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Health & Welfare Plans Newsletter

October 23, 2024

3 New Job Opportunities 3 New Job Opportunities

 

[Guidance Overview]

2025 Health FSA Limit Increases to $3,300

"[F]or plan years beginning on or after January 1, 2025, the health FSA salary reduction contribution limit increases to $3,300. The adjustment for 2025 represents a $100 increase to the $3,200 health FSA salary reduction contribution limit for 2024.... What about the carryover limit into 2025? ... What about employer health FSA contributions? ... Other notable 2025 health and welfare employee benefit amounts."  MORE >>

Newfront

[Sponsor]

2025 Population Health Management Summit for Payers & Providers

February 20-21, 2025; San Diego, CA. Innovative Strategies to Advance Population Health: Achieve the Triple Aim Through Value-Based Care, Improve Patient Centered Care, Enhance Healthcare Data & Technology, and Reduce Overall Healthcare Costs!

Sponsored by World Conference Forum

[Guidance Overview]

Hospital and Fixed Indemnity Insurance: New Notice Requirement

"Aiming to highlight the differences between fixed indemnity coverage and comprehensive coverage, the Departments have introduced a new notice requirement which must ... [1] Explain that a fixed indemnity policy pays a limited amount when sick or hospitalized, but is not health insurance ... [2] Include contact information for the Marketplace ... and [3] Identify where to find state insurance commissioners' contact information if someone has a question or complaint."  MORE >>

Sequoia

[Guidance Overview]

Compliance Deadline Approaching for New HIPAA Privacy Rule on Reproductive Health Care

"The final rule presents plan administrators of self-insured group health plans with a good opportunity to review their current HIPAA compliance status and prepare for the new attestation requirement.... [1] Update HIPAA policies and procedures.... [2] Confirm compliance with TPA.... [3] Review business associate agreements (BAAs).... [4] Schedule HIPAA workforce training.... [5] Stay tuned for updates to HIPAA Notice of Privacy Practices (NPP)."  MORE >>

Ice Miller LLP

[Guidance Overview]

Administration Proposes Health Plan Coverage Mandate for Over-the-Counter Contraception

"[T]he proposed rule in part: [1] Requires non-grandfathered health plans and health insurance issuers to cover, without cost-sharing and without a prescription, the cost of all types of contraception, ... [2] Mandates disclosures to covered persons so they are aware and can take full advantage of the newly available coverage; and [3] Enhances the 'exceptions process' for medical management techniques ... [T]he proposed rule would impose new administrative processes on employer-sponsored plans, mandate employee disclosures, and require plan amendments."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

Departments Propose to Require Coverage of Over-the-Counter (OTC) Contraceptives

"Among other changes, the proposed regulations -- if finalized as proposed -- would require group health plans and health insurers to cover over-the-counter (OTC) contraceptives without a prescription and without imposing cost-sharing requirements[.]"  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Change in Status Rules: Dependent Changes Explained

"The IRS defines a 'change in the number of dependents' to include birth, adoption, placement for adoption, and death. Typically, birth, adoption, or placement for adoption will also trigger HIPAA special enrollment rights for major medical coverage.... Employees may have a limited time to utilize their change in status based on the employer's plan design."  MORE >>

HUB International

[Guidance Overview]

Mental Health Parity, Fiduciary Certifications, and Short-Term Implications

"For plans subject to ERISA, the new rules now require a plan's fiduciary to certify within this analysis that they have [1] engaged in a prudent process for selecting a vendor to complete this analysis and [2] monitored their vendor as they complete the analysis. In most cases, the employer, as the plan sponsor and administrator, will be the designated fiduciary responsible for performing these duties and certifying that they have done so. So, what does the certification of a prudent process of selection and subsequent monitoring of service providers look like?"  MORE >>

MZQ Consulting, LLC

Demystifying the Perceived Simplicity of HIPAA Agreements (PDF)

"BAAs are critically important and can make or break a compliance program if not taken seriously. Though it may seem easiest to simply sign a BAA as a standard attachment to a service agreement, this article highlights five of the many reasons why parties should always read, review and negotiate the terms prior to execution."  MORE >>

Holland & Knight, via Employee Benefit Plan Review

Grandfathering Employee Contribution Rates: Pros and Cons

"Employers typically consider grandfathering employees as a way to keep rates the same or relatively constant for current employees, but charge new employees higher rates for those same benefits.... Grandfathering could be discriminatory under the nondiscrimination rules of Section 125 and Section 105(h) of the Internal Revenue Code.... Employers need to be conscious of affordability ... Grandfathering employees may also cause a divide between longer tenured employees and those newly hired."  MORE >>

HUB International

More Oversight of Health Claims is Needed, ERISA Advisory Council Says

"The ERISA Advisory Council made several recommendations to the [DOL] concerning health plan claim denials and related appeals in a draft report ... The DOL should collect more data on health appeals ... [The report] recommended increased enforcement from the DOL, including penalties for missed deadlines. The DOL should also invest in educating sponsors and participants about appeal rights.... Lastly, the report recommended that those who make claim determinations involving clinical judgement should be considered ERISA fiduciaries, including insurers themselves."  MORE >>

Plan Sponsor Council of America [PSCA]

How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?

"Authorizing coverage of [anti-obesity medications (AOMs)] in Medicare would increase federal spending, on net, by about $35 billion from 2026 to 2034. Total direct federal costs of covering AOMs would increase from $1.6 billion in 2026 to $7.1 billion in 2034. Relative to the direct costs of the medications, total savings from beneficiaries' improved health would be small -- less than $50 million in 2026 and rising to $1.0 billion in 2034."  MORE >>

Congressional Budget Office [CBO]

[Opinion]

The Incursion of Profit-Enhancing Middlemen in U.S. Health Care

"The U.S. health care system, by and large, does not regulate the prices providers charge in the commercial market, nor oversee private insurer claims decisions, particularly denials.... [T]his regulatory vacuum has fostered an ever-growing market for intermediary businesses to help clinicians navigate the processes of filing claims and maximizing reimbursements. At the same time, insurers increasingly contract with intermediary businesses in an effort to manage utilization and up their own margins. These competing 'profit-enhancing middlemen' are likely increasing costs for consumers and spending in the private sector health system as a whole."  MORE >>

Health Affairs Forefront

Employee Benefits Jobs

View job as Retirement Plan Compliance Consultant for Capital Group

Retirement Plan Compliance Consultant

Capital Group

Irvine CA / Carmel IN

View job as Retirement Plan Compliance Consultant for Capital Group
View job as Retirement Plan Consultant for The Finway Group

Retirement Plan Consultant

The Finway Group

Remote / West Des Moines IA

View job as Retirement Plan Consultant for The Finway Group
View job as Onboarding Documents Coordinator for The Finway Group

Onboarding Documents Coordinator

The Finway Group

Remote / West Des Moines IA

View job as Onboarding Documents Coordinator for The Finway Group

Press Releases

Kyla Keck Receives 2024 Harry T. Eidson Founders Award at ASPPA Annual

ASPPA [American Society of Pension Professionals & Actuaries]

Webcasts and Conferences
(Health & Welfare Plans)

Maryland Paid Sick and Safe Leave for Businesses 101

November 7, 2024 WEBINAR

Littler

Navigating High-Cost Healthcare: Strategies for Effective Cost-Containment

November 19, 2024 WEBINAR

UBA [United Benefit Advisors]

Last Issue's Most Popular Items

Text of IRS Rev. Proc. 2024-40: Inflation-Adjusted Amounts for 2025 (PDF)

Internal Revenue Service [IRS]

MHPAEA Final Rules: Plans and Issuers Must Prepare for January 1, 2025 Effective Date

Squire Patton Boggs

Proposed Regs Would Affect Contraceptive Coverage

Henry J. Kaiser Family Foundation

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

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