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Health & Welfare Plans Newsletter

January 9, 2024

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

New York City Council Passes Bill That Would Create a Private Right of Action Under the Earned Safe and Sick Time Act

"The proposed amendment to ESSTA would allow employees who allege a violation of their rights to commence a civil action in court. Such an action could seek compensatory damages, injunctive and declaratory relief, attorneys' fees and costs, as well as other relief the court deems appropriate."  MORE >>


[Guidance Overview]

$160k HIPAA Penalty Warns Health Plans and Other Covered Entities to Deliver Timely Access to Protected Health Information

"Once a health plan or other Covered Entity receives a request protected health information from the individual or his personal representative, the Right of Access Rule requires the Covered Entity to provide access to all requested protected health information within any 'designated record set' within 30 days unless the requested information falls within one of two exceptions to the Rule."  MORE >>

Solutions Law Press

Tenth Circuit Decision on Regulating PBMs Remains in Place as Oklahoma Appeals to U.S. Supreme Court

"A decision from the United States Court of Appeals for the Tenth Circuit, which found that several provisions of an Oklahoma law regulating pharmacy benefit managers (PBMs) were preempted by federal law, will remain in place for now after a panel denied Oklahoma's motion to stay the mandate ... [A] stay would have allowed Oklahoma to enforce the challenged provisions while it pursues review by the Supreme Court of the United States[.]" [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; pet. for en banc hearing denied Dec. 12, 2023; motion to stay denied Jan. 2, 2024)]  MORE >>

Duane Morris LLP

Michigan Health Insurers Cannot Deny New Cancer Treatments: Will Other States Step Up?

"Michigan's top insurance regulator [reminded health plans] that they cannot deny coverage for clinically proven cancer treatments, after a deceased patient's insurer refused to pay for life-saving gene therapy treatment."  MORE >>

BenefitsPro; free registration required

Walgreens to Pay $360 Million to Humana in Drug Pricing Settlement

"Walgreens has agreed to pay $360 million to healthcare insurer Humana to settle a lawsuit claiming that the retail pharmacy giant for years overcharged for prescription drug reimbursements.... Humana had claimed Walgreens filed 'millions of falsely-inflated' prescription drug prices for more than a decade."  MORE >>

Reuters; free registration may be required

Differences in the 30-Day Cost of Two Rx Drugs

"As the call for clearer prescription drug pricing has grown, there could be significant shifts in the prescription drug landscape in the coming years ... Concerns have arisen around manufacturers potentially raising costs for non-Medicare plans to recoup lost revenue from IRA price negotiations. ... [T]here are several situations that could result in increased or decreased costs for plan sponsors in addition to potential price shifting."  MORE >>


Can Employers Help Lower Health Care Prices Through Self-Insured Plans?

"Recent data from the Health Care Cost Institute (HCCI) show that price growth accounted for more than half the change in per person health care spending from 2017 to 2021. Nearly half of people in the US get health insurance through work, either through their own employer or as a dependent.... [This article answers] ten questions about the role of employers in lowering health care spending."  MORE >>

Health Care Cost Institute

Claim Denied? Health Insurers Must Promptly Hand Over Records, But Most Don't

"Federal regulations require health insurers to promptly hand over records to patients facing claim denials within 30 days, however, Anthem, Aetna and UnitedHealth blew past the 30-day deadline in a recent ProPublica investigation."  MORE >>

BenefitsPro; free registration required

Choosing the Right EAP for Your Organization

"When shopping for an EAP, it's important to consider employee knowledge gaps that might be impacting your utilization rate.... It's important to understand the breadth of programs available, and to be able to compare those options head-to-head with your current benefits plan.... When calculating your EAP's ROI, remember that employees tend to engage with these programs in waves."  MORE >>

Corporate Synergies


American Benefits Council Comment Letter to CMS on Notice of Benefit and Payment Parameters for 2025 Proposed Rule

"While the Council appreciates the departments' goal of increasing access to prescription drug coverage and in mitigating the extent of out-of- pocket costs, we are concerned that if the NBPP 2025 EHB prescription drug rule is extended to large group insured and self-funded group health plans, such plans may be forced to eliminate certain prescription drugs from their formularies due to increased plan costs, including because there is no requirement that these plans cover EHBs."  MORE >>

American Benefits Council

Benefits in General

[Official Guidance]

Text of Final DOL Regs: Employee or Independent Contractor Classification Under the Fair Labor Standards Act

339 pages. "[A]fter considering the views expressed by commenters, the Department is finalizing its [October 2022 proposal] with some modifications.... [T]his final rule returns to a totality-of-the-circumstances analysis of the economic reality test in which the factors do not have a predetermined weight and are considered in view of the economic reality of the whole activity."  MORE >>

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

What Would Overruling Chevron Mean for Labor and Employment Law?

"The Supreme Court will hear oral arguments on two cases challenging the deference given to federal agencies' interpretations of statutes they are charged with enforcing. If Chevron is overruled or pared back, federal agencies enforcing labor and employment laws will likely face more challenges to their rules and other interpretive guidance. Overruling Chevron may cause agencies to issue fewer new regulations, take more modest positions in the regulations they do issue, or both."  MORE >>


Living to 100: Strategic Benefits Planning for Employers (PDF)

"A s many as half of today's five-year-olds can expect to live to the age of 100 ... This article looks at the implications this change will have on employment, from changing attitudes toward career paths and career development to the physical and cultural environment of the workplace. Considerations include adapting to changing needs in the areas of employee health and well-being, benefits and financial planning."  MORE >>

Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS]

Employee Benefits Jobs

View job as Enrolled Actuary for Steidle Pension Solutions

Enrolled Actuary

Steidle Pension Solutions

Remote / NJ

View job as Enrolled Actuary for Steidle Pension Solutions

View job as Managing Consultant for CBIZ

Managing Consultant


Torrance CA / Hybrid

View job as Managing Consultant for CBIZ

View job as Sr. Managing Consultant for CBIZ

Sr. Managing Consultant


Philadelphia PA

View job as Sr. Managing Consultant for CBIZ

View job as Retirement Plan Consultant - Combo Plans for Definiti

Retirement Plan Consultant - Combo Plans



View job as Retirement Plan Consultant - Combo Plans for Definiti

Press Releases

WTW Appoints David Eisenreich to Lead Its Retirement Business in North America


OneDigital Announces Acquisition of Houska Insurance in California


Webcasts and Conferences
(Health & Welfare Plans)

Defending Employer Health Plans Against a New Wave of Fiduciary Litigation

January 25, 2024 WEBINAR

Faegre Drinker

Last Issue's Most Popular Items

DOL Provides Optional-Use FMLA Forms for Employers


IRS Confirms E-Filing of Form 5558 Through EFAST2 Postponed Until Jan. 1, 2025

Internal Revenue Service [IRS]

Make Cybersecurity Part of Your 2024 New Year's Resolutions


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

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