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Health & Welfare Plans Newsletter

October 18, 2024

 

[Official Guidance]

Text of IRS Notice 2024-71: Expenses Treated as Amounts Paid for Medical Care (PDF)

"This notice provides a safe harbor under section 213 of the Internal Revenue Code
for amounts paid for condoms."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Compliance Requirements for Fixed Indemnity Insurance Notices

"The notice must be provided whether the marketing, application, or enrollment materials are distributed in paper or electronic form. This means that the notice must be posted in online enrollment portals and included in any enrollment packets if the employer is offering a fixed indemnity plan. If there is a separate enrollment form or application the employee must complete to secure the coverage, the notice must be on the first page there as well."  MORE >>

HUB International

[Guidance Overview]

Midyear Medical Coverage Changes After Employee Adds Dependent

"Is an employer required to allow an employee who has a new dependent to change medical coverage options outside of open enrollment?.... Yes -- assuming that the enrollment request follows the terms of the group health plan (e.g., made on a timely basis, includes required documentation) and that there is another group health plan coverage option available for which the employee is eligible."  MORE >>

Willis Towers Watson

[Guidance Overview]

Summary of Provisions of HHS' Proposed 2026 Notice of Benefit and Payment Parameters and Other Key Regs (PDF)

"HHS proposes to increase user fees  ... HHS proposes several policies to reduce the amount of noncompliance and unauthorized agent/broker activity.... HHS seeks comments on ways it can work with state insurance departments and other entities to reduce the risk of issuer insolvency.... HHS proposes several updates to the risk adjustment model.... HHS proposes to change the MLR formula[.]"  MORE >>

Wakely Consulting Group

[Guidance Overview]

California Dental Plans: New Coverage and Reporting Requirements

"Beginning on or after January 1, 2025, under California Assembly Bill 1048 (AB 1048), dental carriers that are regulated by California's Department of Managed Health Care and the Department of Insurance shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision in a large group plan or preexisting condition provision for any plan."  MORE >>

Sequoia

Fifth Circuit Reverses District Court and Awards Benefits to ERISA Plan Participant for Hospitalization

"The Fifth Circuit’s decision stands as a warning to insurers or other plan administrators who might be tempted to disregard the treatment decisions and recommendations made by a beneficiary’s physicians in favor of cost savings, and from ignoring legitimate requests for relevant plan documents and other regulatorily required information." [Dwyer v. United Healthcare Ins. Co., No. 23-50439 (5th Cir. Sept. 19, 2024)]   MORE >>

Fishman Haygood, via JDSupra

Arizona Surgery Center Files Suit Accusing Aetna of 'Serially' Denying Reimbursements

"According to the allegations, an Aetna patient received medically necessary, nonsurgical pain management services at the ASC. Since the center was not in-network, it followed a process for each rendered service to ensure payment. The suit claims that not only did the ASC confirm with Aetna that the procedure would be covered, but it also received prior authorization. For each of the unpaid claims, the ASC submitted a bill to an Aetna, who began 'serially denying payment.' " [Fortitude Surgery Center, LLC v. Aetna Health, Inc., No. 24-2650 (D. Ariz. complaint filed Oct 1, 2024)]  MORE >>

Becker's Healthcare

How to Differentiate and Win with ICHRA

"No matter where your organization falls on the spectrum of ICHRA readiness, it's critical to factor in how the right technology partner can set you up for success and sharpen your competitive edge.... [1] Offer a shopping experience designed to retain and grow membership ... [2] Maintain broker relationships ... [3] Provide the familiar group experience with ICHRA ... [4] Enabling ICHRA at scale ... [5] Offer ICHRAs in a differentiated way."  MORE >>

Benefitfocus

Benefits in General

A Guide to Buying and Maintaining Cyberinsurance

"DOL guidance assumes that insurance is available for cybersecurity breaches or incidents but does not specify cyberinsurance as the only insurance type. Cyberinsurance covers loss and costs associated with a data breach but does not typically offer coverage related to the theft of money.... Cyberinsurance is not standardized, so sponsors need basic knowledge to evaluate insurance options and policy details properly"  MORE >>

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Webcasts and Conferences
(Health & Welfare Plans)

Is Your Wellness Program Due for a Checkup?

RECORDED

NFP Corp.

Ransomware and the HIPAA Security Rule

October 18, 2024 WEBINAR

Office for Civil Rights [OCR], U.S. Department of Health & Human Services [HHS}

Taxable vs Non-Taxable Fringe Benefits

October 23, 2024 WEBINAR

InEducator

Mental Health Parity Final Rule Deep Dive: The Six Content Elements and Important Deadlines

October 28, 2024 WEBINAR

ERIC [ERISA Industry Committee]

Plan Documents and Annual Required Notices

November 20, 2024 WEBINAR

Savoy

Get Ready for Maine’s Paid Family and Medical Leave Law!

December 12, 2024 WEBINAR

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

ERISA Welfare Plan Participant Disclosures Checklist (PDF)

Bass, Berry & Sims PLC

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

Jackson Lewis, via Association of Corporate Counsel (ACC)

SSA Announces Social Security Taxable Wage Base for 2025

Thomson Reuters / EBIA

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

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