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Health & Welfare Plans Newsletter

October 11, 2024

2 New Job Opportunities 2 New Job Opportunities

 

[Guidance Overview]

Employers Should Confirm Their ACA Affordability Safe Harbors for 2024

"Employers that use an incorrect affordability safe harbor code on Line 16 based on the premium they report on Line 15 could be subject to an ESRP. .. [E]mployers should consider reviewing their 2024 ACA data to make sure they are using the appropriate affordability safe harbor."  MORE >>

EY

[Guidance Overview]

CMS Final Rules on Civil Monetary Penalties for Medicare Secondary Payer Reporting to Be Applied on or After October 11, 2024

"[CMS] issued Final Rules on how and when civil monetary penalties may be imposed when Responsible Reporting Entities (RREs) fail to meet their Medicare Secondary Payer (MSP) reporting obligations.... Generally, a group health plan RRE is the insurer for fully insured plans and the third-party administrator (TPA) for self-funded plans.... Penalties against an RRE are up to $1,000 (as adjusted) per instance of noncompliance for each calendar day that a record is late, with a maximum annual penalty of $365,000 per instance."  MORE >>

Sequoia

[Guidance Overview]

Medical Loss Ratio Rebates for Employer-Sponsored Plans (PDF)

"An employer-policyholder who receives a rebate for its insured group health plan will be responsible for determining how to appropriately use the refund, particularly in the context of [ERISA].... Any portion of the rebate that constitutes a plan asset must benefit plan participants and beneficiaries and cannot be retained by the employer. The [DOL] provides guidance to employers on permitted methods of use and distribution of the refund."  MORE >>

VCG Consultants

[Guidance Overview]

Michigan DOL Publishes Updated Paid Sick Leave Materials as Amended Law's February 2025 Effective Date Looms

"Effective February 21, 2025, Michigan's Earned Sick Time Act (ESTA) will replace the Paid Medical Leave Act (PMLA).... The Michigan [DOL] and Economic Opportunity has published ESTA FAQs, the first administrative guidance interpreting the amendments."  MORE >>

Seyfarth Shaw LLP

Tenth Circuit Clarifies Mental Health Parity and ERISA Disclosure Obligations (PDF)

" The longevity of this dispute underscores the importance of ensuring compliance with both MHPAEA and ERISA's disclosure requirements.... Note that while this court concluded that ERISA did not require the disclosure of the InterQual Criteria, MHPAEA regulations state that the ERISA requirements include documents with information on medical necessity criteria, as well as the processes, strategies, evidentiary standards, and other factors used to apply a nonquantitative treatment limitation (such as a medical necessity requirement)." [S. v. Premera Blue Cross, No. 22-4056 (10th Cir. Oct. 1, 2024]  MORE >>

Thomson Reuters / EBIA

New Wave of ERISA Lawsuits Attack Self-Funded Health Care and Wellness Plans on Tobacco Surcharges

"The recent putative class actions target health-contingent, outcome-based wellness programs that are part of self-funded group health plans. These complaints allege that the wellness programs do not meet HIPAA’s regulatory requirements that the programs must satisfy to be considered nondiscriminatory.... The recent complaints generally claim that the plan sponsors and fiduciaries charged tobacco surcharges that violate HIPAA’s nondiscrimination provision."  MORE >>

Thompson Coburn LLP

Happy Halloween: RIP to the HIPAA Privacy Rule?

"The Texas AG is asking the court to declare that the 2000 Privacy Rule and the 2024 Reproductive Privacy Rule violate the Administrative Procedures Act and to vacate, set aside, and enjoin enforcement of the Rules. Did a black cat just walk under a ladder, or is this all a bunch of hocus pocus?" [Texas v. HHS, No. 24-0204 (N.D. Tex. complaint filed Sep. 4, 2024)]  MORE >>

Quarles & Brady LLP

FMLA Leave: What One Employer (Allegedly) Did Wrong

"[1] Don't let employees work while on continuous FMLA leave.... [2] If you want to restructure the position of an employee on FMLA leave (or soon after they've taken FMLA leave), be very, very careful.... [3] If you offer a 'work hardening' program, give the employee a reasonable chance to 'harden.' ... [4] If a 'problem employee' goes out on FMLA leave, don't view the leave as your opportunity to show them the door.... [5] Never forget that your disability accommodation obligations are in addition to, not instead of, your FMLA obligations.' [Kelley vs. Jewish Voice Ministries Int"l, No. 23-0353 (D. Ariz. Oct. 4, 2024)]  MORE >>

Constangy, Brooks, Smith & Prophete LLP

How Courts Are Handling ERISA Health Benefit Denials in 2024

"[Two recent] cases shed a great deal of light on how courts are looking at health insurance denials.... Insurers that have upheld claim denials are subject to having their decisions overturned unless they can show that they engaged in a meaningful dialogue with claimants and considered the opinions of the treating doctors. Courts are also looking for logical connection between the evidence presented, and the determination reached and are unaccepting of rubber stamps or conclusory denials."  MORE >>

DeBofsky Law

Open Enrollment Season in the Workplace: Legal Considerations with Employer Takeaways

"If you are an ALE, make sure that you give eligible employees an 'effective opportunity' to elect or decline health coverage (or to make changes to elections rolled over from the prior year) for themselves and their qualifying dependent children.... Determine whether any other individuals, such as qualified beneficiaries receiving COBRA continuation coverage or employees out on FMLA leave, are legally entitled to participate in the process and give them an opportunity to do so as if they were active employees."  MORE >>

Fisher Phillips

Survey Reveals Strong Commitment to Digital Health Technologies, with Spending Set to Increase

"According to the survey, 97% of employers, 86% of health systems, and 84% of health plans intend to maintain or increase spending on digital health solutions over the next year. Reasons for increased spending were relatively consistent, with all three purchaser groups reporting increased consumer demand (83%) and improved health outcomes (62%) as primary motivators."  MORE >>

Peterson Health Technology

Trends in Access to Employment-Based Health Benefits: Stability After 50 Years of ERISA

"The percentage of the nonelderly population with employment-based health benefits was at or near 70 percent from 1970 to 1989. By 2023, 60 percent of the nonelderly population had employment-based health coverage.... The erosion in the percentage of employers offering health coverage has been limited to small employers. "  MORE >>

Employee Benefit Research Institute [EBRI]

[Opinion]

Employee-Sponsored Health Insurance: Shift Tax Advantage to Employees

"[W]ith the tax advantage to employers remaining intact, the funds continue to go to insurance and not to the workers. The system has ballooned into an inefficient approach that inflates costs and reduces consumer choice. If the tax advantage were transferred from employer to employee, this would expand the usefulness of these funds to pay for medical expenses."  MORE >>

National Review

Benefits in General

[Official Guidance]

IRS Provides Hurricane Milton Relief for Individuals and Businesses in All of Florida

"Individuals and businesses in six counties that previously did not qualify for relief under either Hurricane Debby or Hurricane Helene will receive disaster tax relief beginning Oct. 5, 2024, and concluding on May 1, 2025. They are Broward, Indian River, Martin, Miami-Dade, Palm Beach and St. Lucie. In addition, individuals and businesses in 20 counties previously receiving relief under Debby, but not Helene will receive disaster tax relief under Hurricane Milton, from Aug. 1, 2024, thru May 1, 2025. They are Baker, Brevard, Clay, DeSoto, Duval, Flagler, Glades, Hardee, Hendry, Highlands, Lake, Nassau, Okeechobee, Orange, Osceola, Polk, Putnam, Seminole, St. Johns and Volusia counties. As a result, affected taxpayers in all of Florida now have until May 1, 2025, to file various federal individual and business tax returns and make tax payments"  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

View job as Retirement Plan Consultant for Ascensus

Retirement Plan Consultant

Ascensus

Remote / PA

View job as Retirement Plan Consultant for Ascensus
View job as VP, Sales Consultant (Manhattan/Long Island Territory) for FuturePlan, by Ascensus

VP, Sales Consultant (Manhattan/Long Island Territory)

FuturePlan, by Ascensus

Remote / NY

View job as VP, Sales Consultant (Manhattan/Long Island Territory) for FuturePlan, by Ascensus

Press Releases

PSCA Releases National HSA Day Materials for Employers

PSCA [Plan Sponsor Council of America]

Vault Names Groom to 2025 'Top 150 Under 150' List

Groom Law Group

Alicia Munnell to Step Down as Center for Retirement Research Director

Center for Retirement Research at Boston College

Webcasts and Conferences
(Health & Welfare Plans)

Handling FMLA Abuse

October 29, 2024 WEBINAR

LearningsPro

Election 2025: What the Results Mean for Retirement & Health Policy

November 12, 2024 WEBINAR

Groom Law Group

Don’t Get Caught Off Guard: What Managers Should Know Before a Request for Leave or an Accommodation is Made

November 19, 2024 WEBINAR

The Wagner Law Group P.C.

Last Issue's Most Popular Items

Final Mental Health Parity Rules Released: Next Steps for Employers

Epstein Becker Green

New Rules on Mental Health Parity Finalized: Next Steps for Employers

AssuredPartners

Infographic: What's Driving Medical and Rx Costs

Segal

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

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