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Health & Welfare Plans Newsletter

February 6, 2024

3 New Job Opportunities 3 New Job Opportunities


[Guidance Overview]

FAQs Provide Guidance on Plan Coverage of Contraceptives

"[The Departments] are providing a new alternative approach, the therapeutic equivalence approach, that non-grandfathered group health plans can use to comply with the ACA preventive service rules regarding contraceptive coverage. As with the current approach, plans must have an exceptions process to allow women to access contraceptives recommended for them based on medical necessity."  MORE >>


[Guidance Overview]

Transparency in Coverage Rules: When Accurate Estimates for Low‑Utilization Items and Services Are Not Available

"[In FAQ Part 65, the Departments] announced that they are likely to exercise discretion to not bring an enforcement action where a plan fails to provide certain information with respect to these items and services. This exercise of discretion is limited to cost‑sharing information otherwise required to be provided to the participant or beneficiary (through the self‑service tool or in hard copy or by phone) where: The cost estimate would need to be based on past claims data AND There have been fewer than 20 claims in the past three years."  MORE >>


Court Awards Minimal ERISA Penalties for Plan's Failure to Furnish Documents During COVID-19

"In determining whether ERISA penalties should be awarded, the district court grouped the claimant's requested documents by category, which it analyzed in turn.... In a ruling that was largely favorable to the employer/plan sponsor, the district court in this case expressly referenced the [DOL's] COVID-related 'outbreak period' rules -- which suspended the deadlines for some plan compliance obligations." [Zavislak v. Netflix, Inc., No. 21-1811 (N.D. Cal. Jan. 31, 2024)]  MORE >>

Thomson Reuters Practical Law

Cigna Asks District Court to Dismiss Lawsuit Alleging Use of Computer Algorithm to Automatically Reject Claims

"Initially filed in July, the federal lawsuit alleges that Cigna used a computer algorithm to automatically reject hundreds of thousands of patient claims without examining them individually as required by California law. At issue is Cigna's 'procedure-to-diagnosis' or PxDx software, which reviewed and denied customer claims." [Kisting-Leung v. Cigna, No. 23-1477 (E.D. Calif second amended complaint filed Dec. 18, 2023; motion to dismiss filed Feb. 1, 2024)]  MORE >>

Lawsuit Alleges Johnson and Johnson Mismanaged Company's Health Plan Prescription Costs

"Ann Lewandowski, a healthcare policy and advocacy director at J&J ... accused the company of breaching its fiduciary duties to manage health benefit funds responsibly. In one instance, the complainant alleges that JNJ pays $10,200 for a multiple sclerosis drug called teriflunomide, which costs no more than $77 out of pocket at retail pharmacies." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

Seeking Alpha

ERISA Fiduciary Suit Challenges Johnson & Johnson Health Plan Prescription Drug Costs

"Echoing the language found in many 401(k) excessive fee suits, this one argues that the plan fiduciaries failed to use their bargaining power to obtain better rates.... The suit would appear to have its basis in the ... Consolidated Appropriations Act of 2021 (CAA) ... In essence, ERISA Section 408(b)(2) -- which greatly expanded fee disclosure responsibilities for retirement plan providers -- now applies to health care providers as well. And plan sponsor fiduciaries are on the hook to ensure that those fees/services rendered are reasonable, as they have been required to do for retirement plans." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]   MORE >>

American Retirement Association [ARA]

Senators Push for Answers in the Fight Against PBMs

"In their letter to FTC Chair Lina Khan, [Sen. James Lankford (R-Okla.)], along with Sens. Chuck Grassley (R-Iowa) and Maria Cantwell (D-Wash.) and 10 other members of Congress, cited the advancement of the PBM Transparency Act [S 2493] and the Prescription Drug Pricing for the People Act [S 113] as evidence of the momentum needed to tackle vertical integration, patient steering, and other PBM strategies to strangle the American health care industry."  MORE >>

National Community Pharmacists Association [NCPA]

Comparing New Prescription Drug Availability and Launch Timing in the United States and Other OECD Countries

"The United States had more total new drugs sold by the end of 2022 (74 percent of all new drugs) compared with any other individual country in the study. Germany had the second-highest share (52 percent of new drugs). New drugs sold in both the United States and at least one other country by the end of 2022 accounted for 90 percent of 2022 spending on all new drugs in the United States. More than half of new drugs were launched first in the United States, and there was an average lag of about one year between launch in the United States and launch in other major markets."  MORE >>

RAND Corporation

Now Trending: Mandatory Vacation Laws

"Effective January 1, 2024, Illinois's Paid Leave for All Workers Act will require nearly all Illinois employers to provide employees with paid leave that can be used for any reason ... While once unheard of, Illinois now joins two states -- Maine and Nevada- in mandating that covered employers provide employees with paid time off."  MORE >>

Robinson & Cole LLP

Benefits in General

[Official Guidance]

IRS Disaster Relief Announcement ME-2024-02, for Taxpayers Impacted by Severe Storms and Flooding in Maine

"[I]ndividuals and businesses in parts of Maine affected by severe storms and flooding that began on Dec. 17, 2023 ... 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 Androscoggin, Franklin, Hancock, Kennebec, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties, qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

IRS Releases Final Guidance on Penalty Exceptions for Failure to File Correct Information Returns or Furnish Payee Statements

"The final regulations update penalty amounts relating to information returns and payee statements that are not currently accounted for in the existing regulations, establish a maximum number of returns to which the de minimis exception can apply for a calendar year, and define when and how a payee may elect not to have the statutory safe harbor rules apply."  MORE >>


Employee Benefits Jobs

View job as ESOP Administrator for Blue Ridge ESOP Associates

ESOP Administrator

Blue Ridge ESOP Associates


View job as ESOP Administrator for Blue Ridge ESOP Associates

View job as Product Support Specialist for / Wolters Kluwer

Product Support Specialist / Wolters Kluwer


View job as Product Support Specialist for / Wolters Kluwer

View job as TPA Department Manager for Keating and Associates, Inc.

TPA Department Manager

Keating and Associates, Inc.

Remote / Manhattan KS / Overland Park KS / Chicago IL

View job as TPA Department Manager for Keating and Associates, Inc.

Press Releases

Ascensus Announces New Retirement Business Structure and Leadership


Webcasts and Conferences
(Health & Welfare Plans)

Why Heart Health Matters: A Look at McDonald’s Investment in Heart Health

February 14, 2024 WEBINAR

The Conference Board

Getting It Right: Know Your Fiduciary Responsibilities, Part 1

March 5, 2024 WEBINAR

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Getting It Right: Know Your Fiduciary Responsibilities, Part 3

March 21, 2024 WEBINAR

Employee Benefits Security Administration [EBSA], U.S. Department of Labor

2024 Healthcare Meeting


Conference of Consulting Actuaries

Last Issue's Most Popular Items

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


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

Withum Smith+Brown, PC

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

Withum Smith+Brown, PC

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

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