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Health & Welfare Plans Newsletter

March 26, 2024

4 New Job Opportunities 4 New Job Opportunities


[Official Guidance]

HHS Announces Medicare Prescription Drug Savings

"[CMS] today announced 41 drugs available through Medicare Part B will have a lowered Part B coinsurance rate from April 1-June 30, 2024, if the drug company raises prices faster than the rate of inflation. An estimated 763,700 people with Medicare use one or more of these drugs annually."  MORE >>

U.S. Department of Health and Human Services [HHS]

New Litigation Brings Attention to Potential Fiduciary Risk for Group Health Plan Sponsors

"Many industry experts believe that this is the first of many fiduciary lawsuits to come in the medical and pharmacy space, particularly due to new transparency requirements.... ERISA plan sponsors should consider the following actions to limit exposure to fiduciary liability. [1] Know the terms of your PBM contract.... [2] Understand how your PBM is compensated.... [3] Consider PBM transparent pricing models.... [4] Work with your advisor or consultant to periodically review market options." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

Krieg DeVault

Fiduciary Duties in Health Plan Vendor Selection and Management

"Simply writing a check or transmitting premiums on their employees' behalf does not relieve plan sponsors of their obligations. Furthermore, recent legislation highlights an increased focus on employers' compliance burdens, including the responsibility employers undertake when selecting vendors to perform services for their benefit plans."  MORE >>


Benefit Advisors Can Help Employers Fix the Lack of Engagement Around Benefits

"Employers, benefits advisors and HR professionals need to leverage the available data, tools, and human connections at their fingertips to reimagine benefits engagement as a year-round conversation -- a communication stream that is dynamic, personal, and robust."  MORE >>

BenefitsPro; free registration required

Beyond Paid Leave: Upping the Table Stakes for Caregiver and Grief Support

"Though caregiving and grief are drastically different experiences than pregnancy, they are all milestones in the life of a family, when extra support is crucial. Employers must start to address them similarly. It's time to up the ante on caregiver and bereavement benefits and include additional support before, during, and after paid leave."  MORE >>



2024 Onsite Employee Health Clinics Forum (June 27 - 28, 2024; Chicago, IL)

Leading Strategies to Build & Expand Worksite Clinics: Reduce Medical Expenses, Ensure/Maintain a Competitive Benefits Strategy and Achieve a High-Performing & Healthy Workforce

Sponsored by World Conference Forum

2023 Year-End Devenir HSA Research Report (PDF)

12 pages. "Supported by stock market tailwinds, HSA assets saw record growth during 2023.... At the end of 2023, there were $123 billion in HSA assets held in over 37 million accounts, a year-over-year increase of 19% for assets and 5% for accounts.... About 2.9 million HSAs, representing almost 8% of all accounts, have at least a portion of their HSA dollars invested.... Account holders contributed $50 billion to their accounts in 2023 (up 7% from the year prior) and withdrew $39 billion from their accounts during 2023 (up 13% from year prior)."  MORE >>



Fifth Circuit NFL Disability Ruling Turns ERISA on Its Head

"The [Fifth Circuit] overturned a [district court ruling which followed] a bench trial that contained shocking revelations about how the National Football League adjudicates disability claims filed by football players who have incurred debilitating injuries during their playing careers.... What the district court described in Cloud is so ... contrary to the goal of accurate claims processing that the outcome of this case turns ERISA's purpose on its head.... The Fifth Circuit's opinion ... elevated form over substance." [Cloud v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 22-10710 (5th Cir. Mar. 15, 2024; pet. for rehearing denied Mar. 15, 2024)]  MORE >>

DeBofsky Law

Benefits in General

[Official Guidance]

Text of IRS Announcement IR-2024-81: Relief for Taxpayers Impacted by Severe Storms, Landslides and Mudslides in Alaska

"The [IRS announced] tax relief for individuals and businesses in the Wrangell Cooperative Association of Alaska Tribal Nation that were affected by severe storms, landslides and mudslides that began on Nov. 20, 2023. These taxpayers now have until July 15, 2024, to file various federal individual and business tax returns and make tax payments."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Penalties for Certain Employee Benefits Failures

Chart lists and describes penalties applicable to retirement and health plans.  MORE >>

KLB Benefits Law Group

Mutual Mistake Under ERISA (PDF)

"[B]ecause reformation is a form of equitable relief, courts have sustained claims for equitable relief under ERISA Section 502(a)(3).... [In] the absence of fraud or inequitable conduct, a unilateral mistake will generally not justify the equitable reformation of a contract ... In the context of ERISA plans, mistake is measured by comparing the actual terms of the plan to the baseline of the beneficiaries' objective, reasonable expectations about the scope of benefits provided."  MORE >>

The Wagner Law Group, via Benefits Law Journal

Employee Benefits Jobs

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

Retirement Plan Administrator

Bates & Company, Inc.

Remote / Winter Park FL

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

View job as Lead Plan Admin Analyst - Retirement Plans for Ameritas

Lead Plan Admin Analyst - Retirement Plans


Remote / Lincoln NE

View job as Lead Plan Admin Analyst - Retirement Plans for Ameritas

View job as Lead Business System Specialist - Retirement Plans for Ameritas

Lead Business System Specialist - Retirement Plans


Remote / Lincoln NE

View job as Lead Business System Specialist - Retirement Plans for Ameritas

View job as Senior Retirement Analyst for Dunbar, Bender & Zapf, Inc.

Senior Retirement Analyst

Dunbar, Bender & Zapf, Inc.

Remote / Pittsburgh PA

View job as Senior Retirement Analyst for Dunbar, Bender & Zapf, Inc.

Selected New Discussions

Employer Insurance Cost for Medicare-Eligible Employees

"We are a large employer (over 200 employees but only 35 who are medical eligible- most employees are part time). Getting fully insured insurance with BCBS. Got quotes from BCBS for employees and they gave 'non Medicare eligible' rates and 'Medicare eligible' rates on the same quote. Medicare eligible were much higher. I thought for large employers they couldn't charge employees or employers more for being Medicare eligible?

"If they can charge employer more, does employer eat the cost difference since the employee can't be charged differently based on age? If employer pays difference, if employee who is Medicare eligible chooses a buy up plan that would cost employer $500 a month for non Medicare employee but is $1200 above that for Medicare eligible employee does employer have to cover that extra $700 of the buy up plan option also? What about if middle of year employee turns 65 but they signed up for 1/1 annual coverage under non Medicare eligible rate? Will BCBS flag it at that point and bill employer for the difference? I can't figure out why BCBS is quoting the Medicare eligible rate separately when everything online says employer and insurance has to offer same benefits at same price if employer has more than 20 employees. Thanks in advance for any insight!"

BenefitsLink Message Boards

Failure to File 5500 Welfare Medical Plan for Failing to Address Refund Allocations in SPD

"[Based on the] rules for insured plans with under 100 participants being exempt from 5500 filing -- has anyone run into someone getting fine for failure to file it they failed to address refund allocations? Did MLR requirements from the ACA address this enough that having the refund allocation detail in the SPD is unnecessary to still have the 5500 exemption? Has anyone ever had this issue come up post MLR/ACA as a road block to small fully insured plan exemption? I ask because I see many small insured plans that are not filing and do NOT have any reference to refunds or refund allocations. Some are claiming the MLR rules negate this since they dictate the refunds."

BenefitsLink Message Boards

Correcting Improper FSA Payments

"Plan sponsor inquiry: Scenario 1: We learned of a qualified FSA expense incurred and made to a participant after date of employment separation due to lag time between the weekly file feed to FSA TPA with employment status changes and TPA updating their records. While we may sometimes know in advance of upcoming employment separations, that is not always the case. Our TPA is telling us that this is not necessarily a violation of FSA regulations and is comparing it to situations where participants use all their FSA funds prior to separation of employment and complete funding of their election. That doesn't sound right to me. Assuming it's not right, are we required to include the improper payment in the former employee's taxable income subject to withholding and payroll taxes in these scenarios? If yes, how is this done when there are no additional wages to take the withholding/payroll taxes from? Scenario 2: FSA TPA fails to terminate FSA account upon receipt of file feed with separation date (error is caught several weeks later). TPA will refund us for any improper reimbursements, and is advising that because it is their error, we have no obligation to include improper reimbursements in the former employee's taxable income. Given our understanding that the plan sponsor has ultimate fiduciary responsibility for proper FSA administration, including monitoring the TPA, this, too, doesn't sound right to me."

BenefitsLink Message Boards

Press Releases

Roger Hobby Joins Empower as EVP for Personal Wealth


The SPARK Institute Elects New Governing Board Officers

SPARK Institute

FiduciaryxChange Helps Drive Pooled Employer Plan (PEP) Popularity


Webcasts and Conferences
(Health & Welfare Plans)

The Evolution of Employee Sick Days in a Post-COVID-19 Workplace

March 26, 2024 PODCAST

Troutman Pepper

Looking Ahead: Employee Benefits Cost Saving Strategies for 2024 and Beyond

April 2, 2024 WEBINAR

Woodruff Sawyer

Last Issue's Most Popular Items

DOL Releases Final Rule Clarifying Employee or Independent Contractor Status


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

HUB International

DOL Submits Final Association Health Plan Regs to OMB

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

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

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