by admin | Oct 11, 2024 | Blog
As a plan sponsor or benefit professional, finding the right information on the IRS website can be a daunting task. To help streamline your search, we’ve compiled a list of the most useful IRS webpages that provide crucial benefit-related information.
- Drop Library. IRS announcements, notices, revenue procedures, and revenue rulings usually appear in the IRS Drop Library before they are published in an IRB: https://www.irs.gov/downloads/irs-drop
- Information Letters. Information letters provide general statements of well-defined law without applying them to a specific set of facts. They are issued by the IRS National Office in response to requests for general information from taxpayers or congressional offices. Although information letters are only advisory and have no binding effect on the IRS, they can be helpful in understanding the IRS’s position on the issues that they cover: https://www.irs.gov/information-letters
- Written Determinations. This webpage provides access to private letter rulings (PLRs), technical advice memoranda (TAMs), and chief counsel advice (CCA). PLRs are rulings or determinations from the IRS Office of Chief Counsel that interpret and apply tax laws to a specific set of facts and are furnished in response to taxpayer requests. TAMs are written memoranda that the IRS Office of Chief Counsel furnishes in response to an IRS director or chief appeals officer request. CCA materials are written advice or instructions that the IRS Office of Chief Counsel prepares and issues to other IRS employees. These written determinations cannot be used or cited as precedent, but they are helpful in determining the IRS’s position, often on very specific facts: https://www.irs.gov/written-determinations
Other helpful IRS webpages include the following:
- IRS Newsroom. The latest news releases, fact sheets, and other IRS-related news items are available here: https://www.irs.gov/newsroom
- News Release and Fact Sheet Archive. This archive contains news releases and fact sheets issued from 2002 to the present: https://www.irs.gov/newsroom/news-release-and-fact-sheet-archive
- Topics in the News. Look here for information about items of current interest, such as new programs, recent guidance, or timely reminders: https://www.irs.gov/newsroom/topics-in-the-news
- Priority Guidance Plan. These documents provide information about regulations, revenue rulings, revenue procedures, notices, and other guidance that the IRS and Treasury Department expect to work on during a particular period: https://www.irs.gov/privacy-disclosure/priority-guidance-plan
- Frequently Asked Tax Questions and Answers. You’ll find FAQs regarding a broad array of tax categories here, as well as a search feature: https://www.irs.gov/faqs
- Affordable Care Act (ACA) Tax Provisions. This webpage provides information about ACA tax provisions for which the IRS has issued regulations or other guidance: https://www.irs.gov/affordable-care-act/affordable-care-act-tax-provisions
- ACA Information Center for Applicable Large Employers (ALEs). This webpage helps employers determine whether they are ALEs and provides helpful links to applicable IRS resources: https://www.irs.gov/affordable-care-act/employers/aca-information-center-for-applicable-large-employers-ales
- ACA Information Returns (AIR). This webpage provides information about electronic filing of returns and transmittals required under the ACA: https://www.irs.gov/e-file-providers/affordable-care-act-information-returns-air
- Tax Information for Retirement Plans. This is the IRS’s home page for retirement plan information, with links to recent developments and guidance, newsletters, and other retirement plan administration resources: https://www.irs.gov/retirement-plans
Keep in mind that other agency websites also provide useful and important benefits-related information. For example, the DOL’s Employee Benefits Security Administration (EBSA) website is also helpful and can be accessed at https://www.dol.gov/agencies/ebsa.
By utilizing these resources, you can efficiently navigate the IRS website and stay informed about the latest developments in employee benefits.
Source: Thomson Reuters
by admin | Sep 19, 2024 | Blog
When companies contribute to the cost of health club memberships or provide on-site fitness centers, questions often arise about whether these benefits fall under the Employee Retirement Income Security Act (ERISA). Understanding the nuances of ERISA and how it applies to health-related benefits is crucial for employers.
What is ERISA?
ERISA is a federal law that sets standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. For a benefit program to qualify as an ERISA plan, it must provide one or more of the benefits listed in the ERISA definition, such as medical, sickness, or disability benefits.
Health Club Memberships and ERISA
Generally, paying for employees’ health club memberships does not constitute an ERISA plan. Health and fitness clubs promote general good health but are typically made available without regard to sickness or disability. They do not diagnose or treat specific medical conditions, so they usually do not provide medical care or any other ERISA benefit. Therefore, a policy or program of paying for health club memberships would not be considered an ERISA plan.
On-Site Fitness Centers and ERISA
Similarly, providing an on-site fitness center for employees does not typically make the program subject to ERISA. On-site fitness centers, like health clubs, promote general wellness but do not provide medical care or benefits in the event of sickness. Thus, they do not meet the criteria for an ERISA plan.
Exceptions: Disease-Management Programs
In rare cases, health club memberships or access to on-site fitness centers may be part of a disease-management program that includes diagnostic, therapeutic, or preventive care. These programs might offer “coaching” for specific health conditions or risks. Such arrangements could be viewed as providing a medical benefit, potentially making them subject to ERISA and applicable group health plan rules. The complexity and fact-specific nature of these programs mean that legal counsel should be consulted to determine ERISA applicability.
Tax Considerations
Whether a benefit is subject to ERISA does not affect whether it produces taxable income for participants or beneficiaries. However, an employer’s payment or reimbursement of health club dues or provision of an on-site fitness center may raise tax issues, which should also be reviewed with legal counsel.
Conclusion
While health club memberships and on-site fitness centers generally do not fall under ERISA, exceptions exist, particularly when these benefits are part of a broader health management program. Employers should carefully evaluate their programs and consult with legal counsel to ensure compliance with ERISA and tax regulations.
Source: Thomson Reuters
by admin | Sep 5, 2024 | Blog
When considering design changes to a self-insured group health plan, it’s crucial to understand the regulations surrounding annual dollar limits on benefits. Specifically, group health plans and insurers are prohibited from establishing annual limits on the dollar amount of essential health benefits for any individual. This means that your plan cannot be amended to impose a $1.5 million annual dollar limit on benefits.
Key Points to Consider
- Prohibition of Annual Limits:
- Since January 1, 2014, group health plans cannot impose annual dollar limits on essential health benefits.
- Essential health benefits include categories such as emergency services, hospitalization, and prescription drugs.
- Permissible Limits:
- While annual dollar limits on essential health benefits are prohibited, limits can be imposed on specific covered benefits that are not considered essential health benefits.
- These limits must comply with other federal and state laws.
- Definition of Essential Health Benefits:
- Essential health benefits encompass a range of categories and services within those categories.
- Self-insured health plans and insured plans in the large group market are not required to cover all essential health benefits but cannot impose annual dollar limits on those they do cover.
- Flexibility in Defining Essential Health Benefits:
- Group health plans not required to cover all essential health benefits have the discretion to define these benefits for the purpose of the dollar-limit prohibition.
- This definition is generally based on any state benchmark plan.
Understanding these regulations is vital for ensuring compliance and making informed decisions about your self-insured group health plan. While you cannot impose an annual dollar limit on essential health benefits, there is flexibility in defining these benefits and imposing limits on non-essential benefits within the bounds of federal and state laws.
Source: Thomson Reuters
by admin | Aug 23, 2024 | Blog
Health plans must communicate effectively with all members, regardless of their language. The Affordable Care Act (ACA) mandates that claims and appeals notices be provided in a culturally and linguistically appropriate manner. Here’s how health plans can meet these requirements.
Key Requirements
1. Population Threshold: If 10% or more of a county’s population speaks a non-English language, notices must include a statement in that language explaining how to get help. This is based on U.S. Census data and updated on government websites.
2. Oral Language Services: Health plans must offer phone assistance in the non-English language to answer questions and help with claims and appeals.
3. Written Notices: All English notices must have a clear statement in the non-English language about how to access language services.
4. Translation Upon Request: Full notices must be provided in the non-English language if requested.
Implementation Tips
- Stay Updated: Regularly check the Department of Labor (DOL) and Health and Human Services (HHS) websites for the latest information.
- Use Provided Language: Utilize the sample statements provided by the agencies to ensure compliance.
- Train Staff: Ensure customer service representatives are trained to assist in multiple languages.
Conclusion
Providing notices in different languages is crucial for fair access to healthcare information. By following these guidelines, health plans can better serve their diverse members and comply with the ACA.
Source: Thomson Reuters
by admin | Aug 15, 2024 | Blog
Navigating the complexities of federal laws like HIPAA and FMLA can be challenging for employers. One common question is whether HIPAA requires an individual’s authorization before an employer can receive their Protected Health Information (PHI) for Family and Medical Leave Act (FMLA) compliance purposes. This blog post aims to clarify this issue and provide guidance on how to handle PHI in compliance with both HIPAA and FMLA.
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law designed to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. It sets the standard for protecting PHI and applies to healthcare providers, health plans, and healthcare clearinghouses.
What is FMLA?
The Family and Medical Leave Act (FMLA) allows eligible employees to take unpaid, job-protected leave for specified family and medical reasons. Employers may require medical certification to support the need for leave due to a serious health condition.
When is Authorization Required?
Whether an employer needs an individual’s authorization to receive PHI under HIPAA depends on the source of the information and the relationship to the individual.
- Employee Provides Information:
- If an employee seeking FMLA leave obtains the necessary medical information from their healthcare provider and then forwards it to the employer, no HIPAA authorization is required. The employee has the right to share their own PHI.
- Direct Communication Between Employer and Provider:
- If the employer communicates directly with the healthcare provider, HIPAA requires the employee’s authorization for the provider to disclose PHI. This authorization must meet HIPAA’s technical requirements.
- Family Member’s Health Information:
- If the FMLA leave is for a family member’s serious health condition, the family member’s authorization is required for the provider to release their PHI to the employee or employer.
FMLA Regulations on Employer-Provider Contact
FMLA regulations limit the contact an employer can have with an employee’s healthcare provider. If the employee submits a sufficient medical certification, the employer cannot request additional information from the provider. However, the employer may contact the provider for clarification and authentication through a designated representative, not the employee’s direct supervisor. If this involves disclosing PHI, the employee’s HIPAA authorization is necessary.
Conclusion
Employers must navigate both HIPAA and FMLA regulations when handling PHI. Understanding when authorization is required can help ensure compliance and protect the privacy of employees and their family members. Always consult with legal counsel to address specific situations and ensure adherence to all applicable laws.
Source: Thomson Reuters
