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Health & Welfare Plans Newsletter

October 21, 2024

2 New Job Opportunities 2 New Job Opportunities

 

[Official Guidance]

Text of Agencies' Proposed Regs: Enhancing Coverage of Preventive Services Under the ACA (PDF)

158 pages. "This document proposes rules that would provide that medical management techniques used by non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage with respect to such preventive services would not be considered reasonable unless the plan or issuer provides an easily accessible, transparent, and sufficiently expedient exceptions process that would allow an individual to receive coverage without cost sharing for the preventive service that is medically necessary with respect to the individual, as determined by the individual's attending provider, even if such service is not generally covered under the plan or coverage....

"[T]hese proposed rules would require plans and issuers to cover certain recommended over-the-counter contraceptive items without requiring a prescription and without imposing cost- sharing requirements. In addition, the proposed rules would require plans and issuers to cover certain recommended contraceptive items that are drugs and drug-led combination products without imposing cost-sharing requirements, unless a therapeutic equivalent of the drug or drug-led combination product is covered without cost sharing. Finally, this document proposes to require a disclosure pertaining to coverage and cost-sharing requirements for over-the-counter contraceptive items in plans' and issuers' Transparency in Coverage internet-based self-service tools or, if requested by the individual, on paper."

Also available:  White House Fact Sheet and HHS Fact Sheet.  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Official Guidance]

Text of IRS Notice 2024-75: Preventive Care for Purposes of Qualifying as a High Deductible Health Plan Under Section 223 (PDF)

"This notice expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) ... to include over-the-counter (OTC) oral contraceptives ... and male condoms. This notice also clarifies that [1] all types of breast cancer screening for individuals who have not been diagnosed with breast cancer are treated as preventive care ... [2] continuous glucose monitors for individuals diagnosed with diabetes are generally treated as preventive care ... and [3] the new safe harbor for absence of a deductible for certain insulin products in section 223(c)(2)(G) applies without regard to whether the insulin product is prescribed to treat an individual diagnosed with diabetes or prescribed for the purpose of preventing the exacerbation of diabetes or the development of a secondary condition."  MORE >>

Internal Revenue Service [IRS]

[Official Guidance]

Text of Agency FAQs About ACA and Women's Health and Cancer Rights Act Implementation, Part 68 (PDF)

15 pages; 7 Q&As. "What changes must plans and issuers make to comply with the 2023 USPSTF recommendation for PrEP?.... If a plan or issuer receives a claim from an in-network provider that identifies an item or service as a recommended preventive item or service using industry-standard coding practices, should the plan or issuer cover the item or service without cost sharing, consistent with PHS Act section 2713 and its implementing regulations?.... What steps are plans and issuers expected to take to ensure that participants, beneficiaries, and enrollees are not improperly denied coverage or charged cost sharing for recommended preventive items and services furnished by in-network providers?"  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Official Guidance]

Draft of Instructions for IRS Form 8994: Employer Credit for Paid Family and Medical Leave (PDF)

Oct 18, 2024; 11 pages. "An eligible employer uses Form 8994 to figure the employer credit for paid family and medical leave. The credit ranges from 12.5% to 25% of certain wages paid to a qualifying employee while the employee is on family and medical leave. You can claim or elect not to claim the employer credit for paid family and medical leave any time within 3 years from the due date of your return on either your original return or an amended return."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Final Mental Health Parity Rules: Employer Action Required

"Employers should begin work promptly on securing the comparative analysis and working through any results from that analysis. For insured plans, the insurance carrier is primarily responsible. However, for self-funded plans, the employer will likely need to engage a third party provider to conduct the analysis. The first stop on that journey is to interface with the plan's third-party administrator or administrative services only provider to determine what support they can provide and then, in all likelihood, retain a third party to conduct the analysis."  MORE >>

HUB International

[Guidance Overview]

New and Improved California Leave Provisions for 2025

"Governor Newsom recently signed new laws which extend and clarify employees’ available reasons for use of California paid sick leave. There are expanded unpaid leave protections for victims of domestic violence, sexual assault, stalking, or qualifying acts of violence, as well as for employees summoned to jury duty or responding to a subpoena or court order to testify under FEHA. The changes go into effect on January 1, 2025."  MORE >>

Seyfarth

[Guidance Overview]

Massachusetts Sick Leave Expanded to Include Pregnancy Loss and Other Reproductive Issues

"Effective November 21, Massachusetts employees will be permitted to use their sick time to 'address the employee's own physical and mental health needs, and those of their spouse, if the employee or the employee's spouse experiences pregnancy loss or a failed assisted reproduction, adoption or surrogacy.' The enacting bill also restates existing law allowing employees to use sick time to attend routine medical appointments for the employee or their child, spouse, parent, or parent of their spouse and to address the psychological, physical, or legal effects of domestic violence."  MORE >>

ArentFox Schiff LLP

Third Circuit Holds That Employers Are Not Obligated to Apply FMLA Entitlements Retroactively

"The Court's decision provides clear guidance to employers within the Third Circuit ... that an employee does not have a 'chronic serious health condition' if the employee is evaluated by a health care provider and obtains FMLA certification regarding the condition after the fact. The Court definitively held that FMLA entitlements only apply prospectively, i.e.,after the condition is certified." [Rodriquez v. SEPTA, No. 23-3074 (3d Cir. Oct. 11, 2024)]  MORE >>

Stevens & Lee

Compliance Considerations for Short Plan Years

"If the plan year is cut short, the change should be communicated to plan participants in writing at least 60 days in advance in accordance with notice of modification rules.... [1] Employee elections ... [2] Health FSA ... [3] Dependent Care Account plan ... [4] HSAs ... [5] Section 4980H (employer mandate) requirements ... [6] PCORI fees ... [7] COBRA ... [8] CMS creditable coverage reporting."  MORE >>

Keenan & Associates

[Opinion]

Do the J&J and Wells Fargo Health Plan Excess Fee Cases Meet the MetLife Decision’s High Bar for ERISA Plan Standing?

"[The Third Circuit Court of Appeals recently] made clear that any future case must allege harm to participants by showing that they were charged more than is allowed under the plan document. Standing cannot be based on pure conjecture or speculation that the plan sponsor had discretion to lower participant health plan fees if the plan experiences an overall lower rate of health expenses.... The key issue is whether the alleged contribution formula is speculation, or grounded in the J&J plan document. This narrow nuance will define whether plaintiff lawyers have standing to sue health plan sponsors for fiduciary breaches in failing to reduce plan health costs." [Knudsen v. MetLife Grp., Inc., No. 23-2420 (3d Cir. Sep. 25, 2024)]  MORE >>

Encore Fiduciary

Benefits in General

U.S. Historical Population Mortality Rates 2000-2022

"To develop these rates, the SOA relied upon data furnished by the Centers for Disease Control and Prevention, [CMS], the U.S. Census Bureau, and the Social Security Administration. A document summarizing key observations, and the process used to develop the rates, along with a table of the rates themselves, [are provided]."  MORE >>

Society of Actuaries

Employee Benefits Jobs

View job as Retirement Plans Analyst or Administrator for Compensation Strategies Group, Ltd.

Retirement Plans Analyst or Administrator

Compensation Strategies Group, Ltd.

Remote / Beaumont TX / Hybrid

View job as Retirement Plans Analyst or Administrator for Compensation Strategies Group, Ltd.
View job as Defined Contribution Consultant for LDSCO

Defined Contribution Consultant

LDSCO

Remote / Friendswood TX

View job as Defined Contribution Consultant for LDSCO

Press Releases

Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans

Oscar Health

Noom Unveils Two New Enterprise Products to Help Employers Offer, Manage, and Effectively Control GLP-1 Expenses

Noom

Inspira Financial Teams Up with Boldin, the Financial Planning Platform, to Empower Accountholders to Confidently Plan for Their Future

Inspira

Webcasts and Conferences
(Health & Welfare Plans)

Benefits Breakdown: Election Insights from James Slotnick

October 21, 2024 WEBINAR

Brown & Brown

Last Issue's Most Popular Items

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

Internal Revenue Service [IRS]

Midyear Medical Coverage Changes After Employee Adds Dependent

Willis Towers Watson

Compliance Requirements for Fixed Indemnity Insurance Notices

HUB International

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

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