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Health & Welfare Plans Newsletter

January 17, 2024

6 New Job Opportunities 6 New Job Opportunities

 

[Guidance Overview]

Employers Should Pay More Attention to USERRA

"[R]ecent history, including ... pending high-stakes litigation regarding whether employers must provide paid short-term military leave in certain cases, shows that the efforts of employers to comply with USERRA may be more critical today than at any previous point in the law's lifespan.... [Here are ten] reasons employers should pay more attention to USERRA and its expansive protections for service members and veterans."  MORE >>

Littler

[Guidance Overview]

CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

"The rule sets requirements for Medicare Advantage (MA) organizations, Medicaid and the Children's Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on the Federally-Facilitated Exchanges (FFEs), to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years."  MORE >>

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

DOL Sues Blue Cross Blue Shield Minnesota for Collecting $66.8m in Provider Tax

"The DOL, in the name of Acting Secretary of Labor Julie Su, sued BCBSM on two causes of action: prohibited transactions and breaches of fiduciary duties under ERISA. In its complaint, the DOL claims that, by charging the client-plans for taxes they did not actually incur, BCBSM became a fiduciary of the plans by exercising control over plan assets[.]" [Su v. BCBSM, Inc., No. 24-0099 (D. Minn. complaint filed Jan. 12, 2024)]  MORE >>

PLANSPONSOR; free registration may be required

Ninth Circuit Affirms Derivative Standing of Provider with Valid Assignment of Benefits

"the court rejected Blue Cross' contrary construction -- that the participants had assigned the right to receive payment but not the right to sue -- as one that makes 'neither textual nor practical sense,' and that would 'stym[y] Congress's purpose in enacting ERISA.' " [S. Coast Specialty Surgery Ctr., Inc. v. Blue Cross of Calif., No. 22-55717 (9th Cir. Jan. 10, 2024)]  MORE >>

Kantor & Kantor

District Court Decision Provides Reminder that Benefit Claim Denial Letters Must Comply with ERISA

"For self-insured plans, typically the administrative services agreement between the employer and the TPA requires the employer to indemnify the TPA in the event of litigation ... Employers should thus ensure that claims denial letters issued by their TPA comply with ERISA's claims review requirements, particularly if the employer is the responsible fiduciary under the plan and ERISA." [R.E. v. Blue Cross Blue Shield of Ill., No. 22-0296 (D. Utah Dec. 27, 2023)]  MORE >>

Haynes and Boone, LLP

Telehealth Use During the Early COVID-19 Public Health Emergency and Subsequent Health Care Costs and Utilization

"[U]sing telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1,000 persons), and inpatient admissions (by -32.4 per 1,000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by.773 days)."  MORE >>

Health Affairs Scholar

Assessing Early Experience with Arbitration Under the No Surprises Act

"Arbitration volumes have been high, generating large and wasteful administrative costs.... [D]ecisions have varied widely from arbitrator to arbitrator, even for similar cases. These challenges were predictable and hold lessons for future policymaking."  MORE >>

The Brookings Institution

Gen Z Employees Seek More Personalized, Year-Round Benefits Experience

"[H]alf of today's Gen Z employees say most of the benefits communications they receive do not feel relevant to them, and 63% wish their employers offered more personalized benefit recommendations.... 68% of Gen Z employees said they want their employer to communicate with them after they have enrolled in benefits, not just during annual open enrollment."  MORE >>

PLANSPONSOR; free registration may be required

What Employees Want in Their Health Care Benefits

"[1] Employees want to keep their primary provider.... [2] Employees want premiums that are affordable and low out-of-pocket costs.... [3] Employees want critical illness insurance.... [4] Employees want access to mental health services: ... [5] Employees want to understand their coverage and how it works."  MORE >>

BenefitsPro; free registration required

As More States Add Paid Family Leave, Advocates Say There's a Need for Federal Policy

"Minnesota joins 14 other states and the District of Columbia that now require paid sick days.... The political momentum for paid sick leave is continuing in other states this year, and policy experts say that momentum may eventually force the federal government to pass federal legislation as more people recognize the economic value of paid sick leave."  MORE >>

Minnesota Reformer

Benefits in General

New Year, New Coverage: Help Your Employees Avoid Mistakes

"Look out for these common stumbling blocks that can trip up any employee.... [1] Skipping dependent coverage ... [2] Misunderstanding dependent care flexible spending accounts ... [3] Frustrations with prior authorizations ... [4] Overlooking health savings account eligibility ... [5] Provider network changes ... [6] Missing or outdated beneficiary information."  MORE >>

Corporate Synergies

Employee Benefits Jobs

View job as Defined Benefit Software Support Specialist / Senior Actuarial Analyst for ASC - Actuarial Systems Corporation

Defined Benefit Software Support Specialist / Senior Actuarial Analyst

ASC - Actuarial Systems Corporation

Remote / Sylmar CA

View job as Defined Benefit Software Support Specialist / Senior Actuarial Analyst for ASC - Actuarial Systems Corporation

View job as Lead Plan Admin Analyst for Ameritas

Lead Plan Admin Analyst

Ameritas

Remote

View job as Lead Plan Admin Analyst for Ameritas

View job as Implementations and Documents Specialist for Stones River Consulting

Implementations and Documents Specialist

Stones River Consulting

Remote

View job as Implementations and Documents Specialist for Stones River Consulting

View job as Operations Manager - Distributions and Loans  for My Benefits, LLC

Operations Manager - Distributions and Loans

My Benefits, LLC

Daphne AL / FL / GA / SC

View job as Operations Manager - Distributions and Loans  for My Benefits, LLC

View job as Relationship Manager for My Benefits, LLC

Relationship Manager

My Benefits, LLC

Daphne AL / FL / GA / SC

View job as Relationship Manager for My Benefits, LLC

View job as Pension Analyst II for My Benefits, LLC

Pension Analyst II

My Benefits, LLC

Daphne AL / FL / GA / SC

View job as Pension Analyst II for My Benefits, LLC

Press Releases

Theresa Taylor re-Elected CalPERS Board President, David Miller Elected Vice President

CalPERS [California Public Employees' Retirement System]

Webcasts and Conferences
(Health & Welfare Plans)

The DOL Fiduciary Rule Proposal

January 31, 2024 WEBINAR

CEFLI [Compliance & Ethics Forum for Life Insurers]

Employee Benefits in Mergers and Acquisitions National Institute 2024

May 14, 2024 WEBINAR

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

The Excellent Fiduciary: Traits of Effective Committee Members (PDF)

Roland Criss, via Journal of Compensation and Benefits

Popular Employee Benefits to Implement This Year

HR Daily Advisor

The Drugs That Got More — and Less — Expensive This January

National Public Radio [NPR]

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

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