Scott A. Davis

Brian, do you also agree that ER HSA contributions can vary by Individual and Family class, plus also allowed with no contribution to Individual coverage QHDHP coverage EE HSA, while contributing to Family Coverage EE HSA, However, the contribution with respect to the self plus two category may not be less than the contribution with respect to the self plus one category and the contribution with respect to the self plus three or more category may not be less than the contribution with respect to the self plus two category? Cornell Law School https://www.law.cornell.edu/cfr/text/26/54.4980G-1 - § 54.4980G-1 Failure of employer to make comparable health savings account contributions. See Q & A-1 in § 54.4980G-4 for the definition of comparable contributions. Thus, the categories of “employee plus spouse” and “employee plus dependent,” each providing coverage for two individuals, are treated as the single category “self plus one” for comparability purposes. See, however, the final sentence of paragraph (a) of Q & A-1 of § 54.4980G-4 for a special rule that applies if different amounts are contributed for different categories of family coverage. §54.4980G-4 Calculating comparable contributions. Q-1: What are comparable contributions? A-1: (a) Definition. Contributions are comparable if, for each month in a calendar year, the contributions are either the same amount or the same percentage of the deductible under the HDHP for employees who are eligible individuals with the same category of coverage on the first day of that month. Employees with self-only HDHP coverage are tested separately from employees with family HDHP coverage. Similarly, employees with different categories of family HDHP coverage may be tested separately. See Q & A-2 in §54.4980G-1. An employer is not required to contribute the same amount or the same percentage of the deductible for employees who are eligible individuals with one category of HDHP coverage that it contributes for employees who are eligible individuals with a different category of HDHP coverage. For example, an employer that satisfies the comparability rules by contributing the same amount to the HSAs of all employees who are eligible individuals with family HDHP coverage is not required to contribute any amount to the HSAs of employees who are eligible individuals with self-only HDHP coverage, or to contribute the same percentage of the self-only HDHP deductible as the amount contributed with respect to family HDHP coverage. However, the contribution with respect to the self plus two category may not be less than the contribution with respect to the self plus one category and the contribution with respect to the self plus three or more category may not be less than the contribution with respect to the self plus two category. (b) Examples. The following examples illustrate the rules in paragraph (a) of this Q & A-1. None of the employees in the following examples are covered by a collective bargaining agreement. The examples read as follows: Example 1. In the 2007 calendar year, Employer A offers its full-time employees three health plans, including an HDHP with self-only coverage and a $2,000 deductible. Employer A contributes $1,000 for the calendar year to the HSA of each employee who is an eligible individual electing the self-only HDHP coverage. Employer A makes no HSA contributions for employees with family HDHP coverage or for employees who do not elect the employer’s self-only HDHP. Employer A’s HSA contributions satisfy the comparability rules. Thanks, Scott A. Davis

See two examples below: Employer contribution, on top of which an administration charge of up to 2% is not one of the two allowed methods unless it is a fully insured HRA. Former employees are not eligible for continued employer contributions to the HRA. If the self-funded HRA is a new plan, a reasonable estimate for the first year is 75%-60%; check with the HRA vendor to confirm. HRA COBRA Premium Calculation Summary and Instructions Rackcdn.com https://0e70309d3d4216e4d023-2f6db220ee2d6e47acef128474ae2f99.ssl.cf5.rackcdn.com › ... Click on the icon below to open the HRA Premium Calculation. Worksheet. If your HRA has tiered contributions (e.g., a different contribution for single and. Determining the COBRA Premium for an HRA Parker, Smith & Feek https://www.psfinc.com › articles › determining-the-co... Oct 16, 2018 — To set HRA premiums using the past-cost method, the employer looks at the total claims reimbursed by the HRA during a 12-month “determination

Can a small group (1-49) offer Stand-alone Telehealth-Only Plan / Benefits After the End of the COVID-19 Public Health Emergency May 11, 2023, to Full-Time, Part-Time, Seasonal, 1099 Employees? I understand that relief is allowed for large employers (ALE) to continue to provide (stand-alone) solely telehealth and other remote-care benefits to employees or dependents who are not eligible for coverage under any other group health plan offered by the employer to the end of the 2023 plan year, including those benefit opt-outs, per Q&A #14, FAQ FFCRA Part 43 https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-43.pdf , also written about by Thomson Reuters and Mercer more generally in https://www.mercer.com/en-us/insights/us-health-news/bipartisan-bill-seeks-stand-alone-telehealth-for-all-workers/. Since telehealth only and other remote-care benefits are not listed as excepted benefits per https://www.law.cornell.edu/cfr/text/45/148.220, a stand-alone telehealth or remote service plan offer after the end of the COVID-19 Public Health Emergency would need to meet many rules applicable to group health plans under ERISA, COBRA, HIPAA and the Affordable Care Act (ACA) minimum essential coverage rule per Thomson Reuters and Q&A #14 above, even if offered by an small employer (1-49 FTEs), although a small employer (1-49 FTEs) is not required to offer ACA MEC or MVP coverage? Like restrictions of offering a stand-alone Health FSA without ACA MEC coverage by a small or large employer, of which the stand-alone Health FSA would not meet group health market reforms and ACA requirements for 100% preventive care benefits. I am interested to know other's thoughts or research for small employers on this subject.

Thanks, Brian, This is also in the Model COBRA Continuation General Notice Model COBRA Continuation Coverage General Notice What is COBRA continuation coverage? .................................................................................................................................................................................................................................................... If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: · Your hours of employment are reduced, or · Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: · Your spouse dies; · Your spouse’s hours of employment are reduced; · Your spouse’s employment ends for any reason other than his or her gross misconduct; · Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or · You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: · The parent-employee dies; · The parent-employee’s hours of employment are reduced; · The parent-employee’s employment ends for any reason other than his or her gross misconduct; · The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); · The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.” Some of the confusion is in the next statement: When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: · The end of employment or reduction of hours of employment; · Death of the employee; · [add if Plan provides retiree health coverage: Commencement of a proceeding in bankruptcy with respect to the employer;]; or · The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

kgr12: To answer your specific question, No, it does not impact the end date for the maximum continuation coverage periods? Peter Gulia has provided you with excellent other impacts lurking in that scenario.

One plus is Partners in a partnership, Sub-S owners, LLC members, Self-employed all can deduct the premium cost of their benefits (Health, Dental, Vision) coverage from thier scheduled income, up to 100% of the cost, in the year incurred, also reducing thier scheduled FICA Taxes. This offsets the ineligibility for Section 125 has been available for many years. Everyone with an eligible HSA contribution is allowed to take the deduction on their Federal 1040 and that reduces their taxable State Income (in most states), no FICA savings.

Carriers file the 1095-A for Individual Health Plans, ICHRA ALEs file 1094-C-1095-C. Non-ALE Self-Funded Group Health Plans also file 1094-B an 1095-B. Checking with an ICHRA vendor to double check if they will confirm or support 1094/1095 filing requirements. Not aware of a ICHRA non-ALE Group Health Plan Sponsor filing 1094-B 1095-B, as this would impact the vast majority of ICHRA Plan Sponsors. The guide below from Newfront is helpful for other questions, and slide 10 and 14 are helpful too. ICHRA Guide for Employers: The Health Plan 401(k) Has Arrived (PDF)

Solutions: Parent Company or Company A upon sale, issue a Plan Termination Notice with Model Exchange Notice - English and Spanish. If Company B is only offering a MEC plan, not a Minimum Value Coverage qualified plan (MVP), then Company A employees are eligible for a special enrollment period (60 days from loss of MVP Coverage) for Individual ACA Marketplace Coverage, with possible Advanced Premium Tax Credit and Cost Share Reduction Health Plan coverage. Four out of five enrolls pay under $20 per month and those under 250% of federal poverty are eligible for Cost Share Reduction Health Plan coverage. The model notices are also available in Spanish and MS Word format at http://www.dol.gov/ebsa/healthreform/. Company B is also required to offer the Model Exchange Notice: Employers must provide the Exchange notice to new hires within 14 days of the employee's start date. Best practice: Include the Exchange Notice as part of the standard new hire materials. Company A employees also have a year round opportunity to enroll in a Medical Share Program - two are advertised nationally - Medi-Share and Christian Health Ministries, see exclusions and enrollment requirements. Add a Prescription Assistance Program option - see attached as many of the Medical Share Programs do not cover Prescription Drugs. Many large agencies use Rx Help Centers and group billing is an option. Medi-Share® - Official Website - Medi-Share® Get Your Pricing Ad·https://www.medishare.com/ Christian Healthcare Ministries | Healthcare cost sharing ministry https://www.chministries.org Christian Healthcare Ministries is a faith-based healthcare cost solution for Christians in all 50 states and around the world. Prescription Assistance and Discount Programs.docx

Great answer Brian, 100% agree!

Good Evening, Simple solution, known by a few, raise the HCP wages by the desired difference between 100% cost of the benefit plan and the normal non-HCP contribution amount. Then the HCP employee can chose to pay that additional wage as a pre-tax contribution in Section 125 Plan, while the employer continues to make comparabe tax-free contributions for all HCP and Non-HCPs eligible benefits. Assuming the HCE at issue is not ineligible for the cafeteria plan, such as more-than-2% S corp owners, K-1 partners, LLC members, etc, as Brian has stated. BRIAN, Do you agree, as one HCE or multiple HCE paid non-discriminitory amount(s), as HCEs are able to make S125 pre-tax contributions as long as they are not lower than the non-HCPs pre-tax contributions?

This depends on Self-Funded or Fully-Insured see the FAQs below: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/nmhpa.pdf For those plans with coverage that is insured by an insurance company or HMO, contact your state insurance department for the most current information on the state laws that pertain to hospital length of stay in connection with childbirth. Also for covered services, see the certificate of coverage and pre-authorization requirements. Can my group health plan require me to get permission (sometimes called prior authorization or precertification based upon medical necessity) for a 48-hour or 96-hour hospital stay? No. A plan cannot deny you or your newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that you, or your attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary. However, plans generally can require you to notify the plan of the pregnancy in advance of an admission in order to use certain providers or facilities or to reduce your out-of-pocket costs. I hope this points you in the right direction,

Yes, thanks Lois. I review this today and found that the TPA was speaking about an non-excepted benefit Health FSA, which would be subjec to PCORI Fees, but is rare to still have due to most comply with the ACA. Otherwise, the PCORI fee also does not apply to health FSAs (which must be an excepted benefit to comply with the ACA) per a update today fron Newfront's Karen Hooper, VP, Senoir Compliance Manager.

This statement was recently made by a TPA. related to PCORI fees in 2022: Generally, health care Flexible Spending Accounts (FSAs) are not required to file a Form 720 unless the employer (and not just the employee) makes contributions to it that exceed the lesser of $500 annually or a dollar-for-dollar match of the employee's contribution. I did look as the IRS Chart chart summary. and FAQs Related Item: Patient-Centered Outcomes Research Trust Fund Fee: Questions and Answer and the final regulations , but do not see the above exception. Does anyone have insight to the above bold exception?? I did see the follow exceptions for FSAs: Special rule for coverage under multiple applicable self-insured health plans: Generally, separate fees apply for lives covered by each specified health insurance policy or applicable self-insured health plan. However, two or more applicable self-insured health plans may be combined and treated as a single applicable self-insured health plan for purposes of calculating the PCORI fee but only if the plans have: The same plan sponsor; and The same plan year. Special counting rule for HRAs and FSAs: Plan sponsors are permitted to assume one covered life for each employee with an HRA. Plan sponsors are permitted to assume one covered life for each employee with an FSA. Q5. Which individuals are taken into account for determining the lives covered under a specified health insurance policy or applicable self-insured health plan? A5. Generally, all individuals who are covered during the policy year or plan year must be counted in computing the average number of lives covered for that year. Thus, for example, an applicable self-insured health plan must count an employee and his dependent child as two separate covered lives unless the plan is a health reimbursement arrangement (HRA) or flexible spending arrangement (FSA). Thanks for you review and reply in advance!

Agree with Brian, well done! You may also see a more restrictive Dependent Care FSA change rule in the cafeteria plan document or SPD similar to Vanguard's below, best to follow plan document the plan has. https://crewconnect.vanguard.com/totalrewards/benefits/statuschange/flexcare_chg_dependent_daycare_fsa_chg.html Change Dependent Day Care FSA If you are changing your dependent day care flexible spending account (FSA) election amount during the plan year is not permitted unless there is a change in your dependent day care provider or a qualified life event change occurs (e.g., marriage, divorce, death of a spouse/domestic partner [DP] or dependent, birth or adoption of a child).

For Welfare Benefit plans normally have a form 5500 filing exception (if not a MEWA or Certain Entities Claiming Exception (ECEs), on page 3 of the instructions, bottom right 1. A welfare benefit plan that covered fewer than 100 participants as of the beginning of the plan year and is unfunded, fully insured, or a combination of insured and unfunded. Some interpret the lines 5 & 6 instructions (page 18 bottom right, bottom link) to include active eligible employees (most full-time employees are eligible at the beginning of the plan year, during Open Enrollment, while new hires can also be elgible as of the beginning of the plan year) to those participating. See the bolded below and let me know if you also believe all active eligible employees are to be counted? The description of ‘‘participant’’ in the instructions below is only for purposes of these lines. An individual becomes a participant covered under an employee welfare benefit plan on the earliest of:  the date designated by the plan as the date on which the individual begins participation in the plan;  the date on which the individual becomes eligible under the plan for a benefit subject only to occurrence of the contingency for which the benefit is provided; or  the date on which the individual makes a contribution to the plan, whether voluntary or mandatory. See 29 CFR 2510.3-3(d)(1). This includes former employees who are receiving group health continuation coverage benefits pursuant to Part 6 of ERISA and who are covered by the employee welfare benefit plan. Covered dependents are not counted as participants. A child who is an “alternate recipient” entitled to health benefits under a qualified medical child support order (QMCSO) should not be counted as a participant for lines 5 and 6. An individual is not a participant covered under an employee welfare plan on the earliest date on which the individual (a) is ineligible to receive any benefit under the plan even if the contingency for which such benefit is provided should occur, and (b) is not designated by the plan as a participant. See 29 CFR 2510.3- 3(d)(2). https://www.dol.gov/sites/dolgov/files/EBSA/employers-and-advisers/plan-administration-and-compliance/reporting-and-filing/form-5500/2021-instructions.pdf Appreciate it if you can answer this question, from prior experience as 2020 and 2019 instructions are similarly stated. Thanks. Scott

Chaz adn Brian, Per today's 2.4.22 Part 52 release https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-52 Q1: Do plans and issuers have flexibility in how they establish a direct-to-consumer shipping program and direct coverage through an in-person network in order to qualify for the safe harbor established in FAQs Part 51, Q2? When providing OTC COVID-19 tests through a direct-to-consumer shipping program, plans and issuers must cover reasonable shipping costs related to covered OTC COVID-19 tests in a manner consistent with other items or products provided by the plan or issuer via mail order. Scott A. Davis Not sure why the extra copies below, but I did click the + button

Tripp, on page 6 A2 of the FAQs Brian provided; No on $12, not sure about Shipping Cost as FAQs discuss cost of Test not other cost, like shipping, I have seen an article about not having to pay Adminstrative Cost that some Pharmacies are tacking on. See middle of the last paragraph: Specifically, a plan or issuer that is unable to meet the requirements of this safe harbor could not deny coverage or impose cost sharing (including setting limits on the amount of reimbursement for OTC COVID19 tests) with respect to any OTC COVID-19 tests, obtained by participants, beneficiaries, or enrollees, that meet the statutory criteria under section 6001(a)(1) of the FFCRA during this period, including those purchased from non-preferred sellers

Template is located in the below post and a separate verision on the NAHU Compliance Corner website in the latest webinare on Disclosures Broker Commission Disclosure | Word & Brown https://www.wordandbrown.com › NewsPost › Broker-... Nov 11, 2021 — Update on Broker Compensation Disclosure Requirement ... The Consolidated Appropriations Act (CAA), a new federal law signed at the end of 2020, ... We recommend you use our exclusive Word & Brown Broker Transparency Disclosure as a best-faith effort to comply with the law in the absence of regulatory guidance. You can download the Disclosure Template here.

Here is the answer per regulations: 29 U.S. Code § 1191b - Definitions https://www.law.cornell.edu/uscode/text/29/1191b (2)Benefits not subject to requirements if offered separately (A) Limited scope dental or vision benefits. (B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof. (C) Such other similar, limited benefits as are specified in regulations. (3)Benefits not subject to requirements if offered as independent, noncoordinated benefits (A) Coverage only for a specified disease or illness. (B) Hospital indemnity or other fixed indemnity insurance.

This is a CAA - Consolidated Appropriations Act due 12/27/2021, thanks for any assistance.

NAHU and others have stated ERISA Sectioin 733 (a) defines group health plan to include Dental and Vision for disclosure purposes. Is anyone aware if the volunatary group products CI, Cancer, and HI in the title are also included in the defined covered plans? Not purely list billed Individual CI, Cancer, HI plans. So far no one has been able to answer this, but each covers medical care and are sold to Groups via payroll pre-tax reduction under Section 125 Plan, so they are included in ERISA Plan Documents. Thanks in advance

Agreed, An HSA benefit could be allocated with Qualifed HDHP plan choice work with USA Bank Account work, or $500 - $1000 HRA benefit for ex-pats class of employee work since it is an ER funded HRA benefit?

Thanks to both of you, BG5150 - EE said clients were gettting asked by 5500 vendor or CPA based on incomes as the compliance form listed income requirements for Non-Disrimination Testing at 2016 levels, which I updated to 2020-2021 recently with a new company. I mentioned if was not needed for Form 5500, but was of NDT. Lou S. and C.B. Zeller: Thanks for the reminder (2022) proposed changes, as the Drug Pricing proposal did not pass out of committe on 9/15/21 per reports today. I am sure many changes are likely with many of the provisions proposed.

Thanks very much, https://www.irs.gov/irb/2007-39_IRB

I did search for the below IRS Section 125 POP Eligibility Safe Harbor link, but have not found the correct one yet. Does anyone have it to share as I did not see it in other blogs or posts for Section 125 Non-Discrimination testing? NOTE: A safe harbor exists where the POP will be deemed to satisfy all nondiscrimination tests if it "satisfies the safe harbor percentage test for eligibility." For example, a POP that might fail the Key Employee Concentration Test would be deemed to pass all tests if it passed the Eligibility Test. See §1.125-7(f) for more information. I get https://www.irs.gov/irb/2007-39_IRB from September 24, 2007 of which I do not see the Eligibility Safe-Harbor. Attached is from Zywave without the link, however lists a Eligibility Test from 2014 on pages 1-2. Thanks, Nondiscrimination-Tests-for-Cafeteria-Plans-02-04-14 Zywave.pdf