by admin | Jul 3, 2025 | Blog
When employees or their dependents lose group health coverage due to a qualifying event, COBRA ensures they can continue their health benefits. But what happens when a qualified beneficiary under COBRA relocates outside the service area of their HMO (Health Maintenance Organization) plan?
This scenario is more common than you might think—and it’s essential for employers and HR professionals to understand their obligations under COBRA in such cases.
COBRA Basics: Same Coverage Rule
Generally, COBRA requires employers to offer the same health coverage the qualified beneficiary had before the qualifying event. However, there’s a key exception for region-specific plans like HMOs.
The HMO Relocation Exception
If a qualified beneficiary moves out of their HMO’s service area, the employer must offer alternative coverage—but only if certain conditions are met.
✅ When Must Alternative Coverage Be Offered?
- Upon Request: The employer must offer other coverage options within a reasonable time after the qualified beneficiary requests it.
- Timing: The new coverage must begin no later than the date of relocation or the first day of the following month after the request.
✅ What Coverage Must Be Offered?
- If the employer offers other plans (e.g., PPO or indemnity plans) to similarly situated active employees that can be extended to the new location without extraordinary cost, those plans must be offered.
- If no such plan exists for similarly situated employees, the employer must offer any available plan that can be extended to the new location.
❌ What If No Coverage Is Available in the New Area?
- If no plan can be extended to the new location without extraordinary cost, the employer is not required to offer alternative coverage.
- However, if another controlled group member (e.g., a parent or subsidiary company) offers coverage in that area, it may be obligated to provide COBRA coverage.
Extraordinary Costs Are Not Required
Employers are not required to:
- Establish new provider networks.
- Create new reimbursement schedules.
- Offer preferred provider rates in areas without existing employee presence.
If a COBRA participant moves out of their HMO’s service area, you must be prepared to offer alternative coverage options—but only if they are already available to active employees and can be extended without significant cost.
Source: Thomson Reuters
by admin | May 22, 2025 | Blog
As employers prepare to offer health flexible spending accounts (FSAs), a common question arises: Are health FSAs administered by third-party administrators (TPAs) subject to HIPAA’s privacy and security rules? The short answer is yes—and here’s why that matters.
Understanding HIPAA’s Scope for Health FSAs
Under HIPAA, a health FSA is considered a group health plan, which makes it a covered entity subject to HIPAA’s privacy and security rules. The only exception is for self-administered FSAs with fewer than 50 participants—a rare scenario for most employers.
If your company uses a TPA to manage FSA claims, this exception does not apply. That means your health FSA must comply with HIPAA’s full privacy and security requirements.
Why Fully Insured Plans Are Different
Employers with fully insured major medical plans often take a “hands-off” approach to protected health information (PHI), receiving only summary or enrollment data. This limits their HIPAA obligations because the insurer, not the employer, handles PHI.
However, most health FSAs are self-insured, and the “hands-off” exception doesn’t apply. Even if a TPA handles the day-to-day administration, your company is still responsible for HIPAA compliance.
What Employers Must Do
To comply with HIPAA when offering a TPA-administered health FSA, employers should:
- Enter into a Business Associate Agreement (BAA) with the TPA, outlining how PHI will be handled.
- Implement privacy and security policies for the health FSA.
- Limit internal access to PHI to only those who need it for plan administration.
- Train staff who may come into contact with PHI.
- Ensure electronic PHI (ePHI) is protected under HIPAA’s security rule.
Minimizing Risk and Burden
While you can’t avoid HIPAA obligations entirely, you can minimize your exposure by delegating as much as possible to the TPA. This reduces the amount of PHI your company accesses and simplifies compliance.
If your company is offering a health FSA administered by a TPA, you are subject to HIPAA’s privacy and security rules. Taking proactive steps to comply—especially by working closely with your TPA—will help protect employee data and reduce legal risk.
Source: Thomson Reuters
by admin | Mar 14, 2025 | Blog
As the FSA grace period draws to a close on March 15, it’s crucial to make the most of your remaining funds. Flexible Spending Accounts (FSAs) offer a fantastic way to save on healthcare expenses, but any unused money will be forfeited if not spent by the deadline. To help you avoid losing your hard-earned dollars, here are five essential items you can purchase with your leftover FSA money:
1. Prescription Eyewear
Why not treat yourself to a stylish new pair of prescription glasses or contact lenses? Not only will you see better, but you’ll also have a chic accessory. Check out the options at the FSA Store.
2. Over-the-Counter Medications
Stock up on everyday essentials like pain relievers, allergy meds, and cold remedies. These are FSA-eligible and super handy to have around. You can find a wide selection at the FSA Store.
3. First Aid Supplies
Be prepared for minor injuries and emergencies by updating your first aid kit. Grab some bandages, antiseptic wipes, and gauze. Check out the FSA Store for all your first aid needs.
4. Health and Wellness Products
Consider investing in health and wellness products like heating pads, hot/cold packs, or even a new humidifier. These items are FSA-eligible and can help you stay comfortable and healthy. Explore the options at the FSA Store.
5. Sunscreen and Skincare Products
Protect your skin by investing in high-quality sunscreen and skincare products. Many of these items are FSA-eligible, making them a smart choice for using up your remaining funds. Check out the FSA Store for some great options.
Don’t let your FSA money go to waste! By purchasing these essential items, you can maximize your savings and ensure you’re well-prepared for the year ahead. Remember to check with your FSA provider for a complete list of eligible expenses and make your purchases before the grace period ends. For a full list of eligible FSA items click here.
by admin | Feb 20, 2025 | Blog
Administering a Health Flexible Spending Account (FSA) can be challenging, especially when employees request midyear changes to their elections due to unforeseen medical circumstances. This blog post aims to clarify the rules surrounding midyear election changes and provide practical tips for employers to manage these situations effectively.
Can Employees Change Health FSA Elections Midyear?
Question: Can employees reduce their Health FSA contributions if they are prevented from receiving anticipated medical care after enrollment?
Answer: No, employees cannot change their Health FSA elections under these circumstances. According to IRS regulations, an employee’s Health FSA election is irrevocable during a plan year unless an event occurs that fits within one of the exceptions available under IRS regulations or other guidance. Changes in medical condition or a provider’s recommendation do not qualify as changes in status and do not fall within the other exceptions applicable to Health FSAs.
Examples of Non-Qualifying Situations
- Pregnancy and Laser Eye Surgery: If a doctor refuses to perform laser eye surgery on an employee who is pregnant, the employee cannot change their Health FSA election.
- Dental Work Changes: If an employee’s spouse does not undergo planned dental work because the dentist’s recommendation changed, the employee cannot adjust their Health FSA contributions.
These situations do not qualify as “mistakes” that would allow an election change. The IRS’s 2007 proposed cafeteria plan regulations include an example where an employee elects Health FSA salary reductions for the next plan year in anticipation of eye surgery. If the surgery cannot be performed after the plan year starts, the employee must forfeit the remaining balance under the use-or-lose rule if their other eligible medical expenses are less than the amount contributed.
Minimizing Employee Relations Issues
While election changes are not allowed under these circumstances, employers can take steps to minimize employee relations issues:
- Clear Communication: Ensure that enrollment and other materials clearly explain the limited reasons for midyear election changes. Including real-life examples can be helpful.
- Remind Employees of Eligible Expenses: Employees may still use the funds by submitting other eligible expenses for reimbursement.
- Plan Amendments: Consider amending your plan to allow Health FSA carryovers of up to $660 to the next plan year. The maximum carryover amount is indexed, so stay updated on the latest limits.
- Grace Period: Adopt a grace period to give employees extra time to use up remaining funds.
By proactively addressing these issues, employers can help employees better understand their Health FSA options and reduce frustration related to midyear election changes.
Source: Thomson Reuters
by Lexi Garcia | Jan 23, 2025 | Blog
In today’s competitive job market, offering attractive employee benefits is crucial for retaining top talent. One effective way to enhance your benefits package is by implementing matching Health Savings Account (HSA) contributions through your company’s cafeteria plan. This blog post will guide you through the process, ensuring compliance with relevant regulations and maximizing the benefits for your employees.
Understanding HSA Contributions and Cafeteria Plans
Health Savings Accounts (HSAs) are tax-advantaged accounts that allow employees to save for medical expenses. Contributions to HSAs can be made by both employees and employers. A cafeteria plan, also known as a Section 125 plan, allows employees to make pre-tax salary reduction contributions to various benefits, including HSAs.
Can Employers Make Matching HSA Contributions?
Yes, employers can make matching contributions to employees’ HSAs through a cafeteria plan. However, it’s essential to understand the regulatory requirements to avoid potential pitfalls.
Comparability Requirements vs. Nondiscrimination Rules
Employers’ HSA contributions are generally subject to comparability requirements, which mandate that contributions must be the same dollar amount or the same percentage of the high-deductible health plan (HDHP) deductible for all eligible employees. This standard effectively prohibits matching contributions, as they would trigger a 35% excise tax on the employer.
However, these comparability requirements do not apply to employer HSA contributions made through a cafeteria plan. Instead, such contributions are subject to the Code § 125 nondiscrimination requirements, which include the eligibility, contributions and benefits, and key employee concentration tests. These tests provide more flexibility for employers to vary HSA contributions on a nondiscriminatory basis.
Designing a Compliant Matching Contribution Plan
To ensure compliance with nondiscrimination rules, carefully design your matching contribution plan. Consider the following:
- Eligibility: Ensure that all eligible employees have the opportunity to participate in the HSA matching program.
- Contribution Limits: Be mindful of the annual dollar limitations for HSA contributions. All contributions made to an employee’s HSA, whether by the employee, employer, or another entity, must be aggregated for these limits.
- Nonforfeitable Contributions: Once made, matching HSA contributions are nonforfeitable. They cannot be subject to a vesting schedule or be returned to the employer if the employee terminates employment midyear.
Communicating the Plan to Employees
Effective communication is key to the success of your HSA matching program. Ensure that the details of the matching contributions are clearly outlined in the cafeteria plan document, summary plan description, and other employee communications, such as open enrollment materials.
Implementing matching HSA contributions through your company’s cafeteria plan can significantly enhance your employee benefits package. By understanding and complying with the relevant regulations, you can offer a valuable benefit that helps attract and retain top talent while providing employees with a tax-advantaged way to save for medical expenses.
For more information on setting up a compliant HSA matching program, reach out to Sales@NueSynergy.com.
Source: Thomson Reuters
