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Health & Welfare Plans Newsletter

January 22, 2024

 

[Official Guidance]

Text of Agency FAQs, Part 64: Coverage of Preventive Services (PDF)

10 pages. "In light of ... reports of continued barriers and difficulty accessing contraceptive coverage without cost sharing the Departments are issuing the following FAQs ... 

  • Q1: Other than what has been described in previous guidance, how can plans and issuers ensure compliance with the requirement to cover the full-range of FDA-approved contraceptive drugs and drug-led devices without cost sharing under PHS Act section 2713 and its implementing regulations? ...
  • Q2: How will the Departments determine whether a contraceptive drug or drug-led device is therapeutically equivalent to another drug or drug-led device? ...
  • Q3: Does the approach to reasonable medical management with regard to therapeutically equivalent products described in Q1 and Q2 apply to all forms of contraception required to be covered under PHS Act section 2713? ...
  • Q4: If a plan or issuer covers without cost sharing all FDA-approved contraceptive drugs or contraceptive drug-led devices other than those for which there is a covered therapeutic equivalent, is the plan or issuer still expected to maintain an exceptions process as previously described in guidance? ...
  • Q5: Can plans and issuers continue to satisfy the requirements under PHS Act section 2713 with respect to coverage of the full range of FDA-approved, -cleared, or -granted products -- including with respect to contraceptive drugs and drug-led devices -- by following the Departments' prior guidance? ...
  • Q6: What should an individual do if the individual has concerns regarding, or has difficulty with, accessing contraceptive coverage under their group health plan or group or individual health insurance coverage?'

MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

Philadelphia's COVID-19 Sick Leave Law Expires

"[E]mployers should be mindful that they may still be required to provide paid or unpaid sick leave to Philadelphia employees under the City’s Promoting Healthy Families and Workplaces law."  MORE >>

Jackson Lewis P.C.

District Court Finds Insurer Owed No Duty to Inform Plan Participant of Life Insurance Conversion Rights Upon Resignation

"[No] exit interview was conducted for Decedent, nor did Beacon advise of her rights under the Policy after termination. The Policy gave Decedent the option of converting her basic life insurance coverage to a personal policy within thirty days of her termination, but Decedent never converted the policy.... The Court held that Seventh Circuit precedent precluded recovery for the alleged lack of disclosure [and that] Beacon had no duty to inform Plaintiffs of Decedent's conversion rights under ERISA. " [Estate of Presnal v. Dearborn National Life Ins. Co., No. 23-0290(N.D. Ind. Jan. 11, 2024)]  MORE >>

Roberts Disability Law

UnitedHealthcare Debuts Resource Hub in Bid to Expand Wellness Programs, Lower Costs

"The UHC Hub, which debuted this month, includes more than 20 stand-alone health programs available for self-funded customers to purchase, including point solutions focused on healthy living, financial planning, complex health conditions and digital coaching."  MORE >>

Healthcare Finance News

Health Insurers' Stocks Drop on More Disappointing Medical Cost News

"[Humana] warned that medical costs were running higher than expected and signaled that the pressure might impact its 2024 results as well.... The company's news, following UnitedHealth Group's recent disclosure of higher fourth-quarter medical costs, adds to Wall Street concerns about health insurers' results[.]"  MORE >>

The Wall Street Journal; subscription may be required

What the Health Care Sector Was Selling at the J.P. Morgan Healthcare Conference

"No one really knows how far -- or where -- AI will take health care ... Recent research shows that the use of [GLP-1] drugs for three years reduces the risk of death, heart attack, and stroke in non-diabetic overweight patients. To do right by them, the U.S. health care system will have to reckon with the need for long-term use ... Biosimilars could save the U.S. health care system $100 billion a year ... but there are challenges since each biosimilar costs $150 million to $250 million to develop."  MORE >>

KFF Health News

Price Transparency Isn't Just a Compliance Measure

"In a [recent survey] ... 93% of respondents said hospitals should be required to post their prices, not estimates, for planned care in advance."  MORE >>

HealthLeaders Media

Benefits in General

Employee Benefits Plan Transition and Integration Decisions Continue After M&A Transactions Close

"[This article provides] a high-level list of post-closing integration considerations with a focus on qualified defined contribution retirement plans and health and welfare plans."  MORE >>

Morgan Lewis

Projected Health Care Costs for Medicare Beneficiaries Rose Again in 2023

"In an extreme case, a couple with high prescription drug expenditures will need to have saved as much as $413,000 to have a 90% chance of having enough money to cover their health costs in retirement ... [A] 65-year-old man enrolled in a Medigap plan with the highest prescription drug expenditures in retirement will need to have saved $215,000 in order to have a 90% chance of having enough money to cover premiums and median prescription drug costs, and a 65-year-old woman will need to have saved $252,000."  MORE >>

PLANSPONSOR; free registration may be required

Press Releases

SageView Advisory Group Acquires Palmer Retirement Consulting

SageView Advisory Group

Pontera Announces Partnership with Commonwealth Financial Network to Help Its Advisors Better Manage Clients' Wealth

Pontera

Webcasts and Conferences
(Health & Welfare Plans)

Washington Legislative Update

May 6, 2024 in DC

International Foundation of Employee Benefit Plans [IFEBP]

Last Issue's Most Popular Items

2024 Federal Poverty Levels Can Impact ESR Affordability

Mercer

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

Thomson Reuters / EBIA

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

Miller & Chevalier

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

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