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CMS Fact Sheet Addresses End of COV-19 Public Health Emergency

by Lexi Garcia | Mar 2, 2023 | Blog

HHS’s Center for Medicare & Medicaid Services (CMS) has issued a fact sheet addressing the end of the COVID-19 public health emergency (PHE), which (along with the COVID-19 national emergency) is anticipated to end on May 11, 2023. The fact sheet, which is addressed to individuals, confirms that HHS is expecting the PHE to expire at the end of the day on May 11 and provides information about the implications for coverage under private health insurance, as well as Medicare, Medicaid, and CHIP. Here are highlights relevant to employer-sponsored group health plans:

COVID-19 Vaccines, Testing, and Treatments. Most plans must continue to cover vaccines furnished by in-network providers without cost sharing but may require individuals receiving vaccines from out-of-network providers to share part of the cost. When the PHE ends, mandatory coverage for OTC and laboratory-based COVID-19 PCR and antigen tests will end. Plans may choose to cover these tests but may require cost sharing, prior authorization, or other forms of medical management. The end of the PHE will not change how COVID-19 treatments are covered; plans that require cost sharing or apply deductibles may continue to do so.
Access to Telehealth Services. As is currently the case during the PHE, coverage for telehealth and other remote care services may vary from plan to plan after the PHE ends. When covered, plans may impose cost-sharing, prior authorization, or other forms of medical management.

Source: Thomson Reuters

Can employees be reimbursed for their entire health FSA election early in the year?

by Lexi Garcia | Feb 28, 2023 | Blog

QUESTION: For 2023, an employee elected $2,400 of health FSA coverage under our calendar-year cafeteria plan, which is funded solely through employee salary reductions and does not provide for carryovers or include a grace period. The employee has already incurred medical expenses equal to this amount in 2023 and wants to be reimbursed for the expenses now, even though she has only made health FSA salary reductions of $400 to date. Do we have to reimburse all of these expenses right away, or can we limit reimbursements to the amount our employee has already contributed and ask her to resubmit the remaining expenses as additional contributions are made?

ANSWER: Your employee must be reimbursed for all of her expenses now, assuming that the expenses are otherwise eligible for reimbursement (e.g., they are for medical care incurred during the current period of coverage, and appropriate substantiation has been provided). That’s because IRS requirements for health FSAs include a “uniform coverage” rule under which the maximum amount of reimbursement must be available at all times during the plan year (or other period of coverage), reduced only for any prior reimbursements for the same period. Reimbursement is deemed “available” under the uniform coverage rule if claims are paid at least monthly, or when an employee’s submitted claims reach a reasonable plan minimum (e.g., $50). Thus, reimbursements cannot be restricted to the amount of the employee’s contributions.

The uniform coverage rule also prohibits accelerating an employee’s salary reductions based on health FSA claims submitted or paid. Note that the uniform coverage rule does not apply to DCAPs, so reimbursements under a DCAP can be limited to the amount that has been contributed, less expenses already reimbursed.

Source: Thomson Reuters

IRS issues 2022 version of publications 502 and 503 for medical and dependent care expenses

by Lexi Garcia | Feb 23, 2023 | Blog

The IRS has released updated versions of Publications 502 and 503 for the 2022 tax year. Publication 502 describes the medical expenses that are deductible by taxpayers on their 2022 federal income tax returns. Publication 503 explains the requirements that taxpayers must meet to claim the dependent care tax credit (DCTC) for child and dependent care expenses.

The 2022 version of Publication 502 is substantially similar to its 2021 counterpart. Reflecting prior guidance, personal protective equipment (e.g., masks, hand sanitizer, and hand sanitizing wipes) for the primary purpose of preventing the spread of COVID-19 is now included in the list of medical expenses. Clarifications have been added regarding expenses to treat excessive use of alcohol and drugs, and relevant dollar amounts (e.g., the standard mileage rate for use of an automobile to obtain medical care) have been revised to reflect their 2022 inflation-adjusted values. Publication 502 has also been revised to reflect that the health coverage tax credit (HCTC) is not available after 2021. Publication 503 has been revised to note that most of the temporary changes to the DCTC and DCAP rules that were provided as COVID-related relief are no longer available, and to delete references to those changes. It also references prior guidance under which DCAPs could be amended to allow unused amounts from 2021 to carry over to 2022.

Source: Thomson Reuters

What do all these employee benefit acronyms stand for?

by Lexi Garcia | Feb 21, 2023 | Blog

Everyone in the employee benefits field uses acronyms like COBRA, FSA, and CDHC. What do these and other employee benefit acronyms stand for?

Here’s an explanatory list of common employee benefit acronyms used:

ACA – Patient Protection and Affordable Care Act

AHP – Association Health Plan

ASG – Affiliated Service Group

ASO – Administrative-Services-Only

ATIN – Adoption Taxpayer Identification Number

BA – Business Associate

CDHC – Consumer-Driven Health Care

CE – Covered Entity

COB – Coordination of Benefits

COBRA – Consolidated Omnibus Budget Reconciliation Act

COLA – Cost-of-Living Adjustment

CONUS – Continental United States

DCAP – Dependent Care Assistance Program

DOL – Department of Labor

EIN – Employer Identification Number

EAP – Employee Assistance Plan

EBHRA – Expected Benefit HRA

EBSA – Employee Benefits Security Administration

EEOC – Equal Employment Opportunity Commission

EFAST2 – ERISA Filing Acceptance System II

EOB – Explanation of Benefits

EOI – Evidence of Insurability

ePHI – Electronic Protected Health Information

ERISA – Employee Retirement Income Security Act

FICA – Federal Insurance Contributions Act

FLSA – Federal Labor Standards Act

FMLA – Family and Medical Leave Act

FSA – Flexible Spending Amount

FUTA – Federal Employment Tax Act

GHP – Group Health Plan

HCE – Highly Compensated Employee

HCP – Highly Compensated Participants

HDHC – High Deductible Health Coverage

HDHP – High Deductible Health Plan

Health FSA – Health Flexible Spending Arrangement

HHS – Department of Health and Human Services

HIPPA – Health Information Technology for Economic and Clinical Health Act

HMO – Health Maintenance Organization

HRA – Health Reimbursement Arrangement

HSA – Health Savings Account

ICHRA – Individual Coverage HRA

IIAS – Inventory Information Approval System

MCC – Merchant Category Code

PBM – Pharmacy Benefit Manager

PCOR Fees – Fees for Patient-Centered Outcomes Research

PEO – Professional Employer Organization

POP – Premium-Only Plan

PPO Plan – Preferred Provider Organization Plan

QB – Qualified Beneficiary

QE – Qualifying Event

QMCSO – Qualified Medical Child Support Order

QSEHRA – Qualified Small Employer Health Reimbursement Arrangement

R&C – Reasonable and Customary

RRE – Responsible Reporting Identity

SBC – Summary of Benefits and Coverage

SMM – Summary of Material Modification

SPD – Summary Plan Description

TPA – Third Party Administrator

UCR Rate – Usual, Customary, and Reasonable Rate

VEBA – Voluntary Employees’ Beneficiary Association

Proposed regulations aim to expand contraceptive access and eliminate moral exemption for coverage mandate

by Lexi Garcia | Feb 15, 2023 | Blog

The Internal Revenue Service, Department of Labor, and U.S. Health and Human Services Department have issued proposed regulations that would provide an additional method for individuals to obtain no-cost contraceptive services if their health plan or insurer does not provide such services due to a religious exemption. Under final regulations issued in 2018, qualifying religious employers and other entities with sincerely held religious beliefs or moral convictions are exempt from the Affordable Care Act’s contraceptive coverage mandate, which generally requires coverage of contraceptive services without cost-sharing. Exempt entities may voluntarily engage in an accommodation process that allows plan participants to receive contraceptive services directly from a TPA or insurer without the employer’s involvement. In an FAQ issued in 2021, the agencies announced they were considering changes to the 2018 regulations “in light of recent litigation”. Here are highlights of the proposal:

Individual Contraceptive Arrangement: Leaving in place the existing religious exemptions and accommodations, the agencies have proposed to add a new “individual contraceptive arrangement” through which individuals enrolled in plans or coverage sponsored or arranged by entities with religious objections could access no-cost contraceptive services without the involvement of their employer, group health plan, plan sponsor, or insurer. A provider or facility that furnishes contraceptive services in accordance with the individual contraceptive arrangement would be reimbursed through an arrangement with an Exchange insurer, which would request an Exchange user fee adjustment to cover the costs.
Moral Exemption Rescinded: The proposed regulations would revoke the 2018 regulations’ moral exemption and accommodation. The agencies explain that “there have not been a large number of entities that have expressed a desire for an exemption based on a non-religious moral objection” and that there is no legal obligation (including under the Religious Freedom Restoration Act) to provide such an exemption.

Source: Thomson Reuters

White House signals COVID-19 public health emergency and national emergency end soon

by Lexi Garcia | Feb 10, 2023 | Blog

The Biden Administration announced on Jan. 30 its intent to end the public health emergency and national emergency on May 11, 2023. Former President Donald Trump issued the emergency declaration in March 2020 in response to the nation’s COVID-19 crisis. President Joe Biden extended the emergency again on Feb. 18, 2022.

The House of Representatives proposed ending the emergency immediately rather than wait until May 11. The administration responded saying that an abrupt end to the emergency declarations would create chaos within the nation’s health care system.

The 60 days after the end of the national emergency will be significant as benefit related changes will take affect July 10, 2023. For plan sponsors, many benefit-related deadlines were extended as part of the national emergency, such as COBRA election and payment periods. With deadlines extensions ending, plan sponsors should work with COBRA and other third party-administrators in preparation for the rule changes affecting:

election periods for COBRA continuation coverage
COBRA premium payments
HIPPA special enrollments
claims, adverse decision appeals and external reviews

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Next Entries »

CMS Fact Sheet Addresses End of COV-19 Public Health Emergency

Can employees be reimbursed for their entire health FSA election early in the year?

IRS issues 2022 version of publications 502 and 503 for medical and dependent care expenses

What do all these employee benefit acronyms stand for?

Proposed regulations aim to expand contraceptive access and eliminate moral exemption for coverage mandate

White House signals COVID-19 public health emergency and national emergency end soon

Understanding Special Enrollment Rights When Employees Lose Other Coverage