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Health & Welfare Plans Newsletter

January 4, 2024

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

Are Self-Employed Owners Eligible to Participate in a Cafeteria Plan?

"Section 125 establishes the rules for cafeteria plans, which limits participation in those plans to 'employees,' a term that excludes individuals deemed 'self-employed' under the Code, including sole proprietors, partners in partnerships and LLPs, members of LLCs, and more-than-2% owners of S corporations. Being employed by the business (for example, as its CEO) does not change this determination because, from a tax perspective, at least, a person who works for a business they own is essentially working for themselves (i.e., they are self-employed)."  MORE >>


[Guidance Overview]

New York State Circular Letter Addresses Reimbursement for Treatment by School-Based Mental Health Clinics

"[F]or comprehensive health insurance policies and contracts issued, renewed, amended, modified, or altered on or after January 1, 2024, insurers must provide reimbursement for covered outpatient care when provided by a school-based mental health clinic licensed at a pre-school, elementary school, or secondary school, regardless of whether the school-based mental health clinic furnishing such services is a participating provider with respect to such services."  MORE >>


New Issue for ACA Risk Adjustment Payers and Recipients: Interest Rates

"In the context of ACA-compliant individual and small group health insurance ... the current interest rate environment has implications for some issuers that have not arisen during the history of the ACA. In particular, current interest rates could impact premium for issuers that expect to make or receive large risk adjustment transfers (potentially including high-cost risk pool collections), which occur near the end of the following plan year."  MORE >>


HIPAA Enforcement: Lessons from an Active 2023 and Regulatory Initiatives to Watch for in 2024

"OCR's first enforcement action related to a phishing attack ... Embedded tracking technologies- HIPAA covered entities and business associates should carefully review their websites ... Rights of access initiative still a top priority for OCR ... Major source of risk: Covered entity and business associate failure to conduct enterprise-wide security risk analysis ... Even small breaches can result in liability ... Ongoing OCR regulatory initiatives: changes are coming."  MORE >>

Society for Human Resource Management [SHRM]

How Prices for the First 10 Drugs Up for Medicare Price Negotiations Compare Internationally

"List retail prices for the 10 selected drugs are, on average, three times higher in the United States than in the other high-income countries. Prices after discounts and rebates in the U.S. are higher than almost all prices before discounts and rebates in peer countries, ... leaving significant room for further reductions in negotiation ... Switzerland has the second-highest prices for most of the 10 drugs, but U.S. prices remain substantially higher."  MORE >>

The Commonwealth Fund

Attracting Top Talent with Effective Leave Policies

"Conduct surveys or focus groups to gather insights into employee needs and preferences regarding leave policies.... Balance employee needs with the operational requirements of the business.... Stay abreast of federal, state, and local laws governing employee leave.... Clearly communicate leave policies as well as any changes to all employees."  MORE >>



AHIP Comment Letter to CMS on Proposed Regs for Federal Independent Dispute Resolution Operations (PDF)

25 pages. "AHIP appreciates the Departments' interest in resolving communication issues throughout the IDR process and addressing the ongoing challenges for parties to determine accurate contact and plan information necessary to initiate and ultimately resolve a dispute. While well-intentioned to address these information-sharing challenges, the proposed IDR registry would likely not achieve its intended objectives."  MORE >>

America's Health Insurance Plans [AHIP]

Employee Benefits Jobs

View job as Enrolled Actuary for Pinnacle Plan Design, LLC

Enrolled Actuary

Pinnacle Plan Design, LLC


View job as Enrolled Actuary for Pinnacle Plan Design, LLC

View job as Retirement Plan Onboarding Coordinator for The Finway Group

Retirement Plan Onboarding Coordinator

The Finway Group

West Des Moines IA

View job as Retirement Plan Onboarding Coordinator for The Finway Group

View job as Retirement Account Administrator for Alerus

Retirement Account Administrator


Remote / MN / ND

View job as Retirement Account Administrator for Alerus

Last Issue's Most Popular Items

Drugmakers Planning to Hike Prices on 500 Drugs


Massachusetts Revises Paid Family and Medical Leave Guidance to Provide More Discretion to Employers


2024 Employer Sponsored Health Plan Predictions: GLP-1s, Vendors, Data

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

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