by admin | Apr 17, 2025 | Blog
HIPAA special enrollment rights allow eligible employees to enroll in health plans outside the regular enrollment period due to specific life events. These rights also impact Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and Flexible Spending Accounts (FSAs).
When and Who Receives the Notice?
Notices must be provided to all eligible employees at or before the time they are first offered the opportunity to enroll. This includes employees who:
- Decline coverage due to other health insurance and later lose eligibility.
- Become eligible for state premium assistance under Medicaid or CHIP.
- Acquire a new spouse or dependent by marriage, birth, adoption, or placement for adoption.
What Should the Notice Include?
The notice must describe special midyear enrollment opportunities and inform participants about deadlines for enrollment requests—30 days for most events, 60 days for Medicaid or CHIP-related events.
Distribution Methods
Include the notice with plan enrollment materials and, if conditions are met, distribute it electronically.
Impact on HRAs, HSAs, and FSAs
Special enrollment rights can affect contributions and usage of HRAs, HSAs, and FSAs:
- HRAs: Adjust contributions or usage to align with new coverage.
- HSAs: Review HSA contributions and ensure compliance with IRS rules.
- FSAs: Update FSA elections to reflect changes in coverage or dependent status.
Consequences of Non-Compliance
Failing to provide the notice timely can lead to enrollment issues and potential penalties from the Department of Labor (DOL).
Providing HIPAA special enrollment notices is essential for compliance and helps employees make informed decisions about their health coverage and financial accounts. Understanding the impact on HRAs, HSAs, and FSAs ensures that employees can effectively manage their health-related financial accounts in conjunction with their health plan enrollment.
Source: Thomson Reuters
by admin | Apr 10, 2025 | Blog
If your company sponsors a self-insured health plan, you might be wondering whether you still need to pay Patient-Centered Outcomes Research Institute (PCORI) fees. These fees, which fund research on patient-centered outcomes, have been a requirement for several years. However, there have been changes to the legislation that you should be aware of. In this post, we’ll clarify the current requirements for PCORI fees and what you need to do to stay compliant.
What Are PCORI Fees?
PCORI fees are paid by health insurers and sponsors of self-insured health plans. The funds collected are used to support research that helps patients, clinicians, purchasers, and policymakers make informed health decisions.
Legislative Background
Initially, PCORI fees were required for plan and policy years ending before October 1, 2019. For calendar-year plans, this meant that the 2018 plan year was supposed to be the last year for which these fees applied. However, budget legislation passed in 2019 reinstated the PCORI provision, extending the fee requirements through plan years ending before October 1, 2029.
Current Requirements
As of now, if your self-insured health plan’s policy year ends on December 31, 2024, you are required to pay the PCORI fee. This fee is considered an excise tax under the Internal Revenue Code and must be reported on IRS Form 720. Although Form 720 is filed quarterly for other federal excise taxes, the PCORI fee reporting and payment are only required annually. The deadline for filing Form 720 for the 2024 plan year is July 31, 2025.
Record-Keeping
The instructions for Form 720 advise taxpayers to keep their tax returns, records, and supporting documentation for at least four years from the latest of the date the tax became due or the date the tax was paid. This is crucial for ensuring compliance and being prepared for any potential audits.
Conclusion
In summary, PCORI fees are still required for self-insured health plans through plan years ending before October 1, 2029. Make sure to file IRS Form 720 by July 31, 2025, for the 2024 plan year, and keep all related documentation for at least four years. Staying informed and compliant will help your company avoid any penalties and contribute to valuable health outcomes research.
Source: Thomson Reuters
by admin | Mar 20, 2025 | Blog
Navigating the requirements for Summary Plan Descriptions (SPDs) under ERISA health and welfare plans can be complex. Ensuring compliance is crucial for plan administrators, especially for COBRA qualified beneficiaries. This guide will help you understand who must receive SPDs and the specific considerations for COBRA compliance.
Who Must Receive SPDs?
Plan administrators must automatically furnish SPDs to all participants covered under ERISA health and welfare plans. This includes current employees, former employees who are or may become eligible for benefits, and their beneficiaries.
COBRA Qualified Beneficiaries
COBRA qualified beneficiaries are a key group that must receive SPDs. These individuals have the right to continue their health coverage under the plan after certain qualifying events, such as termination of employment or reduction in hours. Here are the specific considerations:
- Automatic Provision of SPDs: COBRA qualified beneficiaries must receive SPDs automatically.
- Single SPD for Same Address: Separate SPDs are generally not required for qualified beneficiaries living at the same address.
Other Categories of Individuals Who Must Receive SPDs
In addition to COBRA qualified beneficiaries, the following categories must also receive SPDs:
- Employees or Former Employees Covered Under the Plan: Current plan participants and former employees, such as retirees, who remain covered under the plan.
- Alternate Recipients Under QMCSOs: Typically furnished to the child’s custodial parent or guardian.
- Spouses or Dependents of Deceased Participants: Those who continue to receive benefits under the plan.
- Representatives or Guardians of Incapacitated Persons: Sent to the individual’s representative or guardian.
Triggering Events for Automatic SPDs
ERISA specifies the events that trigger the requirement to automatically furnish SPDs. Additionally, SPDs must be provided to plan participants and beneficiaries who request them.
Understanding who must receive SPDs and the specific requirements for COBRA qualified beneficiaries is essential for compliance with ERISA health and welfare plans. By following these guidelines, plan administrators can ensure they meet their obligations and provide necessary information to all eligible participants.
Source: Thomson Reuters
by Lexi Garcia | Sep 26, 2024 | Blog
As the deadline for the 2024 HIPAA Privacy Rule approaches, companies sponsoring ERISA group health plans must take specific actions to ensure compliance. This rule introduces new prohibitions on the use and disclosure of protected health information (PHI) related to reproductive health care, along with new attestation requirements and updates to privacy practices. Here’s a comprehensive guide to help your company navigate these changes.
Modify HIPAA Policies and Procedures
Review and update your HIPAA policies and procedures to align with the 2024 Privacy Rule. Key updates include:
- Definitions: Add or revise definitions of reproductive health care, person, and public health.
- Prohibited Uses and Disclosures: Include language prohibiting the use or disclosure of PHI for:
- Investigations against individuals seeking or providing lawful reproductive health care.
- Identifying individuals for investigation or liability purposes related to lawful reproductive health care.
- Attestation Process: Describe the attestation process and required content for requests related to reproductive health care PHI. Utilize the model attestation form provided by HHS.
- Reporting and Requests: Revise provisions for reporting abuse, neglect, or domestic violence, and for law enforcement administrative requests.
- Personal Representatives: Clarify when to treat a person as an individual’s personal representative.
Conduct Training
Update your HIPAA training programs to incorporate the 2024 Privacy Rule requirements. Ensure that workforce members understand the new processes for handling PHI requests related to reproductive health care.
Review Business Associate Agreements
Examine and update business associate agreements to ensure compliance with the 2024 Privacy Rule. Verify that business associates are adhering to the new requirements.
Update Risk Analysis and Risk Management Plans
- Risk Analysis: Review and update the risk analysis to address the risk of impermissible disclosures of ePHI related to reproductive health care.
- Risk Management Plans: Evaluate and update risk management plans to address identified risks and vulnerabilities.
Conclusion
By taking these steps, your company can ensure compliance with the 2024 HIPAA Privacy Rule to Protect Reproductive Health Care. Staying proactive and informed will help safeguard PHI and uphold the privacy rights of individuals seeking reproductive health care.
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
