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Health & Welfare Plans Newsletter

January 24, 2024


[Guidance Overview]

Exceptional Usefulness and Quality icon ACA Employer Mandate Requirements

"Employers who average 50 or more full-time equivalent (FTE) employees during the prior calendar year are considered Applicable Large Employers (ALE) and thus subject to the employer mandate.... ALE status is always based on the calendar year rather than the employer's plan year.... some employers who average 50 or more FTEs may still avoid ALE status designation if their employee count exceeds 50 for 120 days or fewer due to the employment of Seasonal Workers.... Employers who are just becoming ALEs need to consider the compliance implications given the potential penalties involved."  MORE >>

HUB International

[Guidance Overview]

New York City Creates a Private Right of Action for Alleged Violations of the Earned Sick and Safe Time Act

"New York City enacted a law that will allow individuals to file civil actions alleging violations of the city's safe and sick time requirements within two years. The filing of an administrative complaint will neither be a prerequisite nor bar to filing a civil action. Complainants will be able to recover compensatory damages, injunctive and declaratory relief, attorneys' fees and costs, and other appropriate damages. The law takes effect on March 20, 2024."  MORE >>

Ogletree Deakins

Ninth Circuit Rules That Premature Litigation for Disability Benefits Doesn't Bar Subsequent Lawsuit

"[If] a plaintiff brings a lawsuit seeking benefits, and the court rules against her because she hasn't yet complied with the benefit plan's claim submission requirements, can she bring a subsequent action for those same benefits after she does comply with the requirements? ... The [Ninth Circuit] concluded that ... Flores' claim regarding LTD benefits did not accrue until LINA denied her claim in 2022, and thus ... it could not have been brought in the prior action." [Flores v. Life Ins. Co. of N. Am. (LINA), No. 22-55779 (9th Cir. Jan. 22, 2024)]  MORE >>

Kantor & Kantor

Key Employee Benefits Trends in 2024

"[1] Managing health care costs ... [2] Increasing personalization and flexibility ... [3] Prioritizing employee mental health ... [4] Focusing on belonging ... [5] Expanding family-building and reproductive health benefits ... [6] Balancing flexibility with return-to-office mandates ... [7] Prioritizing preventive care services."  MORE >>


Health Cost and Affordability Policy Issues and Trends to Watch in 2024

"Will policymakers pass site-neutral payment reforms? ... Will price transparency requirements drive down costs? ... How will prescription drug pricing policies affect health spending and affordability? ... What new policies might affect PBMs, the so-called prescription drug middlemen? ... How will new drugs and therapies impact health spending and outcomes? ... How will expansion of virtual care affect costs, access, and affordability? ... Will state cost control measures succeed at curbing spending?"  MORE >>

The Peterson-Kaiser Health System Tracker

Increase HR's Efficiency Through Strategic Benefits Management

"Modern benefits management refers to an end-to-end benefits administration system, which offers a variety of advantages. Outsourcing the management of your benefits programs can save time, provide a higher level of confidence through expert administrators and enable your HR team to focus on strategic initiatives that can positively impact talent attraction/retention, engagement and productivity."  MORE >>


State Employees in North Carolina Could Lose Coverage of Wegovy, Other Weight Loss Medicines

"The board that oversees the North Carolina State Health Plan will ... [consider] dropping coverage of weight loss medications like Wegovy.... The State Health Plan is the health insurance plan for more than 740,000 teachers, state employees, retirees, and their dependents.... [It] paid more than $4 billion in claims last fiscal year ... But even at that size, the high costs of these GLP-1 medications take an outsized bite of the pie."  MORE >>

WUNC 91.5


What Does Arbitrary and Capricious Review Really Mean, Anyway?

"[If] you are a plan administrator or sponsor, or a lawyer representing one, you think it describes a standard of review that should broadly insulate plan decisions from challenge, while if you are a plan participant, or a lawyer who represents plan participants, you think the entire doctrine is a wrong road that the Supreme Court set off down years ago without thinking and from which no one can now exit.... [In] the real world, arbitrary and capricious review is often little more than a shibboleth that precludes, rather than encourages, careful thought over these issues."  MORE >>

Stephen Rosenberg, The Wagner Law Group


ERIC Amicus Brief to the U.S. Supreme Court in United Behavioral Health

28 pages. "May a court, at the invitation of an agency in an amicus brief, effectively amend regulations by judicial fiat, providing the agency with an end-run around the APA's notice-and- comment rulemaking procedures? The answer to that question is an obvious no. But the Tenth Circuit below disagreed, decreeing a new regulatory requirement for health-benefit denials that the [DOL], in dual 2015 and 2016 rulemakings, expressly considered and chose to adopt only for disability-benefit denials and not for health-benefit denials." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023; cert. pet. filed Nov. 29, 2023, No. 23-586)]  MORE >>

McDermott Will & Emery

Benefits in General

[Guidance Overview]

DOL Increases Civil Monetary Penalties for Certain ERISA Violations

"The DOL recently issued a final rule that adjusts for inflation the amounts of civil monetary penalties assessed for certain ERISA violations. The adjusted penalty amounts apply to penalties assessed after January 15, 2024, and for which the associated violations occurred after November 2, 2015."  MORE >>

Haynes and Boone, LLP

Advances in AI and Other Technologies to Enhance Employee Benefits

"Advances in financial technology will soon lead to better improvements in employee benefits in addition to artificial intelligence (AI) ... For example, anti-fraud, health data and language models, which analyze bodies of text data to provide a basis for their word predictions, can help boost offerings to employees[.]"  MORE >>


ERISA Litigation Faces New Frontiers in 2024 (PDF)

"In 2023, just over 100 new class actions were filed under [ERISA] -- the lowest number filed since 2018 ... Plaintiffs firms continue to explore new theories. In 2023, they filed new lawsuits challenging the use of plan forfeitures, sought named plaintiffs for new lawsuits challenging health plan fees, and filed a record number of actuarial equivalence lawsuits."  MORE >>

Groom Law Group, via Law360

Webcasts and Conferences
(Health & Welfare Plans)

2024 Employment & Employee Benefits Seminar

February 7, 2024 WEBINAR

Poyner Spruill

Benefit Trends in Mergers and Acquisitions

February 8, 2024 in OH

Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

ERISA Preemption and Employee Benefit Claims: Recent Court Decisions, Causes of Action, Plan Administration

February 27, 2024 WEBINAR


Last Issue's Most Popular Items

Departments Announce Therapeutic Equivalence Approach to ACA Contraceptives Compliance

Thomson Reuters Practical Law

Florida PBM Law Limits Mail-Order Prescription Drug Programs, Requires State Filings by Employer Plans

Ogletree Deakins

Correcting Missed HSA Contributions


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

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