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Health & Welfare Plans Newsletter

January 19, 2024

5 New Job Opportunities 5 New Job Opportunities


[Guidance Overview]

2024 Federal Poverty Levels Can Impact ESR Affordability

"[HHS] issued updated FPL figures effective Jan. 11, 2024, that will apply for 2025 calendar-year plans and noncalendar-year plans beginning in 2024. Employers with calendar-year plans can't rely on those higher FPLs for 2024 affordability testing. Instead, 2024 calendar-year plan sponsors must use the 2023 FPL amounts."  MORE >>


[Guidance Overview]

PCORI Fees Due by July 31, 2024

"Notice 2023-70 sets the adjusted applicable dollar amount used to calculate the fee at $3.22.... [T]his fee is imposed per average number of covered lives for plan years that end on or after October 1, 2023, and before October 1, 2024. For self-funded plans, the average number of covered lives is calculated by one of three methods: [1] the actual count method; [2] the snapshot method; or [3] the Form 5500 method."  MORE >>

Fraser Trebilcock

Ninth and Eleventh Circuits Issue Mixed Decisions on Assignments of ERISA Claims

"The [Ninth Circuit] cautioned that not 'all assignments of the right to benefits ... necessarily confer the right to sue under ERISA' and expressly limited its decision ... The Ninth Circuit's decision ... came on the heels of pair of appeals before the Eleventh Circuit that also raised questions regarding the assignment of ERISA claims.... In both cases, the Eleventh Circuit held that [the provider] ... lacked standing under ERISA." [South Coast Specialty Surgery Ctr., Inc. v. Blue Cross of Calif., No. 22-55717 (9th Cir. Jan. 10, 2024); Griffin v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., No. 23-11414 (11th Cir. Dec. 19, 2023); Griffin v. AT&T Services, Inc., No. 23-11408 (11th Cir. Dec. 21, 2023)]  MORE >>

Miller & Chevalier

District Court Orders Claims Reprocessing for TPA Activities That Violated ACA Section 1557 (PDF)

"Court decisions continue to demonstrate the uncertainty surrounding the scope of Section 1557 as applied to employer-sponsored health plans. As we wait for the Section 1557 regulations proposed in 2022 to be finalized, this court has already rejected the 2020 regulations based on a plain reading of the statute's text." [C.P. v. Blue Cross Blue Shield of Ill., No. 20-6145 (W.D. Wash. Dec. 19, 2023)]  MORE >>

Thomson Reuters / EBIA

Want to Fire Your Employee for FMLA Fraud?

"Of course, employees do sometimes do get caught ... taking fraudulent FMLA leave ... If it turns out that the employee's activity was consistent with her alleged medical condition and that the activity had been authorized by her health care provider, then the leave is almost certainly not fraudulent. Which means that if you fire without considering these possibilities and conducting an adequate investigation, you could be liable -- in one way or another -- for terminating an employee on a legitimate FMLA leave." [Burnett v. East Tallahatchie School Dist., No. 23-183 (N.D. Miss. Jan. 11, 2024)]  MORE >>

Constangy, Brooks, Smith & Prophete LLP

Some Employers Are Adding Psychedelic Drugs to Their Roster of Health Benefits

"Traditional treatment for depression, like SSRIs, doesn't serve everyone.... Yet, coverage of alternatives, such as generic ketamine, that might just stand to get people off of ineffective SSRIs altogether, is scarce among major commercial health insurance plans.... Employers across industries, from trucking, to software, gaming, financial services, healthcare, and retail, are adding this medicine to health benefits packages."  MORE >>


No Surprises Act Continues to Prevent More Than 1 Million Surprise Bills Per Month, While Provider Networks Grow (PDF)

"[D]espite a high volume of claims being submitted to independent dispute resolution (IDR), the law's components appear to be working ... Health care providers typically accept the initial payment made by health insurance providers ... [T]wo-thirds of health insurance providers report their provider networks have increased since the NSA became law, with none reporting an overall reduction in participating providers."  MORE >>

America's Health Insurance Plans [AHIP]

Out-of-Control Healthcare Costs Are a Symptom of a Broken System

"The debate about cost often moves between unit cost and utilization. However, [the authors] believe it's a combination, with utilization the bigger concern. Also, the most critical requirement is keeping quality of care high. This article will examine these issues and explores how value-based care models, directed by primary care physicians, are a potential solution."  MORE >>

Willis Towers Watson

Summary of California Large Group Health Insurance Filings 2021-2024

"The large employer group health insurance market lacks a standardized source for nationwide premium development information. California regulations require issuers of these health insurance products to submit rate filings to their regulator(s). This whitepaper summarizes key statistics from the first four years of these filings."  MORE >>


Crossroads of Tech and Benefits: Navigating Self-Funded Benefit Plans in 2024

"In addition to being cognizant of requirements and best practices, employers now must understand how new innovative technologies and solutions, namely artificial intelligence (AI), will impact their businesses and benefit offerings.... [As] employers consider the best way to leverage AI, they should be aware of the impact it may have on data privacy and security, sensitive personal information, and potential breaches."  MORE >>

BenefitsPro; free registration required

Employee Benefits Jobs

View job as Retirement Operations Supervisor for Alerus

Retirement Operations Supervisor


Remote / MN / ND

View job as Retirement Operations Supervisor for Alerus

View job as Employee Benefits Attorney for Hill Ward Henderson

Employee Benefits Attorney

Hill Ward Henderson

Tampa FL / Hybrid

View job as Employee Benefits Attorney for Hill Ward Henderson

View job as Retirement Plan Relationship Manager for ERISA Services, Inc.

Retirement Plan Relationship Manager

ERISA Services, Inc.


View job as Retirement Plan Relationship Manager for ERISA Services, Inc.

View job as Distribution Specialist for ERISA Services, Inc.

Distribution Specialist

ERISA Services, Inc.


View job as Distribution Specialist for ERISA Services, Inc.

View job as Client Service Manager for July Business Services

Client Service Manager

July Business Services


View job as Client Service Manager for July Business Services

Selected New Discussions

Exceeded FSA Contribution Limit

"An employee elected $3,050 for 2023 FSA. During 2023, the employer began using direct deposit for payroll. The result of the direct deposit is that the payroll company processed the 01/01/2024 payroll early, December 29, 2023. The 01/01/2024 compensation and deductions are now included for all purposes in 2023. So the participant that elected the $3,050 FSA for 2023 has now deferred $3,200 for 2023. It seems to me this is an excess contribution. Does it need to be distributed to the participant as such?"

BenefitsLink Message Boards

Press Releases

WELCOA and the National Wellness Institute (NWI) Announce New Partnership

National Wellness Institute

PBGC Names Six Firms for Smaller Asset Managers Program

PBGC [Pension Benefit Guaranty Corporation]

Webcasts and Conferences
(Health & Welfare Plans)

Taking on 2024 as We Leave 2023


Seyfarth Shaw LLP

Risks May Be Bigger Than They Appear: A Rearview Look at 2023 Labor and Employment Law Changes and a Guide to Potential 2024 Obstacles

February 6, 2024 in NY

Davis+Gilbert LLP

Last Issue's Most Popular Items

2023 Year in Review Plus What to Expect in 2024 (PDF)


ACA Reporting Deadlines and Penalties Cheat Sheet


When to Distribute an Updated Wrap SPD


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

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