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Compliance Issues for Employer Health and Welfare Plans: Fees, Services, Plan Contracts, Reporting, Audits

CAA Challenges, Removal of Gag Clauses, Compliance Attestations, Determining Reasonableness in Vendor Fees and Services

Recording of a 90-minute premium CLE video webinar with Q&A

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Conducted on Thursday, January 4, 2024

Recorded event now available

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This CLE webinar will provide employee benefits counsel a comprehensive analysis of evolving compliance challenges for employer-sponsored health and welfare plans. The panel will discuss key areas of focus of Department of Labor (DOL) audits, significant compliance issues for health plan sponsors under the Consolidated Appropriations Act of 2021 (CAA), plan contracts and the removal of "gag clauses," vendor fees and services, and new compliance attestation requirements. The panel will also discuss other key items impacting health and welfare plan administration and compliance.

Description

The DOL has an active enforcement program focused on health and welfare plans in response to rules provided under the CAA. ERISA counsel, fiduciaries, and administrators must ensure strict compliance with current regulations and implement procedures to overcome administrative challenges.

The administrative challenges and compliance failures for health and welfare plans can lead to lawsuits and significant penalties. The enactment of the CAA significantly impacts the administration and fiduciary obligations for health plans. In particular, the CAA impacts health and welfare plans’ compliance obligations with regard to (1) plan contracts and the removal of "gag clauses"; (2) determining "reasonableness" for vendor fees and services; (3) prescription drug reporting; and (4) parity between medical and mental health coverage.

The DOL's key areas of focus for audits and enforcement will encompass the aforementioned items in addition to other critical issues. ERISA counsel must identify potential compliance pitfalls and understand the required documentation and procedures, audit triggers, and plan provisions targeted by the DOL and IRS to minimize these plan administration issues.

Listen as the panel discusses significant compliance issues for health plan sponsors under the CAA and recent guidance for plan contracts and the removal of "gag clauses," vendor fees and services, and new compliance attestation requirements.

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Outline

  1. CAA compliance for health and welfare plans
  2. Plan contracts and "gag clauses"
  3. Vendor fees and services
  4. Mental health parity rules
  5. Fiduciary rules and liability
  6. Recent DOL developments
  7. Best practices for plan sponsors and administrators

Benefits

The panel will review these and other key items:

  • What are the administrative challenges for health and welfare plans under the CAA?
  • What are the requirements under the new mental health parity rules under the CAA?
  • What are the next steps and pitfalls to avoid for plan contracts and "gag clauses"?
  • What factors must be considered in determining the "reasonableness" of vendor fees and services?
  • What are the fiduciary obligations and rules for health plan sponsors and administrators?
  • What are the recent DOL developments and plans for enforcement actions?
  • What are the best practices to overcome legal and compliance challenges?

Faculty

Delano, Dannae
Dannae Delano
Partner
The Wagner Law Group

Ms. Delano concentrates her practice in employee benefits law, executive compensation and taxation. She counsels...  |  Read More

Swanson, Amanda
Amanda Swanson
Compliance Manager, Employee Benefits
Woodruff-Sawyer & Co.

Ms. Swanson provides compliance support, training, and deliverables to clients and to our teams at Woodruff Sawyer. She...  |  Read More

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