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Health & Welfare Plans Newsletter

January 29, 2024

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

Workers Poised to Score Benefits as DOL Rule Creates 'Employees'

"A major problem for employees determining to whom they want to offer benefits is the a wide variety of tests under different laws they must consider, many of which have overlapping elements.... The possible addition of new 'employees' to a company's payroll to eliminate confusion over multiple tests would have potentially far-ranging consequences ... Reclassification could affect company leave policies as well, including the need to cover more newly minted 'employees' under the federal Family and Medical Leave Act[.]"  MORE >>

Bloomberg Law

District Court Affirms Insurer's Right to Recover Overpaid Long-Term Disability Benefits Based on Award of Social Security Disability Benefits

"Plaintiff [contended] that the Court should enjoin Hartford's recovery of the overpayment on equitable grounds.... Facts supporting the Court's conclusion [included] ... a record that supports the finding that Plaintiff was informed of and understood or should have understood that he was being overpaid LTD benefits ... and Hartford's repeated effort to get accurate information and documentation from Plaintiff about his SSDI payments." [Cutway v. Hartford Life & Accident Co., No. 22-00113 (D. Me. Jan. 22, 2024)]  MORE >>

Roberts Disability Law

What to Expect from the States in 2024

"Key areas of focus.... [1] ERISA preemption.... [2] Prescription drugs.... [3] Paid leaves.... [4] Telehealth.... [5] Insurance coverage mandates.... Key action steps ... [1] Engage with peers, trade groups.... [2] Leverage vendor relationships.... [3] Keep your superiors informed."  MORE >>


Employer-Sponsored Healthcare Coverage Would Benefit from Better Access to Data, Congress Is Told

"As employers seek to utilize direct contracting and similar arrangements, 'a critical component … is use of transparent data on differences in provider price and quality,' [Christopher Whaley, health economist with the Rand Corporation,] said during the hearing. 'Unfortunately, several self-funded employers who want access to their plans' claim data for auditing or monitoring purposes have actually had to file lawsuits to gain access to this type of data.' "  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

House Committee Seeks Feedback from Employers on ERISA and Health Care System

"The House Education and Workforce Committee is seeking input from employers on policies that will strengthen and protect ERISA and the employer-sponsored health care system. The committee is requesting information on how to update and strengthen ERISA and the employer-sponsored system particularly related to industry changes around data sharing, AI, and specialty drugs."  MORE >>

HR Policy Association [HRPA]

Mental Health Benefits: 2023 Year-End Update

"This article seeks to provide an overview and explore a few of the recent developments in the mental health parity domain and how such changes might shape the future of mental health care. [1] Finalization of the proposed regulations ... [2] Mental health care and Medicare ... [3] MHPAEA claims in the Tenth Circuit."  MORE >>

Maynard Nexsen

A Primer on Health Reimbursement Arrangements

"Health reimbursement arrangements (HRAs), which can be offered in lieu of, or in combination with, an employer-sponsored medical plan, may be an attractive benefit depending on an employer's situations, including size and budget. More specifically, HRAs provide a way for employers to reimburse their employees for qualified medical expenses, including insurance premiums in some cases, on a tax-favored basis."  MORE >>

Maynard Nexsen

Strategy and Tactics of Employee Wellness Programs

"[E]mployers must answer important questions to anticipate their immediate, short-term and long-term goals & objectives.... Focusing too intently on the implementation of wellness tactics at the beginning can distract from strategic goals and defining metrics. Once the strategic why, what and who are decided, then you can move on to the more tactical how, where and when."  MORE >>

Corporate Synergies

Pennsylvania Launches External Review Program for Health Claim Denials

"The Pennsylvania Insurance Department's Independent Review Program launched this month. It assigns eligible cases to teams of doctors, specialists and other experts who determine if an insurance denial was correctly or incorrectly issued.... The program will take cases submitted by residents who have health plans they purchased through Pennie, the state's [ACA] marketplace; people who buy their insurance directly from a company; and workers who get health plans through their employers."  MORE >>


CMS Announces New Primary and Behavioral Health Care Integration Demonstration Model

"[T]he Innovation in Behavioral Health (IBH) Model [is] designed to improve outcomes for adults with mental health and substance use disorders (MH/SUD) by enhancing behavioral health provider capacity to integrate physical health care into their practice settings and services ... CMMI will provide infrastructure funding to providers that participate in Medicare, and the selected states will provide similar funding for Medicaid-only provider practices under aligned program requirements."  MORE >>

Health Law Advisor, Epstein Becker Green

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Announcement RI-2024-01, for Taxpayers Impacted by Severe Storms, Flooding and Tornadoes in Rhode Island

"[IRS announced] tax relief for individuals and businesses in parts of Rhode Island affected by severe storms, flooding and tornadoes that began on Sept. 10, 2023. These taxpayers now have until June 17, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Providence County, qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Negotiating Provider Contracts for Benefit Plans

"The provider industry, particularly among retirement plan recordkeepers and self-funded health plan TPAs, has become very consolidated resulting in fewer alternative providers for sponsors to choose.... [T]his consolidation has enhanced the leverage of providers and caused 'market terms' to be dictated by the few. In addition, providers have become very adept at maximizing contract leverage via process."  MORE >>

Holland & Hart LLP

Employee Benefits Jobs

View job as Retirement Plan Administrator for Bates & Company, Inc.

Retirement Plan Administrator

Bates & Company, Inc.

Winter Park FL

View job as Retirement Plan Administrator for Bates & Company, Inc.

View job as Defined Contribution Account Manager for Nova 401(k) Associates

Defined Contribution Account Manager

Nova 401(k) Associates


View job as Defined Contribution Account Manager for Nova 401(k) Associates

View job as DB/DC Consultant for Nova 401(k) Associates

DB/DC Consultant

Nova 401(k) Associates


View job as DB/DC Consultant for Nova 401(k) Associates

Press Releases

Mid Atlantic Trust Company Takes Leading Role in Supporting Department of Labor Efforts to Protect Retirement Plan Participant Accounts

Mid Atlantic Trust Company

OneAmerica® Announces Brand Refresh as OneAmerica Financial℠

OneAmerica Financial

New York Life Launches Voluntary Benefits Designed to Support Employees’ Financial Wellbeing

New York Life Insurance Company

Last Issue's Most Popular Items

Possible Impact of New DOL Employee Classification Rule on Employee Benefits

Groom Law Group

ACA Non-English Language Requirements Update

Burnham Benefits

Employer Reporting for State Individual Mandates

HUB International

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

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