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Health & Welfare Plans Newsletter

May 15, 2024

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[Guidance Overview]

Recent Developments in Pharmacy-Related Legislation and Regulations

"[GAO] published a report examining the regulation of pharmacy benefit managers (PBMs) in five states.... [HRSA] issued a final rule for the 340B Program's administrative dispute resolution process.... Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a quite ambitious draft legislative proposal to address prescription drug shortages.... [CMS] issued new draft guidance for the second cycle of negotiations for the Medicare Drug Price Negotiation Program established by the Inflation Reduction Act of 2022."  MORE >>

Wiley Rein LLP

[Guidance Overview]

In a PWFA World, Can an Employer Safely Request FMLA Medical Certification for an Absence Due to Pregnancy?

"In its final rules implementing the PWFA, the EEOC went to unusual lengths to rein in an employer's ability to obtain medical documentation when an employee requests a pregnancy accommodation.... FMLA medical certification would be an acceptable tool to use first if an employee limited by pregnancy is seeking leave from work, or if leave is the only option available.... But what's the employer's response if the employee fails to return the FMLA certification?"  MORE >>

FMLA Insights

[Guidance Overview]

Important Takeaways for Employers Following the EEOC's Final Rule Implementing the Pregnant Workers Fairness Act

"This alert outlines employers’ duties under the new law, provides clarity on pregnant workers’ rights and protections, and guides employers on ways to minimize risk and liability under the PWFA."  MORE >>

The Wagner Law Group

[Guidance Overview]

HHS Issues New ACA Section 1557 Nondiscrimination Regs

"New Section 1557 regulations published on May 6, 2024, which go into effect August 6, 2024, restore some repealed 2016 provisions and add provisions to enhance nondiscrimination requirements to which covered healthcare providers must adhere."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

Overview of Maryland Paid Family and Medical Leave (PDF)

18 slides. "Payroll tax begins July 2024. Contributions will be shared 50/50 by employers and employees.... Benefits begin July 2026 ... Employers with fewer than 15 employees are exempt from contributions; employees are required to contribute."  MORE >>


Eleventh Circuit Finds Employer's Health Plan Violated Federal Law by Denying Coverage for Gender-Affirming Care

"A federal appeals court has upheld a lower court's ruling that the Houston County, Ga., Sheriff's Office violated antidiscrimination law by denying transition-related health care to a deputy.... It is only the second decision by a federal appellate court affirming that it is unlawful for an employer to discriminate against transgender people in an employee health plan ... [and] is immediately binding on employers in Georgia, Florida, and Alabama, the states covered by the 11th Circuit[.]" [Lange v. Houston County, Georgia., No. 22-13626 (11th Cir. May 13, 2024)]  MORE >>

The Benefits Professional of the Future: How AI Could Change the Way Your Team Works

"[1] Claims could be processed instantly ... [2] Employee experience could be improved with AI-powered self-service ... [3] Analysis of benefits performance could be easier and more insightful ... That gives the benefits professional of the future significantly more bandwidth to focus on the areas of the job that require human touch, empathy, and ingenuity."  MORE >>


Employer Offers Ketamine Therapy as Part of Standardized Benefits Plan

"According to data from benefits provider Enthea ... 86% of the employees who accessed ketamine therapy saw an improvement with PTSD symptoms. 67% saw an improvement in depressive disorders and 65% felt better in dealing with their anxiety. 65% saw an improvement in dealing with a generalized anxiety disorder."  MORE >>

HRD [Human Resources Director]

Reducing the Stigma of Paid Parental Leave for Fathers

"While men taking time off to care for their children is still a newer concept, it is becoming a more common practice at employers who make it an available option. Employers who offer new dads the chance to bond with their newborns and spend time with their significant others as they heal indicate that these policies promote employee retention, advance gender equity, and help maintain better work-life balance for employees."  MORE >>

Hall Benefits Law

Benefits in General

[Guidance Overview]

FTC Bans Noncompete Agreements

"The final rule already faces multiple legal challenges which may delay the final rule's effective date or invalidate it entirely.... Despite the uncertainty ... employers should consider taking steps to identify current noncompetes, individuals who would need to receive notice, and post-employment restrictions for senior executives that may need to be shored up in the event that the rule takes effect on September 4."  MORE >>


[Guidance Overview]

FTC Noncompete Ban: What You Need to Know

"The U.S. Chamber of Commerce and other entities have already filed federal court lawsuits seeking an emergency injunction against the regulations. There is reason to believe that these efforts will be successful ... To the extent employers believe noncompetes constitute a valuable business practice designed to protect company trade secrets and confidential information as well as the valuable goodwill that exists between employers and their customers, noncompetes remain legal and enforceable, subject to the various state laws limiting them."  MORE >>

Ice Miller LLP

ERISA Advisory Council to Study QDIAs and Health Insurance Appeals Processes

"QDIAs received a unanimous vote for further study by the Council. As a default investment selected by a plan for their participants, the QDIA is of increasing importance due to the proliferation of automatic enrollment in defined contribution plans.... The second ... topic for study is welfare claims and appeals ... This group will look at how to make welfare plans claims and appeals easier to access for participants."  MORE >>

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Employee Benefits Jobs

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Press Releases

Vanguard Announces Appointment of Salim Ramji as New CEO


Webcasts and Conferences
(Health & Welfare Plans)

A Cost Containment Wake-Up Call: Why Plan Members are Suing Their Employers



The Future of Benefits HR & Finance Forum

June 6, 2024 in NJ

Corporate Synergies

Last Issue's Most Popular Items

Medicare Part D: The Simplified Method for Determining Creditable Coverage

HUB International

Text of 2024 IRS Publication 15-B: Employer's Tax Guide to Fringe Benefits (PDF)

Internal Revenue Service [IRS]

HIPAA Privacy Final Rule: Landmark Changes Related to Reproductive Health Care Information

Polsinelli PC

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

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