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Health & Welfare Plans Newsletter

December 5, 2023


[Guidance Overview]

Furnishing Forms 1095-C to Employees Electronically

"To furnish the forms electronically, employers must obtain the employee's affirmative consent specifically relating to receiving the Form 1095-C electronically. This approach, which is similar to the Form W-2 electronic distribution rules, is a more difficult standard to satisfy than the general ERISA electronic disclosure rules for plan materials."  MORE >>



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[Guidance Overview]

Michigan Will Require PBMs to Be Licensed Starting in 2024

"In 2024, pharmacy benefit managers in Michigan must begin applying for licenses and pay a $5,000 fee, according to new requirements the state's Department of Insurance and Financial Services unveiled this week.... Michigan's Pharmacy Benefit Manager Licensure and Regulation Act goes into effect on the first day of 2024 ... PBMs will need to apply for a third-party administrator certificate of authority, as well as for a PBM license[.]"  MORE >>

Law360, via Nexis NewsDesk

[Guidance Overview]

California Employees Will Enjoy Additional Leave Entitlements Starting in 2024

"Senate Bill 616 increases the amount of paid sick leave an employee is entitled to accrue and makes other changes with respect to accruals, frontloading, carryover and use caps. Senate Bill 848 allows employees to take up to five days leave for a reproductive loss."  MORE >>


Upcoming Deadline icon Signed, Sealed, Delivered: Have You Completed Your Plan's 'No Gag Clauses' Attestation?

"All group health plans, whether fully insured or self-insured, are required to submit an attestation to [CMS] confirming that the plan has been compliant with the prohibition on gag clauses since December 27, 2020. This must be completed by December 31, 2023, and annually thereafter. Plans are permitted to contract with their TPA or carrier to complete the gag clause reporting on behalf of the plan."  MORE >>

Holland & Hart LLP

Here's How Much GLP-1 Drugs for Weight Loss Are Amounting to in Employer Claims

"In 2023, the average representation of GLP-1 drugs used for weight loss in employers' total annual claims was 6.9 percent ... Employers that are covering GLP-1 drugs are relying heavily on utilization management (79 percent) to control costs.... 14 percent of employers have no cost control mechanism in place."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

Handling Employee Requests for Time Off for Religious Observances, Especially During the Holidays

"While employers generally are free to approve or refuse employee requests for time off, ... they are required by law to provide reasonable accommodations to employees for religious observances that conflict with work requirements at any point during the year, including holidays when there is an increase in such requests, unless doing so would create an undue hardship."  MORE >>

Wilson Elser


ERIC Comment Letter to EBSA Responding to RFI on Coverage of Over-the-Counter Preventive Services (PDF)

10 pages. "ERIC member companies ... support covering OTC preventive items and services ... However, [they] have concerns about the Departments' suggested legal and policy changes associated with requiring self-insured plans to provide coverage for OTC preventive and contraceptive preventive items or services without cost-sharing and without a prescription. These include operational challenges and barriers to access, potential strain on pharmacies, retailers, and the existing health care delivery system, threat of fraud and abuse, and increased costs for plan sponsors and plan participants."  MORE >>

The ERISA Industry Committee [ERIC]

Benefits in General

[Guidance Overview]

Checking It Twice: End of Year Actions for Benefit Plans (PDF)

"[1] Long-term part-time administrative changes ... [2] SECURE 2.0 Optional changes.... [3] Pre-approved plans with discretionary match ... [4] Qualified retirement plan routine year-end maintenance ... [5] Gag clause prohibition compliance ... [6] [MHPAEA] comparative analysis ... [7] Cafeteria plan 'family glitch' amendment."  MORE >>

Eversheds Sutherland

Using AI in Employee Benefits

"During open enrollment season, an AI platform could send out personalized reminders and help employees learn about their benefits.... Employers can use AI to sift through employee data ... and make recommendations for all kinds of benefits applications.... A chatbot could potentially answer basic questions about benefits and be used during onboarding for new employees or for all employees throughout the year.... What are the risks?"  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

Make the Most of Your Benefits Administration Platform

"Eligibility errors introduced during implementation can result in employees not getting the right benefits at the right time.... 'What if' scenarios challenge the standard operation of your platform by introducing rare, specific or nuanced situations ... Look at the full end-to-end spectrum and test how your requirements interact with each other in your system to avoid a domino effect when making changes to certain benefits.... Develop onboarding templates to help ensure there is no missing information when adding new employees to your system."  MORE >>

Corporate Synergies

Avoiding and Mitigating M&A Integration Issues in Employee Benefits (PDF)

"Most of a target company's employees will not be aware that their company will be part of an add-on acquisition until it has already happened.... Effective harmonization involves creating a seamless integration process that educates participants about the program's features and addresses their individual needs and concerns."  MORE >>


Press Releases

Hub International Strengthens Wealth Management and Retirement Consulting Services with AFS 401(k) Retirement Services, LLC and AFS Financial Group, LLC in Maryland

HUB International

Alliant Insurance Services Expands Retirement Consulting Footprint in the Northeast with FJC & Associates Acquisition

Alliant Insurance Services

Last Issue's Most Popular Items

Year‑end Health Plan Compliance Reminders


ERISA Plan Sponsors Are Responding to Heightened Fiduciary Risk


Recent ERISA Litigation Highlights

Saul Ewing LLP

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

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