The latest news, official guidance, analysis, jobs, and more.

Health & Welfare Plans Newsletter

May 10, 2024

[Guidance Overview]

IRS Announces 2025 Limits for HSAs, HDHPs and Excepted Benefit HRAs

"All of the dollar limits currently in effect for 2024 will change for 2025, with the exception of ... [the] HSA catch-up contribution for individuals ages 55 and older ...[A table] compares the applicable dollar limits for HSAs, HDHPs and excepted benefit HRAs for 2024 and 2025."   MORE >>

McDermott Will & Emery

[Guidance Overview]

Final Rule Issued by OCR and CMS for Nondiscrimination Protections Under Section 1557 of ‎the ACA

"[T]he preamble to the Final Rule clarifies that the provisions would not apply to employers as it relates to the provision of employee health benefits.... In addition, the preamble to the Final Rule clarifies that even if a plan sponsor or a third-party administrator of a group health plan receives Federal financial assistance, such assistance does not make the group health plan a 'covered entity'."   MORE >>

Locke Lord LLP

[Guidance Overview]

New Section 1557 Regs Focus on Health Care Industry But Indirectly Impact Employee Benefits

"[B]ecause most insurers will be covered entities, [the authors] expect they (and their TPA and PBM counterparts) will request that plan sponsors remove potentially discriminatory plan designs to avoid liability. Insurers, TPAs, and PBMs can be held responsible for discriminatory plan designs that they originated or controlled. Conversely, when a plan sponsor controls a discriminatory plan design, the plan sponsor can be held liable if it is a Section 1557 covered entity."   MORE >>

Buck

[Guidance Overview]

Final HIPAA Privacy Rule Increases Protection of Reproductive Health Care Data

"Employers sponsoring self-insured health plans will want to pay particular attention.... Consider implementing a system to identify and track PHI that is potentially related to reproductive health care.... Once the model attestation has been published, customize it as needed, but keep in mind an attestation will not be valid if combined with other documents or if it contains elements or statements not otherwise required under the Reproductive Health Care Rule.... Incorporate the Reproductive Health Care Rule into annual HIPAA training, ... Review business associate agreements to determine whether any updates are needed[.]"   MORE >>

Proskauer

[Guidance Overview]

Agency FAQ Part 67 Extends Nonenforcement for Surprise Billing QPA Calculations (PDF)

"The FAQ is in response to feedback that plans and insurers need additional time to complete the 'significant efforts' associated with recalculating QPAs consistent with the guidance that remains in effect after TMA III.... [U]pdates regarding IDR portal availability and process changes continue to be posted on the CMS website , including a recent announcement of a new process for resubmitting IDR disputes that were originally improperly batched or bundled."   MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

CMS Revised Final Key Dates for Calendar Year 2024: Qualified Health Plan Data Submission and Certification, Rate Review, and Risk Adjustment (PDF)

6-page chart summarizes key dates for calendar year 2024 regarding activities and policies that are outlined in other documents. Rev. May 8, 2024,   MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Connecticut Legislature Passes Major Expansion of Paid Sick Leave Law

"Connecticut's paid sick leave law currently applies to employers who employ at least 50 individuals in the State of Connecticut. That threshold will be lowered beginning on the effective date of the new law (expected to be Jan. 1, 2025) and will reduce annually until Jan. 1, 2027, at which time it will apply to employers with one or more employees in the State of Connecticut.... Beginning on Jan. 1, 2025, the 'service worker' concept will be removed from the law entirely, and covered employers will be required to provide paid sick leave to all employees, with limited exceptions[.]"   MORE >>

Jackson Lewis P.C.

District Court Holds That HRA Is Not Commensurate with Promised Lifetime Retiree Health Benefits (PDF)

"The employer argued that it met its obligation to provide lifetime benefits by providing the HRA, which it said was 'reasonably commensurate' with the old plan. But the court pointed out three reasons why this was not the case." [ Kaiser v. Alcoa U.S. Corp. , No. 20-0278 (N.D. Ind. Mar. 25, 2024)]   MORE >>

Thomson Reuters / EBIA

FMLA Doesn't Shield Employee from Dismissal Due to Misconduct Prior to Leave Request

"The court found that the plaintiff, who was on approved FMLA leave at the time she was discharged from employment for prior acts of theft of food pantry donations in violation of the city's code of ethics, had failed to offer any evidence that she would have retained her job but for her request for FMLA leave and had failed to establish that the city's stated reason for her dismissal was a pretext for FMLA retaliation and race discrimination." [ McBeath v. City of Indianapolis , No. 22-1216 (S.D. Ind. Apr. 29, 2024)]   MORE >>

Ogletree Deakins

Fiduciary Best Practices for Health Plan Sponsors

"[1] Regularly review and update plan documents ... [2] Conduct thorough due diligence on current and potential vendors ... [3] Implement strategies to proactively identify and mitigate potential threats to the plan's financial stability and participant satisfaction.... [4] Compliance adherence and conflict of interest avoidance ... [5] Education and training ... [6] Maintain open lines of communication with plan participants ... [7] Engage independent third-party reviewers ... [8] Maintain detailed records of all decisions ... [9] Proactive cost-containment efforts."   MORE >>

OneDigital

The Public's Use and Views of GLP-1 Drugs

"[O]ne in eight adults (12%) say they have ever taken a GLP-1 agonist ... including 6% who say they are currently taking such a drug.... Most adults who have taken GLP-1 drugs say they took them to treat a chronic condition including diabetes or heart disease (62%), while about four in ten say they took them primarily to lose weight. About half (54%) of all adults who have taken GLP-1 drugs say it was difficult to afford the cost ... [E]ven among insured adults about half (53%) say the cost was difficult to afford."   MORE >>

Henry J. Kaiser Family Foundation

[Opinion]

PBMs: Impact on Employer-Provided Coverage Contract and Benefit Design (PDF)

"Given employer preferences for contracting flexibility and the importance of gainsharing contracts in reducing prescription drug spending, legislative proposals aimed at banning either spread pricing in the commercial market or variable rebate contracts restrict PBMs' ability to work with employers to design the plan that is right for their employees. With increased pricing transparency to plan sponsors, employers will be well-positioned to negotiate contract terms and select models that reduce prescription drug spending."   MORE >>

America's Health Insurance Plans [AHIP]

Benefits in General

FTC's Noncompete Rule: Fireworks Are Coming Before Independence Day

"[T]he presiding judge ... issued a series of Orders that require all briefing on the request to stay/enjoin the FTC Rule to be completed by June 12. The Court will then announce by June 13 whether it will make a decision based on the parties' briefing or conduct a hearing, which would take place on June 17.... [T]he Court has committed to issuing a decision by no later than July 3 on the request to stay/enjoin the FTC Rule from going into effect." [Ryan v. FTC, No. 24-0986 (N.D. Tex. complaint filed Apr. 23, 2024)]   MORE >>

Polsinelli PC

Will New York City's Noncompete Ban Beat the FTC Final Rule to the Punch?

"Given the legal challenges to the FTC's rule, employers should know New York City's recent proposed challenge to using noncompete agreements, Bill 140 , is more onerous to employers than the FTC rule.... If passed, Bill 140 will be retroactive and require employers to affirmatively 'rescind' any noncompete by the date the law goes into effect."   MORE >>

FordHarrison

Employee Benefits Jobs

View job as 401k & Defined Contribution Plan Consultant for Planned Retirement Consultant & Administrators, LLC

401k & Defined Contribution Plan Consultant

Planned Retirement Consultant & Administrators, LLC

Remote / Ridgewood NJ

View job as 401k & Defined Contribution Plan Consultant for Planned Retirement Consultant & Administrators, LLC

View job as Employee Benefits Associate for Shipman & Goodwin LLP

Employee Benefits Associate

Shipman & Goodwin LLP

Remote / CT

View job as Employee Benefits Associate for Shipman & Goodwin LLP

View job as Employee Benefits and Executive Compensation Associate for ArentFox Schiff

Employee Benefits and Executive Compensation Associate

ArentFox Schiff

CA / DC / IL / MA / NY

Selected New Discussions

Plan Year for Form M1 and Form 5500

"Is the Plan year in the Form 5500 and the Form M1 to match? The instructions in the Form M1 do not provide instruction on this. On page two the instructions note to use the same identifying information but do not classify if the Plan year is to be included in this case."

BenefitsLink Message Boards

Ending FSA for HCE and Refunding All Contributions

"So my company failed Section 125 Nondiscrimination Testing and a decision was made to change all pre-tax benefits for Highly compensated employees to taxable income immediately ending the FSA program for 2024. Company is refunding all the contributions made to the date. If an employee already made payout on the FSA account, are they legally required to pay back? What happens if they don't?"

BenefitsLink Message Boards

Press Releases

Webcasts and Conferences(Health & Welfare Plans)

Striking a Balance: Creating Leave Policies That are Compliant and Caring

RECORDED

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

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

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