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Health & Welfare Plans Newsletter

January 15, 2024

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[Guidance Overview]

Fast-Approaching Deadlines for ACA Reporting and Similar State Reporting

"With respect to health coverage in 2023, the ACA deadlines range from February 28, 2024 to April 1, 2024, and the state deadlines range from January 31, 2024 to April 30, 2024."  MORE >>

Venable LLP

[Guidance Overview]

A Change Would Do You Good, But Do the Section 125 Cafeteria Plan Rules Permit It?

"[If] an employee accidentally checked the wrong box on the form ... or there was a computer error, you might decide to put them in the position they thought they had elected. But if it looks like the employee simply regrets their choice and wishes they had done something different, be very careful in allowing changes! You'll be violating the Section 125 rules, possibly committing a fiduciary breach under the medical plan, and might be getting in hot water with your stop-loss carrier."  MORE >>

Holland & Hart LLP

[Guidance Overview]

Potential New York City Paid Sick Leave Private Right of Action Looms

"[T]he New York City Council [has] passed legislation that would create a private right of action to enforce the Earned Safe and Sick Time Act (ESSTA). If the legislation becomes law, it would allow employees who allege a violation of ESSTA to bring forward a civil action in court, in addition to filing a complaint ... If the legislation is not vetoed by [January 19, 2024], it becomes law and would go into effect 60 days later, i.e., by no later than March 19, 2024."  MORE >>

Seyfarth Shaw LLP

Ninth Circuit Finds Assignment of Rights Gives Surgery Center Authority to Sue Anthem for Non-Payment of Benefits

"The Ninth Circuit reversed the district court's determination and held that a healthcare provider does have derivative authority to enforce ERISA's protections if it has received a valid assignment of rights ... The court did limit its decision by stating that it does not hold that all assignments confer the right to sue under ERISA. The court explained that the decision does not give standing to third parties, with no relationship to the beneficiary, that purchase assignments of claims for the purpose of litigating them." [Coast Specialty Surgery Ctr., Inc. v. Blue Cross of Calif., No. 22-55717 (9th Cir. Jan. 10, 2024)]  MORE >>

Roberts Disability Law

The Role of Pharmacy and Employer Strategies in the Obesity Crisis

"As health plan sponsors, employers play a crucial role in combating the obesity crisis within their organizations ... [1] Health benefits design ... [2] Wellness programs ... [3] Education and awareness ... [4] Employee assistance programs ... [5] Collaboration with Pharmacy Benefit Managers (PBMs)."  MORE >>

AssuredPartners

Over Half of U.K. Employers Report a 'Formal Wellbeing Strategy': Does It Help?

"[T]his article uses survey data to compare participants and nonparticipants in a range of common individual-level well-being interventions, including resilience training, mindfulness and well-being apps. Across multiple subjective well-being indicators, participants appear no better off.... Overall, results suggest interventions are not providing additional or appropriate resources in response to job demands."  MORE >>

Health Services Research

[Opinion]

United Behavioral Health in the Supreme Court: When Is Residential Treatment Covered as Medically Necessary?

"UBH is asking the Supreme Court to validate its ability to ignore physician-recommended treatment plans in order to deny paying for residential treatment.... If the extraordinarily acute claim presented in the A.K. case is not medically necessary, then claim administrators will have unfettered license to deny virtually any future claim for residential treatment. It may be what health care companies want, but is that the result plan sponsors want for their employees and plan participants?" [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023; cert. pet. filed Nov. 29, 2023, No. 23-586)]  MORE >>

Euclid Specialty Managers

Benefits in General

Justice O'Connor Was Architect of ERISA's Lasting Success

"The Dec. 1 death of retired U.S. Supreme Court Justice Sandra Day O'Connor ... allows us to reflect on her impact on [ERISA] as we look ahead to the statute's 50th anniversary later this year.... Two common themes in these cases are reliance on the principles of trust law and faithful adherence to the language in the controlling plan documents. Other ERISA issues shaped by Justice O'Connor's reasoning include the formal processes of plan operations, amendments to plans, vesting and nonforfeitable rights, welfare plans, interplay between ERISA and employment law, and finally, ERISA preemption."  MORE >>

Fox Rothschild LLP

Employee Benefits Jobs

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Last Issue's Most Popular Items

Is an 'Excepted Benefit' Subject to ERISA?

Willis Towers Watson

Self-Funded Plan Administrators Must Meaningfully and Effectively Communicate with Plan Participants and Their Providers on Appeal of Claim Denial

Woodruff Sawyer

DOL Issues 2024 Adjusted Penalty Amounts (PDF)

Thomson Reuters / EBIA

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

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