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Health & Welfare Plans Newsletter

February 5, 2024

6 New Job Opportunities 6 New Job Opportunities


[Guidance Overview]

Reminder: CMS Medicare Part D Reporting Due Feb. 29, 2024 for Calendar Year Plans

"This reporting obligation encompasses both self-funded and fully insured group health plans, and it is mandatory, regardless of whether the prescription drug coverage functions as the primary or secondary option alongside Medicare.... Completing the disclosure to CMS form ... Disclosure to plan participants ... Plans exempt from the filing process."  MORE >>


[Guidance Overview]

Can Time Increments Play a Role in Company PTO Policies?

"The salary basis provision requires full compensation in the predetermined amount for weeks in which any work is performed by the exempt employee and prohibits reductions from that pay unless covered by a specific exception. One such exception is for full-day absences unrelated to sickness or disability.... [If] the exempt employee has run out of the accrued PTO and is absent for less than a full day, the pay can't be reduced to account for no available PTO, and the employer must pay the entire guaranteed salary."  MORE >>

HR Daily Advisor

Recent Tenth Circuit Opinion Clarifies Pleading Elements Required Under MHPAEA

"[T]he Tenth Circuit concluded that ... requiring beneficiaries to satisfy acute-care criteria for mental health or substance-use benefits, while not requiring the same of those seeking medical or surgical benefits, would constitute a discrepancy between treatment limitations on benefits for mental health or substance-use and for analogous medical or surgical benefits." [E.W. v. Health Net Life Ins. Co., No. 21-4110 (10th Cir. Nov. 21, 2023)]  MORE >>

ArentFox Schiff LLP

The Value of an Administrative Manual in Effectively Managing Employee Health Plans

"Navigating the complexities of day-to-day operations and meeting fiduciary obligations necessitates a comprehensive understanding of applicable laws and regulations, compelling the need for a well-crafted Plan Administration Manual. The absence of such a manual places plan administrators at risk of regulatory non-compliance, potentially resulting in costly consequences."  MORE >>

Withum Smith+Brown, PC

Considerations for Self-Insured Plan Sponsors Moving Toward Innovative Plan Designs

"While the traditional turn-key approach simplifies administration and provides a network of providers, it may also limit flexibility, hindering the implementation of third-party cost containment solutions not supported by the chosen carrier.... [B]efore embracing change, sponsors must assess their readiness to navigate the fiduciary challenges associated with such a transition."  MORE >>

Withum Smith+Brown, PC

A Sustainable Employer Framework for Effective Global Health and Well-Being Strategies

"In a 2023 survey of global employers, 80% reported they have or are developing a globally consistent well-being strategy, a significant upward trend and a shift compared to prior years. Before developing such strategies, employers need to understand the macro challenges and trends influencing the need for effective global well-being plans and outcomes."  MORE >>

Brown & Brown, Inc.

Helping Your Employees Navigate Rising Healthcare Costs

"[E]mployers can advise employees to shop around for their healthcare needs, just as they would shop around for other products or services.... By encouraging your employees to establish regular care with a primary care physician, you can expect to see a reduced overall cost of healthcare and improved outcomes.... Virtual care options can be seamlessly integrated into an organization's current benefit plan offerings, enabling employees to access care when and where they need it."  MORE >>



Demanding Health Plan Vigilance

"Instead of a vibrant marketplace driven by competition and consumer choice, the pharmaceutical sector resembles an arena where a few dominant players wield disproportionate influence ... Into this multifaceted drama enters the CAA ... [T]he fiduciary duty of prudence is no longer just about selecting and monitoring plan options. It's about ensuring that these options are presented and operated with a level of transparency that leaves no room for ambiguity or concealment. Plan sponsors are now under a microscope, with every decision subject to scrutiny, not just by regulatory bodies but by the very individuals they serve -- the plan participants."  MORE >>

Craig Gottwals, via Substack; free registration may be required


Are We Valuing Prescription Drugs Appropriately?

"[The authors] argue that methods for valuing drug therapies need updating. Such improvements would make the estimated value of some, although not all, prescription drugs more favorable in economic assessments. In the long run, these improvements will have the effect of promoting the continued development of drugs that produce health benefits that are worth more than what society must spend to invent those drugs in the first place."  MORE >>

Health Affairs Forefront

Employee Benefits Jobs

View job as Plan Document Specialist for MAP Retirement USA LLC

Plan Document Specialist

MAP Retirement USA LLC


View job as Plan Document Specialist for MAP Retirement USA LLC

View job as Retirement Plan Administrator for Retirement Solutions Specialists

Retirement Plan Administrator

Retirement Solutions Specialists

Remote / Jacksonville FL / Hybrid

View job as Retirement Plan Administrator for Retirement Solutions Specialists

View job as Retirement Distribution & Tax Specialist for Alerus

Retirement Distribution & Tax Specialist


Remote / MN / ND

View job as Retirement Distribution & Tax Specialist for Alerus

View job as Employee Benefits Account Manager for U.S. Retirement & Benefits Partners

Employee Benefits Account Manager

U.S. Retirement & Benefits Partners

Wayne PA / Hybrid

View job as Employee Benefits Account Manager for U.S. Retirement & Benefits Partners

View job as Defined Benefit Plan Enrolled Actuary for Associated Pension Consultants

Defined Benefit Plan Enrolled Actuary

Associated Pension Consultants


View job as Defined Benefit Plan Enrolled Actuary for Associated Pension Consultants

View job as Retirement Plan Termination Specialist for SS&C Technologies

Retirement Plan Termination Specialist

SS&C Technologies

Quincy MA / Kansas City MO / Hybrid

View job as Retirement Plan Termination Specialist for SS&C Technologies

Selected New Discussions

Breach of Unsecured PHI: Notification Window

"Under HIPAA, a business associate must notify a covered entity health plan no later than 60 days from the time it discovered a breach of unsecured protected health information. If a business associate has, say, thousands of covered entity clients and discovers that only a few participants of only a few of the covered entity health plans are affected by a breach (and the business associate does not know which ones until later), when does that 60-day window start? Does it start when it determines which specific covered entities are affected? Or does it start when it discovered the breach (which would require that it notify all of its clients, most of which would ultimately be unaffected)? I could not find any HHS guidance on point."

BenefitsLink Message Boards

On-Site Clinics and ACA Ban on Annual/Lifetime Caps

"Assume an employer did not offer a group health plan, but was interested in purchasing access to a health clinic for its employees and their families. This clinic is not located on the employer's premises, it offers an array of primary care services, and will be shared with other employers. There is an exception to the ACA requirements for 'on-site medical clinics,' but that term does not appear to have been defined by the regulators or courts. Because of the scope of benefits offered (more than minor injuries/illness or first aid), the location of the services (not on employers premises) and the fact they will available to family members, this will be treated as a group health plan. 29 CFR 2510.3-1(c). It also wouldn't meet the requirements to be avoid COBRA obligations. 26 CFR 54.4980B-2, Q&A 1(d). Many commentators seem to hang their hat on the ACA exception for 'on-site medical clinics' to open the door to allow this kind of arrangement, but I'm not sure I see it. Can an employer offer certain essential health benefits through a shared clinic without triggering the ACA rules on caps, preexisting conditions, etc.?"

BenefitsLink Message Boards

Webcasts and Conferences
(Health & Welfare Plans)

Defending Mental Health Parity and Addiction Equity Act Claims

March 12, 2024 WEBINAR


HIPAA Nondiscrimination for Employer Sponsored Wellness and Wellbeing Programs

March 27, 2024 WEBINAR

Baldwin Risk Partners

Last Issue's Most Popular Items

Text of Agency ACA FAQs, Part 65: Transparency in Coverage (PDF)

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

Health and Welfare Benefits Monthly Update, February 2024 (PDF)

Alston & Bird

EBSA Steps Up Mental Health Parity Enforcement

Kutak Rock LLP

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

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