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Health & Welfare Plans Newsletter

March 25, 2024

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[Official Guidance]

Text of CMS Announcement of Deadline Extensions for 2023 Benefit Year EDGE Data and MLR Submissions (PDF)

"CMS recognizes that some issuers are facing challenges ... related to the CHC cybersecurity incident ... CMS is exercising enforcement discretion to extend ... the BY 2023 EDGE server data submission deadline ... to 4:00 p.m. ET on Tuesday, May 21, 2024.... CMS has also been working with interested parties to evaluate the impact of the CHC cybersecurity incident on ... reporting under the Medical Loss Ratio (MLR) program.... CMS will consider BY 2023 MLR Reporting Forms to be filed on time as long as they are filed with HHS by August 15, 2024."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Understanding OCR's Updated Guidance on Health Data Tracking and HIPAA Privacy Rule

"OCR's updated guidance reflects its view that tracking technologies used by regulated entities on user-authenticated webpages and mobile applications generally do collect protected health information, referred to as PHI. Where the new guidance differs, however, is on the information collected via tracking technologies on unauthenticated webpages."  MORE >>

Constangy, Brooks, Smith & Prophete LLP

[Guidance Overview]

Employer Mandate Penalties Fall for 2025

"[T]he (a) penalty will be only $2,900 (down from $2,970 in 2024) and the (b) penalty will go down to $4,350 (down from $4,460).... Despite what employers may be seeing on their individual plans, the projection used by the Department of Health and Human Services shows that the premiums are actually going down compared to 2024."  MORE >>

HUB International

[Guidance Overview]

New York City Will Allow a Private Right of Action for Violations of Earned Sick and Safe Time Act

"This new right will allow individuals to bypass the filing of an administrative complaint with the Department of Consumer and Worker Protection and, instead, file a lawsuit within two years from the date the person knew or should have known of the alleged violation."  MORE >>

ArentFox Schiff LLP

DOL Submits Final Association Health Plan Regs to OMB

These final regs to reflect DOL reconsideration of those issued in 2018 but vacated by D.C. District Court in 2019, as described in RIN 1210-AC16. Received by OMB on Mar. 22, 2024; full text to be available after OMB action and publication in Federal Register.  MORE >>

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

Failure to Send a Life Insurance Conversion Notice May Be a Fiduciary Breach

"If the surviving wife is successful in her breach of fiduciary duty claim, the employer could be on the hook for paying the entire life insurance benefit ... Her claim is simple: the employer did not communicate this important conversion right to her husband as required by the life insurance policy." [Watson v. EMC Corp., No. 22-1356 (10th Cir. Feb. 9, 2024)]  MORE >>

HUB International

The Essential Elements of a Strong Benefits Advisor and Benefits Administration Vendor Partnership

"[B]enefits administration solutions can help employers maximize the impact and ROI of their benefits programs.... [B]rokers and consultants should expect to encounter the following with a right-fit benefits administration partner: [1] Alignment of corporate values and culture ... [2] A robust (and reliable) solution roadmap ... [3] Customized guidance and consultation ... [4] Transparent and responsive communication."  MORE >>



Mercer Comment Letter Responding to House Committee RFI on Ways to Strengthen ERISA (PDF)

"Mercer recommends the committee direct the Congressional Research Service to publish an extensive report on ERISA preemption. Copies of the report should be sent to every state's insurance commissioners and legislators, as well as the leadership of the National Association of Insurance Commissioners  ... Mercer recommends building on recent transparency improvements to ensure that group health plan fiduciaries have access to the information they need to better fulfill existing fiduciary duties, including selecting and monitoring service providers that administer plan benefits."  MORE >>


Benefits in General

[Guidance Overview]

DOL Releases Final Rule Clarifying Employee or Independent Contractor Status

"The 2024 final rule provides a comprehensive test to determine whether a worker is considered an employee or an independent contractor. While the final rule does not directly impact retirement or health and welfare benefits governed under [ERISA] or the Internal Revenue Code, there are potential indirect impacts that employers should consider[.]"  MORE >>


Fiscal 2025 Budget Proposal Outlines Health, Retirement and Comp Changes

"The budget proposal ... would require that all health plans cover mental health and substance use disorder benefits and require plans to have an adequate network of mental healthcare providers. It also proposes to expand enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA).... The budget also proposes that health plans cover three primary care visits and three behavioral health visits without cost sharing.... The budget proposes a $10 million aggregate cap on accumulations in defined contribution (DC) plans and individual retirement accounts (IRAs).... The budget would also prohibit Roth rollovers and conversions by high-income taxpayers.... The budget proposes a national paid family and medical leave program that would be administered by the Social Security Administration.... Mental health parity, paid leave and prescription drug costs are among those that were in President Biden's campaign proposals in 2020 and could see additional campaign discussion this year."  MORE >>

Willis Towers Watson

Employee Benefits Jobs

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

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