MORE >>

ArentFox Schiff LLP

Eleventh Circuit Affirms District Court's Approval of the BCBSA $2.67 Billion Settlement

"[E]mployers should be aware that they may have fiduciary duties under ERISA with respect to the use of any proceeds from the settlement fund.... Unless specific guidance is issued related to the BCBSA settlement, employers may want to use the [DOL's] MLR guidance as a reference when determining how to calculate what portion of the BCBSA settlement proceeds should be considered 'plan assets,' and how those funds can be used." [ In re: Blue Cross Blue Shield Antitrust Litigation MDL 2406, No. 22-13051 (11th Cir. settlement agreement approved Oct. 25, 2023)]  MORE >>

Miller Johnson


2024 Onsite Employee Health Clinics Summit (February 1 - 2, 2024; Scottsdale, AZ)

The Leading Forum on Building & Expanding On-Site Health Clinics – Incorporating Strategies that Reduce Costs, Ensure Employee Satisfaction and Positively Impact Patient Behavior

Sponsored by World Conference Forum

Employers Grapple with Claims Costs Versus Outcomes of GLP-1 Drugs

"Among survey respondents, 76% provide GLP-1 drug coverage for diabetes, 27% provide coverage for weight loss, and 13% are considering covering for weight loss.... Those who are covering GLP-1 drugs are relying heavily on utilization management (79%) to control costs. A less common approach (32%) is step therapy. Fourteen percent of employers have no cost control mechanism in place."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

Will Amazon's One Medical Discount for Prime Members Make a Dent in American Healthcare?

"The sheer volume of Amazon Prime members and the ability for them to add others to their One Medical subscription means that a very large fraction of the American population is now able to access care provided by One Medical at a discounted rate.... [It] is possible that [Amazon] could eventually disrupt the status quo by undercutting mainstream providers on price and becoming a leader in virtual healthcare delivery."  MORE >>



Will PBM Reforms, Transparency and Data-Sharing Requirements Ever Get Enacted Into Law?

"Despite all of the hard work that was put into the House PBM/Transparency/Data-Sharing legislative package ... coupled with the 'wait' of over three months now ... the Transparency and Data-Sharing requirements included in the House package are less likely to become law at this point in time. That said, there is a strong likelihood that the PBM reforms make their way into the law by the end of the year or at least by the end of the second quarter of 2024."  MORE >>


Benefits in General

Common Mistakes in Communications to Employees About Benefits

"This is the age of information overload: don't assume that means everyone knows and understands what your message is about.... Are you placing an over reliance on one form of employee communication to the exclusion of all others? ... Transparency builds trust and helps eliminate the blank spaces that will be surely filled in with assumptions, rumors and misinformation."  MORE >>


Employee Benefits Jobs

View job as Senior Implementations Associate
            for Vestwell

Senior Implementations Associate


Remote / New York NY

View job as Senior Implementations Associate for Vestwell

View job as Senior Account Executive
            for Vestwell

Senior Account Executive


Remote / New York NY / Hybrid

View job as Senior Account Executive for Vestwell

View job as Retirement Plan Consultant
            for 401k Industry Matchmakers - CPS Inc

Retirement Plan Consultant

401k Industry Matchmakers - CPS Inc

Remote / Chicago IL / CA / CO / FL / IN / KY / OH / PA / TX / WA / WI

View job as Contribution Specialist
            for American Trust Retirement

Contribution Specialist

American Trust Retirement

Remote / Lexington KY / Hybrid

View job as Contribution Specialist for American Trust Retirement

Selected New Discussions

Trying to Get Access to Critical Drug on Temporary, 'Exception Basis' Under Self-Insured Plan

"Employer has self-insured health plan. One participant depends on prescription drug to stay alive. The drug is covered under the formulary and normally no issue; however, the drug is in short supply currently and the one network pharmacy for the plan cannot provide on a reliable basis. The drug can, with some effort, be found elsewhere, including at retail, but is out of network. Network provider (ASO insurance company) has suggested coverage be extended at member's current benefit level to cover purchases at any pharmacy that has drug available for temporary period while supply is so restricted. Provider wants employer / plan sponsor to sign an exception form agreeing to cover all costs and also to hold provider harmless, etc. Employer is eager to help and ok with exception generally and picking up the additional drug costs. (The added costs have not been great thus far. They will also clear with their stop loss provider.)

"Part of the hold harmless agreement, however, has Plan acknowledge that making benefit exceptions for the group health plan could violate provisions of state and federal law, including ERISA, the Code, HIPAA, COBRA, etc. and result in significant penalties and adverse tax consequences, etc. Here the member at issue is not a highly compensated individual and the exception being made is tied just to the lack of consistent supply for the drug with the plan's pharmacy network. The drug is covered under the plan and so not an exception in and of itself. The Plan / Employer is just trying to find a way to provide a critical drug that it has otherwise promised to provide.

"Plan wants to know if there really are material discrimination concerns or other significant penalties or adverse tax consequences here that could arise."

BenefitsLink Message Boards

Press Releases

Empower Small Plan Sales Top $10 Billion for 2023


The ERISA Industry Committee President and CEO James Gelfand Named a Top Lobbyist of 2023

ERIC [ERISA Industry Committee]

Envestnet Launches Envestnet Retire Complete -- Providing Advisors Access to a Competitive Retirement Savings Program for Clients


2023 Executive and Board Comp Survey Results Now Available

National Center for Employee Ownership [NCEO]

Intuit QuickBooks Partners with Allstate Health Solutions to Bring Comprehensive Healthcare Coverage to Small Businesses


Webcasts and Conferences
(Health & Welfare Plans)

2023 Compliance Year-End Review



How to Stay Golden in California as Paid Sick & Safe Leave Standards Change in 2024

December 5, 2023 WEBINAR


Last Issue's Most Popular Items

2024 Health FSA, Other Health and Fringe Benefit Limits Now Set


Employers with Chicago-Based Employees Face Significant New Mandatory Paid Leave Requirements Effective January 1

Hinshaw & Culbertson LLP

Changes to Chicago's Paid Leave Ordinance Create Challenges for Employers

Quarles & Brady LLP

Unsubscribe  |   Change Email Address

Search Past Issues   |   Privacy Policy

Submit an Article   |   Contact Us   |   Advertise Here

Copyright 2023, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

Links to web sites other than and are offered as a service to our readers. We are not involved in their production and are not responsible for their content.