Chaz

What is the penalty for not (timely or at all) obtaining an HPID?

I came across this old topic in my research as I am looking at almost exactly this issue. My reading of subsection (e) is that it only provides a list of "examples" of "other benefits" (hence the title of the subsection). As long as the program "protects against a contingency that interrupts or impairs a member's earning power” under section (d)(2) and is not listed as a nonqualifying benefit in section (f), I think it would be okay, even if the program is not listed in section (e) (i.e., it is not a “facility”). If the program is set up to meet the requirements of Code Section 129, which permits tax-free day care reimbursements only to the extent that they enable the employee to be “gainfully employed” (subject to the other requirements of Section 129, including the $2,500/$5,000 limit), I read that to be a program that protects against a participant’s earning power being impaired due to having to take care of a child during work hours. Therefore, it should meet the requirements of 501(c(9). Anyone have any thoughts on this? (To answer the OP's question, even if a VEBA could provide dependent care assistance program benefits in excess of the $5,000 cap under Code Section 129, without it participants would be taxed on the reimbursements, in my view, if the requirements of Section 129 are not met.)

Our local monolithic BCBS bureaucracy offers participants in its clients' self-insured health plans the ability to receive rewards for participating in certain participatory "wellness" activities in the form of cash reimbursements. For instance, if a participant joins a gym and documents that it completed X number of workouts, BCBS will reimburse a portion of the gym membership fee. This reimbursement is a taxable fringe benefit under the Code. As such, each employee must include it in gross income and the employer must properly withhold the amounts and report the amount on the employee's Form W-2 BCBS appears to be, thus far, unwilling and/or unable to provide its clients with information about these reimbursements to permit the clients to comply with its reporting obligation. There does not seem to be a legal obligation on BCBS to provide the information. I understand the risk of liability is relatively low here but has anyone come across this situation and, if so, how did you address it? Thanks!

I would review the DOL's Technical Release 92-01.

The plan administrative scheme should be changed so that all amounts for claims come from the employers's general assets and there are no amounts held by the TPA. In that way, there are no plan assets and the attendant obligations. The best way to do this is to have a bank account in the employer's name (not the plan's) from which the TPA has check-writing authority. This arrangement may conflict with the TPA's business model and may require discussion during the ASO agreement negotiation but I advise clients to go in another direction if the TPA insists on holding amounts in its own name (e.g., reserve deposit, bank accounts, etc.)

Does anyone have any thoughts on this?

You may get more responses to this question if you ask it in the "403(b) Plans, Accounts or Annuities" group. This forum is for discussions on securities law questions.

Employer has employees spread out all over the country. Many of these employees are unionized and participate in various multiemployer welfare plans depending on their locations. Employer is concerned about the Section 6056 reporting requirements for 2015 (i.e., providing information whether it offers its full-time employees with affordable, minimum value coverage). It does not have information about the employee contribution for coverage under the multiemployer arrangements (it generally only knows its contribution to the funds). Employer is particularly concerned that the funds may not be willing to share this information with the employer. The final section 6056 regulations provide that multiemployer funds are "permitted" to submit 6056 forms with respect to the full-time employees that participate in the funds but also that the employer is ultimately responsible for the filing. The IRS declined to require multiemployer funds to submit the form or even to provide information to employers with respect to information that it has in its possession. Do you see multiemployers funds being willing to cooperate with employers in providing information so that employers will be able to satisfy their section 6056 obligations? Do employers have any recourse to obtain this information? Thanks for any help you can provide.

If a health care provider (physician practice, hospital, etc.) agrees by contract to be a participating provider in a third party administrator's network, is the third party administrator a business associate of the provider thus requiring a business associate agreement between the provider and the TPA?

Until the IRS comes out with fully insured plan nondiscrimination regulations, this is still permissible.

There is no prohibition on enrolling in an HDHP (which is just a type of health plan) at the same time as you are enrolled in an HMO. You are just ineligible to contribute to an HSA for months in which you are covered under the HMO.

You have a lot of good questions that are not amenable to responding here. You should engage counsel or other adviser to give provide you with answers. Alternatively, there are a lot a good resources (white papers, client alerts, and the such) on the internet that you can look at. And, yes, I believe that there are some things that you might have missed "in the last few years"!

In the wake of Windsor, the IRS granted relief for plans to enroll same-sex spouses married prior to the date of the decision. That relief expired at the end of 2013. In my client's circumstance, it's not the IRS tax treatment (which happened in 2013) that is triggering the new eligibility for enrollment, it's the employer changing the eligibility requirements in the plan (which is happening in June 2014).

Well, it is really the IRS who needs to provide guidance because this is a Section 125 issue but I get your point.

HIPAA's special enrollment rights apply in the event that, among other things, an employee gets married, and requires the spouse to be added to the plan if the employee notifies the plan within a specified period (e.g., 30 days after marriage). In my circumstance, the affected employees were married long before the date that the plan was amended. I don't see these special enrollment rights being applicable here.

Does anyone have any thoughts?

An employer's cafeteria plan and underlying benefit plans excludes same sex spouses. In June 2014, the employer amends the plan to make same sex spouses eligible for benefits. Can the employer permit employees (who married their same sex spouses in 2013 or earlier) change their elections mid-year to add their same sex spouses to the plan? If so, under what provision of the proposed cafeteria plan regulations? It seems intuitive that these election changes should be permitted but I am not finding anything in the regulations to support this intuition. Does anyone have any thoughts?

The plan document may provide for coverage for an adult child who is disabled and who meets the requirements of being a dependent of the employee. The only way to know is to check the plan/SPD.

Why does the employer want to do this?

If you can't get a copy of the plan from the company, you can simply search the sec.gov website for the public company's '33 and '34 Act filings. The company would have to had filed a copy of the plan in one of those filings. There also should be a form of stock option agreement. Between these two documents, you can determine the transferability of the options. Often, options are not transferable except by will, etc., particularly if they are incentive stock options. Note that a stock option plan is generally NOT subject to ERISA so the plan administrator has no ERISA fiduciary obligations towards either your or your ex.

A HDHP is just a special type of health plan that permits contributions to be made to an HSA. An individual can only make contributions to an HSA if the employee has an HDHP and does not have disqualifying coverage. A general purpose health FSA is disqualifying coverage, which means that you cannot have the FSA and still contribute to the HSA even though you have a HDHP. So, you are correct that you can keep the HDHP and the health FSA.

Is an Employee Assistance Program, for which an employer pays a PEPM fee to provide its employees, a "fully insured" or "self-insured" benefit? It seems as if it is fully insured but would then the EAP provider be subject to state insurance law? Assume that the EAP provides more than just referrals and is a group health plan under ERISA.

The plan at issue is a calendar year plan so this would be inapplicable. The problem here is not a plan year issue, it is the fact that the government's determination of whether the individual is eligible for a subsidy takes longer than the plan's initial enrollment period.

That's my interpretation too. Unfortunately, a representative of healthcare.gov thinks otherwise.

Is the termination of Marketplace coverage (due to nonpayment of premiums because of a loss of subsidy) a qualifying change in status event permitting an election change (i.e., adding medical coverage under an employer plan) under the cafeteria plan rules?