by Lexi Garcia | Mar 23, 2023 | Blog
The IRS has issued FAQs that explain when certain costs related to nutrition, wellness, and general health are medical expenses under Code § 213 that may be paid or reimbursed under a health FSA, HSA, or HRA. As background, Code § 213 defines medical care as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting a structure or function of the body. The FAQs explain that medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness, and do not include expenses that are merely beneficial to general health.
The FAQs confirm that the costs of dental, eye, and physical exams are medical expenses that can be paid or reimbursed by a health FSA, HSA, or HRA because these exams diagnose whether a disease or illness is present. The costs of smoking cessation programs and programs that treat drug-related substance use or alcohol use disorders are also medical expenses because they treat a disease. For the cost of therapy to be a medical expense, the therapy must treat a disease—thus, amounts paid for therapy to treat a diagnosed mental illness are medical expenses, while amounts paid for marital counseling are not. Likewise, the costs of nutritional counseling and weight-loss programs are medical expenses only if the counseling or program treats a specific disease diagnosed by a physician (e.g., obesity or diabetes); otherwise, these costs are not medical expenses. The cost of a gym membership is a medical expense only if the membership was purchased for the sole purpose of affecting a structure or function of the body (e.g., a prescribed plan for physical therapy to treat an injury) or treating a specific disease diagnosed by a physician (e.g., obesity or heart disease). However, the cost of exercise for the improvement of general health is not a medical expense, even if recommended by a doctor.
The FAQs also explain the circumstances under which the cost of food or beverages purchased for weight loss or other health reasons will qualify as medical expenses, and that the cost of non-prescription drugs can be paid or reimbursed by a health FSA, HSA, or HRA even though these items (except for insulin) are not deductible under Code § 213. The FAQs confirm that the cost of nutritional supplements is not a medical expense unless the supplements are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician.
Source: Thomson Reuters
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
by admin | Dec 20, 2022 | Blog
As many know, a Health Reimbursement Arrangement (HRA) is an employer-funded account that helps pay for a medical plan’s deductible and co-insurance expenses. There are three ways to access an HRA. Here they are as follows.
- Filing an electronic claim: this can be submitted by signing into your NueSynergy account.
- Filing a paper claim: a paper claim along with a copy of Explanation of Benefits (EOB) can be emailed to NueSnergy. A paper claim can be obtained by signing into your NueSynergy account or by calling NueSynergy’s customer service team (855-890-7239).
- Providing documentation: A copy of your EOB from your insurance company is required to approve any claim for reimbursement.
For more information on accessing HRA funds and about this account in general, check out this handout.
by admin | Dec 19, 2022 | Blog
Two months ago, NueSynergy wrote about several Health Reimbursement Arrangement (HRA) FAQs to keep in mind. Now, taking it a step further, NueSynergy will discuss what employers, specifically, should look for in regard to an HRA. Here it is as follows:
An HRA can be paired with any health plan with no limitations
This means that high-deductible health plans (HDHPs) are not required in order to offer this account.
What happens to the funds if my employee leaves the company?
HRA funds are not portable. Therefore, if any funds become unused then any remaining amount returns to you (employer).
An employer can only contribute funds to an HRA
This also means that owners and partners cannot participate in this account. Per IRS guidelines, anyone with two percent or more ownership in a schedule S corporation, LLC, LLP, sole proprietorship, or partnership may not participate. If you would like to provide an opportunity for your employee to save for additional medical expenses tax-free, then suggest them to enroll in a Flexible Spending Account (FSA).
As an employer, can I choose proration for new hires and family status change?
Yes. You can prorate contributions as long as it occurs throughout the year.
When does an HRA begin paying for an employee’s expenses?
An employer can either allow an HRA to pay before the employee meets any deductible, or it can be set up so that the employee has to meet a certain amount of out-of-pocket expenses before the HRA begins to pay.
by admin | Dec 1, 2022 | Blog
Back in the spring, NueSynergy wrote about the basics of a Spousal Incentive Health Reimbursement Arrangement (SIHRA). Now, as the year closes, NueSynergy is excited to list off many frequently asked questions (FAQs), associated with this account. Here they are as followed:
How does a SIHRA work and how is it beneficial?
A SIHRA’s goal is to offer an employee’s spouse the opportunity for full coverage on eligible health expenses without the hassle of co-pays, coinsurance, and deductibles. This is all possible if an employee is part of a company’s group health plan. Once that’s established, then an employee can simply elect their spouse and/or dependent(s) to the plan. This allows their spouse to become incentivized through a SIHRA if he/she has access to a group health plan through their employer or a different organization.
When does enrollment start?
Enrollment takes place either within 30 days of a qualifying event, during the spouse’s annual open enrollment window or once a new employee is eligible for benefits.
What’s the enrollment process?
The process is as follows:
- Employee elects coverage for themselves (or employee + dependent) on employer-sponsored group health plan
- Employee’s spouse enrolls in his/her qualified alternate group health plan
- Employee (or their spouse) completes SIHRA enrollment and attestation e-forms via the online benefit administration system and provides proof of premium contribution paid for alternate group plan coverage
How to complete SIHRA enrollment?
In order to complete enrollment, a spouse is required to provide:
- Proof of paid premium contribution: paystub showing premium contribution amount (pre or post tax)
- Plan details indicating the cost of each coverage tier (not required if the entire family is enrolling)
