Compliance Corner: Federal Health & Welfare Updates

On January 3, 2022, the IRS released Revenue Procedure (Rev. Proc.) 2022-4, which outlines the procedures for requesting determination letters and private letter rulings from the IRS for qualified retirement plans. Rev. Proc. 2022-4 is a general update of the information provided in Rev. Proc. 2021-4. Determination letters indicate whether the IRS finds an employer's employee benefit plan to meet the requirements necessary for the plan to be a qualified plan. Private letter rulings interpret an

On January 12, 2022, Commissioner Conway adopted amendments to Regulation 4-2-73. This regulation applies to all carriers marketing and issuing individual and group health benefit plans subject to the state's regulation. The regulation requires carriers to provide coverage for the federal Food and Drug Administration (FDA)-approved medication prescribed for pre-exposure prophylaxis (PrEP) without copayment or cost-sharing for individuals who, according to their provider or pharmacist, are indic

On January 14, 2022, the Pension Benefit Guaranty Corporation published revised civil penalty amounts for failure to provide certain notices or other material information, as required by ERISA. The amounts apply to penalties assessed on or after the publication date. The adjusted maximum amounts are $2,400 (up from $2,259) for Section 4071 penalties and $320 (up from $301) for Section 4302 penalties, which are related to multiemployer plan notices. PBGC Revised Penalties »

The Department of Fair Employment and Housing (DFEH) updated the 'Your Rights and Obligations as a Pregnant Employee' and 'Family Care and Medical Leave and Pregnancy Disability Leave' posters. These publications inform employees of their rights under California's Family Rights Act (CFRA) and Pregnancy Disability Leave (PDL). Employers with five or more employees must post the notices at their California worksites. If employees work remotely, the notice may be delivered electronically. If 10% o

The Department of Fair Employment and Housing (DFEH) revised the Certification of Health Care Provider, which is used for an employee requesting leave under the California Family Rights Act (CFRA). CFRA is California's version of FMLA. It previously applied to employers with 50 or more employees. However, effective January 1, 2021, the law and its requirements apply to employers with five or more California employees. The law provides up to 12 weeks of unpaid leave for an eligible employee with

On January 10, 2022, the DOL, HHS and the Treasury (the 'Departments') issued guidance in the form of FAQs regarding new COVID-19 test requirements. The guidance states that, starting January 15, 2022, and effective until the end of the public health emergency, health insurance carriers and group health plans (including self-insured plans) must pay for over-the-counter (OTC) COVID-19 tests without cost-sharing, prior authorization or other medical management requirements. The Departments produc

On December 17, 2021, Gov. Inslee and the legislature issued statements to delay the payroll premium collections that will fund the state's new long-term care (LTC) program '” the Washington Cares Fund. On December 23, 2021, Gov. Inslee issued a statement clarifying that if the legislature fails to change the law, 'employers will still be legally obligated to pay the full amount owed to state Employment Security Department (ESD) to begin the long-term care program' since 'only the legislat

On December 31, 2021, the Department of Insurance issued Bulletin No. 2021-09 regarding compliance with the Consolidated Appropriations Act, 2021 (CAA), which includes the No Surprises Act (NSA) and transparency provisions. The stated purpose of the bulletin is to inform insurers, pharmacy benefit managers, independent review organizations and other third-party service providers of the CAA requirements. The bulletin outlines the NSA surprise billing prohibitions, the independent dispute resolu

We do not recommend that employers create composite rates where the carrier is billing on an age-banded basis. This is because it can result in issues under ERISA and the Age in Employment Discrimination Act (ADEA). Specifically, it is a violation of ERISA if the employer rate for some employees is higher than the insurer rate for those employees. Additionally, if the employer calculates its own composite rates, it becomes unworkable if new employees are hired or if employees present when the

On December 21, 2021, the Commissioner of Health of the City of Chicago signed Order No. 2021-2. Effective January 3, 2022, indoor restaurants, fitness centers, and entertainment and recreation venues (where beverages or food is served) must require patrons aged 16 and older to provide proof of vaccination from COVID-19. Employees of such entities must either provide proof of vaccination; or continue to mask and provide proof of a negative COVID-19 test on a weekly basis. The order applies rega

On December 28, 2021, HHS issued the proposed Notice of Benefit and Payment Parameters Rule for 2023. This notice is issued annually preceding the applicable benefit year and, once final, adopts certain changes. While the proposed rule primarily impacts the individual market and the Exchange, it also addresses certain ACA provisions and related topics that impact employer-sponsored group health plans. Highlights include: Annual Cost-Sharing Limits. As background, the ACA requires non-grandfath

Group health insurance policies that provide coverage for outpatient services must provide benefits for lead poisoning screening, testing, diagnostic evaluations, screening/testing supplies and home visits for children who are at risk for lead poisoning. The coverage may be subject to the plan's normal cost-sharing provisions. The requirement applies to policies issued or renewed after December 31, 2021. Employer plan sponsors should work with their insurers to communicate the coverage change