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Health & Welfare Plans Newsletter

February 19, 2024

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

What Employers Need to Know About the Consolidated Appropriations Act

"Understanding the new obligations imposed by the CAA can help sponsors of group health plans avoid audits and class-action lawsuits, and can even allow sponsors to take advantage of a new defense against liability.... [T]he new disclosure requirements should provide sponsors with new levels of detail to ensure their plan's fees are reasonable.... [T]he same data may also be used against plan sponsors in suits over the reasonableness of disclosed fees."  MORE >>


Lawsuit Alleges Fiduciary Breach of Johnson & Johnson Health Plan

"The plaintiff ... claims that Johnson & Johnson breached its ERISA fiduciary duties ... [costing] the plan and its participants millions of dollars by requiring them to pay more in prescription drug prices and higher premiums, deductibles, copays, and coinsurance. The lawsuit, believed to be the first of its kind, may open up a new pathway in ERISA fiduciary litigation." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>


J&J Drug Pricing Lawsuit Seeks Class Action Status

"Allegations included in the 74-page complaint includes the eye-opening example of the Johnson & Johnson benefits manager paying a whopping $10,239.69 for a 90-day supply of a treatment for multiple sclerosis when a generic drug was available at local pharmacies for as little as $28, even before accounting for insurance. That's 'not a typo,' the complaint states." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

First Circuit Finds Insurer Owed Fiduciary Duty Under ERISA When It Increased Premium Rates for Group Long-Term Care Insurance

"The First Circuit first determined that Prudential's decision to exercise its discretion and increase premiums is part of the overall management of the welfare benefit plan and that Prudential owed Parmenter a fiduciary duty of prudence to manage the plan in accordance with the plan documents." [Parmenter v. Prudential Ins. Co. of Am., No. 22-1614 (1st Cir. Feb. 14, 2024)]  MORE >>

Roberts Disability Law

District Court Grants Plaintiff Limited Discovery Upon Allegation of Insurer Bias In ERISA Benefits Action

"[T]he Court noted that, notwithstanding the broad restriction on discovery in ERISA matters, limited discovery is available if the claimant makes a satisfactory allegation of a violation of due process or bias by the plan administrator." [Dotson v. Metropolitan Life Ins. Co., No. 23-0178 (E.D. Ky. Feb. 9, 2024)]  MORE >>

Roberts Disability Law

Projected 2025 HSA, HDHP and Excepted-Benefit HRA Figures

"These unofficial 2025 amounts are determined using the Internal Revenue Code (IRC)'s cost-of-living adjustment methods, the US Bureau of Labor Statistics (BLS) published Chained Consumer Price Index for All Urban Consumers (C-CPI-U) values through January 2024, and Mercer's projected C-CPI-U values for February and March."  MORE >>


Employers Reduce Retiree Healthcare Costs by 40% with Medicare Individual Market

"Employers can reduce their healthcare subsidy by an average of 39% while still benefiting retirees.... Most retirees experience cost savings, with a considerable percentage seeing annual savings of $2400 or more.... Employers face less administrative burden in managing healthcare plans in the Medicare Individual Market."  MORE >>

Alight Solutions; free registration required for full report

In California, Faceoff Between Major Insurer and Health System Shows Hazards of Consolidation

"[I]ndustry analysts say the conflict has become part of a trend in which patients are increasingly caught in the crossfire of contract disputes. Amid negotiations over rising labor and equipment costs, it's often patients who are ultimately saddled with higher bills as the health industry continues to consolidate."  MORE >>

KFF Health News


Is the No Surprises Act Backfiring on Patients?

"[T]he Biden Administration's regulations empowered insurers to set the QPA amount and then made it a 'rebuttable presumption' of payment in the arbitration -- meaning the QPA as determined by the insurer is just assumed to be appropriate and fair -- ignoring all other factors. This is not what lawmakers intended, but Secretary Becerra essentially ignored Congressional intent and rewrote the law in a way that enabled the health insurance industry to put its big thumb on the scale."  MORE >>

Wendell Potter NOW

Benefits in General

[Guidance Overview]

CRS Insight: Internal Revenue Service Standard Mileage Rates

"The [IRS] provides standard mileage rates as optional methods for taxpayers to substantiate their transportation expenses. This Insight reviews how the standard mileage rates are set, who uses them, and a history of the rates." [IN12320 Feb. 16, 2024]  MORE >>

Congressional Research Service [CRS]

[Guidance Overview]

DOL's New Worker Classification Rules: Do You Know Who Your Employees Are? (PDF)

"The final rule adopts a multifactor economic realities test and returns to the pre-2021 totality-of-the-circumstances approach to determining whether a worker is properly classified as an employee or as an independent contractor. Classification under the final rule depends on 'whether the worker is economically dependent on the potential employer for work.' "  MORE >>


Employee Benefits Jobs

View job as Manager, Defined Contribution (TPA) for HowardSimon, Strongpoint Partner

Manager, Defined Contribution (TPA)

HowardSimon, Strongpoint Partner


View job as Manager, Defined Contribution (TPA) for HowardSimon, Strongpoint Partner

View job as Benefits Manager for Catholic Diocese of Arlington

Benefits Manager

Catholic Diocese of Arlington

Arlington VA

Press Releases

OneDigital Company Launches Broker-Carrier Portal


Last Issue's Most Popular Items

New RxDC Reporting Instructions: Headaches or Opportunities?


Text of OCR/NIST Publication SP 800-66 Rev. 2, Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource Guide (PDF)

Office for Civil Rights [OCR], U.S. Department of Health and Human Services [HHS], and National Institute of Standards and Technology [NIST]

Can a Health Plan Exclude Drug Manufacturers' Coupons from Participants' Cost-Sharing? (PDF)

Thomson Reuters / EBIA

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

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