Christine Zinter

I reluctantly agree with OP - vaccination status is a "health condition" and therefore plans cannot discriminate in terms of benefits which includes employee premiums. The loophole is the activity-based wellness plan exception (subsection f). "An activity-only wellness program is a type of health-contingent wellness program that requires an individual to perform or complete an activity related to a health factor in order to obtain a reward but does not require the individual to attain or maintain a specific health outcome." Here, the activity is getting a vaccination. In order to be "reasonable," the wellness program incentive cannot be more than 30% of the employee-only premium (is $200 too much?) and there must be reasonable alternatives for those who cannot fulfill the activity because of a health condition. There is no exception for those who cannot fulfill the activity due to political opposition. This is going to decrease the number of people who are adversely impacted by the requirement to a very small percentage of the employer's population. So long as Delta accepts a doctor's opinion that an employee is medically unable to get vaccinated and then waives the $200 surcharge, there is no problem with the design.

I'm fairly new to the world of VEBA, but my understanding has always been that in order to have an HRA, there can be no employee contributions. Since a VEBA is just the funding vehicle, how can an association have a post-retirement HRA that is funded by voluntary post-tax employee contributions with a small employer match? I have an IRS approval letter for the VEBA where the plan accurately described itself as voluntary post-tax with a death benefit, but I'm perplexed as to how/why the IRS granted approval to begin with. What am I missing?

According to the IRS FAQ (Notice 2021-31 found at https://irs.gov/pub/irs-drop/n-21-31.pdf, Q24 "An involuntary termination of employment means a severance from employment due to the independent exercise of the unilateral authority of the employer to terminate the employment, other than due to the employee's implicit or explicit request, where the employee was willing and able to continue performing services." Q27 also indicates termination for cause is still involuntary termination - so even if the cause was alleged job abandonment, the IRS says that's an involuntary termination. He should have the lawyer who wrote the first letter about breach of contract follow up with that employer immediately and put them on notice that they will pursue the employer for the full amount of all the COBRA premium subsidy that they are blocking. The attorney should also state that should the employee or his family members have any medical claims for which he has no insurance because of the employer's willful disregard in blocking the subsidy, they will pursue the employer for those expenses as well. I'd copy the Insurance Company and the local Insurance Commissioner's office as well. I know the OIC won't get involved because it's technically not the insurer who is refusing to allow this person the subsidy (as they are taking their queues from the employer), but it affects them as well. If he's in Oregon or Washington give me a shout, I have my bar license in those 2 states only.

I agree, a MEC can't be offered with an ICHRA because a MEC is, by definition, a group health plan. The fact that it doesn't provide minimum value is irrelevant to its status as a group health plan. I'm not familiar with the term "Group GAP coverage" but what you described sounds like an HRA that reimburses for certain medical expenditures up to a maximum dollar limit. An HRA (established under Section 105(h)) is also, by definition, a group health plan and, as an HRA by itself it is supposed to be integrated with an underlying group health plan. Standalone HRAs were prohibited by the ACA.

I'd say he's eligible. He involuntarily lost his job. He's not eligible for other group coverage. Even if the DOL/IRS puts out guidance, this is question is fairly in the weeds and I doubt they'll address such a scenario. I'd say he was a responsible person for not living on unemployment and going out and finding other work when he had no idea if his employer would call him back.

I'm confused. The provider was in-network - check. However, the claim for benefits was denied, and the patient went thru two appeals, both denied. I don't understand what "denied for improper billing" means? As in, the provider used the wrong ICD-10 code and that ICD-10 code happens to be a non-covered benefit? Need more details.

I've been filling in everything online as if I was going to file, then taking a screenshot of everything I've done. I give the screenshot to the employer and tell them they have to re-enter all the data on their own, and then go the pay.gov website and complete the transaction. It isn't "consultant friendly" but it's all I've been able to come up with.

I agree with Mr. Gilmore - the IRS rules speak to non-taxable contributions not non-taxable reimbursements. It doesn't matter that you could rollover money from 2020 into 2021 and be reimbursed more than $5,000 so long as you don't make more than $5,000 in non-taxed contributions this year.

Even if the spouse's notification of special enrollment right was tolled, the special enrollment would be retroactive to the date that was missed. Theoretically this would mean having to add the spouse to coverage retroactive to her loss of employment that created the enrollment right. I cannot see how the COVID-19 extended deadline period would create an opportunity to enroll the spouse prospectively when she has to start paying for COBRA which is what the employee is hoping to do.