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 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 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 | 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 8, 2024 | Blog
COBRA, the Consolidated Omnibus Budget Reconciliation Act, provides employees with the option to continue their health insurance coverage after leaving their job. However, certain circumstances can lead to the early termination of this coverage. One such circumstance is the submission of fraudulent claims.
Terminating COBRA Coverage for Fraudulent Claims
A qualified beneficiary’s COBRA coverage can be terminated for submission of fraudulent claims if three key requirements are met:
- The health plan must allow the termination of active employees’ coverage for the same reason.
- The plan must permit the termination of COBRA coverage for cause.
- The plan’s COBRA notices and communications must disclose the plan’s right to terminate coverage for cause.
Regulatory Guidelines
COBRA regulations specify that a qualified beneficiary’s coverage may be terminated for cause on the same basis that would apply to similarly situated active employees under the terms of the plan. This includes the submission of fraudulent claims. Thus, if an active employee’s coverage can be terminated for submission of fraudulent claims, COBRA coverage can be terminated early for the same reason, provided it is allowed by the plan and disclosed in COBRA notices and the plan’s summary plan description.
Proceeding with Caution
Terminating coverage early is a decision that should be made with caution. Employers wishing to terminate COBRA coverage early for other types of misconduct would need to analyze the circumstances to determine whether the plan would allow termination of an active employee’s coverage for that type of misconduct. It is advisable to consult with legal counsel and the plan’s insurer or stop-loss insurer if applicable.
Final Steps
If you decide to terminate the qualified beneficiary’s coverage based on fraudulent submission, remember to send the required notice of termination of COBRA coverage to any qualified beneficiary whose COBRA coverage terminates before the expiration of the maximum coverage period.
In conclusion, while it is possible to terminate COBRA coverage early due to fraudulent claims, it is a decision that should be made carefully, following the guidelines set forth by your health plan and COBRA regulations.
Source: Thomson Reuters
