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Health & Welfare Plans Newsletter

October 17, 2024

3 New Job Opportunities 3 New Job Opportunities

 

[Guidance Overview]

Exceptional Usefulness and Quality icon ERISA Welfare Plan Participant Disclosures Checklist (PDF)

8 page chart lists required disclosures, along with required timing for initial disclosure and other periodic disclosures.  MORE >>

Bass, Berry & Sims PLC

[Guidance Overview]

Is Your Group Health Plan 'Affordable'? ‎

"Based on the three different safe-harbor methods, employers in the Pacific NW, where minimum wage rates are higher than the federal minimum of $7.25 per hour, using the Rate of Pay safe harbor method would allow for greater contributions."  MORE >>

Schwabe, Williamson & Wyatt, P.C.

[Guidance Overview]

The In-House Lawyer's Guide to Workplace Wellness Compliance

"Whether 'participatory' or 'health-contingent,' standalone or part of a group health plan, or subject to [ERISA], there are many ways to structure a wellness plan.... An overlapping number of federal laws and agencies sets compliance rules for wellness programs.... Compliance requirements can include making reasonable alternatives available, maintaining data privacy and security, and ensuring incentives do not lead to discrimination or affect minimum value and affordability under the ACA."  MORE >>

Jackson Lewis, via Association of Corporate Counsel (ACC)

[Guidance Overview]

ERISA at 50: ERISA and Health Benefits (PDF)

"[T]his issue brief covers the history of ERISA's application to health benefits, subsequent amendments to the law, ERISA's facilitation of coverage under employer-sponsored health plans, and its challenges. ERISA establishes uniform federal standards regarding reporting and disclosure requirements, fiduciary responsibilities, grievance and appeals processes, and plan participation and antidiscrimination rules. In addition, ERISA preempts self-funded employer-sponsored health plans from state insurance laws, thus facilitating health coverage among large multi-state employers. Nevertheless, policymakers and regulators may wish to revise ERISA rules that are complex or inconsistent and address gaps in regulatory oversight."  MORE >>

American Academy of Actuaries

[Guidance Overview]

HHS FAQs Elaborate on HIPAA Administrative Simplification Enforcement and Compliance (PDF)

"The FAQs note that the Administrative Simplification Enforcement and Testing Tool (ASETT) is a free, multipurpose tool that may be used by anyone to file an anonymous complaint with [HHS's National Standards Group] against a HIPAA covered entity that they believe failed to comply with regulations for electronic transactions, operating rules, code sets, and unique health identifiers"  MORE >>

Thomson Reuters / EBIA

'Meaningful Dialogue' Standard Gains Traction

"The court found that United had failed to engage in any dialogue with the plaintiff. It faulted United's benefits termination letter for not addressing applicable plan provisions or how the beneficiary's medical needs were evaluated under the terms of the plan.... [T]he court said administrators may not arbitrarily ignore credible evidence and must address contrary medical opinions as part of the required 'meaningful dialogue.' " [Dwyer v. United Healthcare Ins. Co., No. 23-50439 (5th Cir. Sept. 19, 2024)]  MORE >>

Miller & Chevalier

Telehealth Relief Update: Impact on Plans for 2025 and Beyond

"Absent further guidance to save the telehealth relief safe harbor, any telehealth plan offering more than just preventive care that is provided at no cost to participants after January 1, 2025, will result in an ineligibility to make or receive HSA contributions. There are rumblings that some last-minute developments will change this relief from sunsetting completely or that it will be revisited by Congress at a later date, but as of now nothing is certain in that regard so plans should act accordingly."  MORE >>

AssuredPartners

Beyond Traditional Funding Options: Fully Insured, Self Insured and Gap Funding

"Employee benefits funding is much more than just a choice between fully insured and self-funded insurance. There's a whole rainbow of options in between, and it can get confusing very quickly.... In this blog, you'll find clear definitions, the pros and cons of each funding strategy, and tips for how to choose the funding strategy that works best for your company and your overall employee experience."  MORE >>

Nava

The New Caregiver Benefits: Precision Support Through Expanded Understanding

"Recognize that nearly all employees have some caregiving duties, whether for children, aging relatives or others.... Engage with employees to understand their specific needs and challenges in balancing caregiving with work ... Evaluate current caregiving benefits to determine their effectiveness and relevance.... Based on the feedback received and budget available, implement customized caregiving benefits."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

No Surprises Act Independent Dispute Resolution Outcomes for Emergency Services

"[The authors] analyzed public IDR data from 2023 for the most common disputed professional service: evaluation and management of a moderate to severe emergency medicine visit. Providers won 86% of the cases ... Private equity-backed providers won more often and higher monetary awards than other providers. The mean QPA was 2.4 times Medicare payments. Disputes were dominated by a small group of health plans and providers[.]"  MORE >>

Health Affairs Scholar

Should Spouses Have Separate Health Insurance Coverage?

"If you're part of a married couple or family working your way through open enrollment in 2024, here are some of the key issues to keep in mind as you decide whether to choose employee-only, employee-plus-one, or family coverage. [1] Compare the costs of health insurance coverage under different plans: is a traditional PPO or HDHP right for you? ... [2] Understand your healthcare needs and insurance policy usage ... [3] Does dual health insurance coverage make sense?"  MORE >>

MSN News

[Opinion]

2024 State PBM Regulation Recap: A Year of Hard Knocks

"This year, there were fewer PBM-related bills introduced compared to recent years.... The sheer amount of PBM lobbying power and ... tactics that they now use to oppose reimbursement floor legislation suggest that pharmacy advocates are now touching PBM nerves on a whole new level."  MORE >>

National Community Pharmacists Association [NCPA]

Benefits in General

[Guidance Overview]

DOL Updates Cybersecurity Guidance for ERISA Plans

"The DOL's reissued cybersecurity guidance should remind plan sponsors, fiduciaries and service providers of all ERISA plans of the critical importance of safeguarding plan assets and plan data against cybersecurity threats. Additionally, ERISA plan stakeholders should continue to maintain awareness of the ever-changing legislative and regulatory landscape."  MORE >>

Reinhart Boerner Van Deuren s.c.

SSA Announces Social Security Taxable Wage Base for 2025

"For 2025, that amount will be $176,100 (up from $168,600 for 2024).... Some 401(k) plans that provide for profit-sharing contributions use the Social Security taxable wage base for their permitted-disparity allocation formulas. The taxable wage base also impacts certain fringe benefits and is relevant when determining the tax savings from a cafeteria plan."  MORE >>

Thomson Reuters / EBIA

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 DB Retirement Plan Consultant for EGPS

DB Retirement Plan Consultant

EGPS

Remote

View job as DB Retirement Plan Consultant for EGPS
View job as Client Relationship Manager for The Retirement Advantage, Inc.

Client Relationship Manager

The Retirement Advantage, Inc.

Remote

View job as Client Relationship Manager for The Retirement Advantage, Inc.

Selected New Discussions

Plan Sponsor's Ability to Waive / Negotiate Subrogation Rights

"Employer has self-insured health plan administered by large national insurer providing administrative services only. Plan document contains very broad, expansive 'latest and greatest' subrogation provisions provided by ASO provider. Employee / participant was injured in auto accident more than a year ago. About a year ago, participant's lawyer wrote employer inquiring about plan sponsor / employer's willingness to waive subrogation rights under the plan or possibly agree to reduced subrogation amounts. Lawyer also requested usual host of plan documents per ERISA. Employer / Plan Sponsor did not respond or provide any plan documents. Participant's lawyer has surfaced again noting they have negotiated settlement and are ready to disburse proceeds. Lawyer reminded employer of its failure to provide documents per ERISA and the potential penalties that have now accrued. Lawyer is pushing for immediate answer from employer on follow-up request to waive all subrogation rights (or settling for about 1/15th of value) in exchange for agreeing not to report plan's failures to provide plan documents. The overall subrogation amounts at issue here are not that great. Employer freely admits it ignored all requests to provide documents. Can the employer (as plan sponsor and ultimate ERISA plan administrator) agree to simply waive pursuing subrogation here without giving rise to a possible fiduciary breach or other potential exposure? Any suggestions on how to negotiate and limit possible exposure to employer?"

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Press Releases

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EPIC

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Last Issue's Most Popular Items

ACA Reporting Cheat Sheet: Reporting Made Easy

OneDigital

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Is Your Plan Prepared for the Mental Health Parity Fiduciary Certification Requirements?

Bricker Graydon

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

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