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.
Forms, Instructions, and Publications. You can view, download, and order IRS forms, instructions, and publications on this webpage: https://www.irs.gov/forms-instructions
Internal Revenue Bulletins (IRBs). These weekly bulletins include IRS announcements, notices, revenue procedures, revenue rulings, regulations, and other items of general interest: https://www.irs.gov/internal-revenue-bulletins
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
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
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.
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.
Navigating the complexities of medical coverage during unpaid Family and Medical Leave Act (FMLA) leave can be challenging for both employees and employers. One common question that arises is whether employees can prepay their share of medical plan coverage on a pre-tax basis. The answer is yes, but it depends on the specifics of your cafeteria plan.
Prepayment Option Under FMLA
The IRS FMLA regulations permit three payment options for employees wishing to pay their share of the premiums for group health coverage during an unpaid FMLA leave. These options are prepay, pay-as-you-go, and catch-up.
Prepay allows employees to pay the contributions due during the leave before the leave commences. This option cannot be the sole option offered to employees on FMLA leave, although it may be restricted to employees on FMLA leave.
Pay-as-you-go enables the employee to pay his or her share of the cost of coverage during the leave.
Catch-up involves the employer advancing payment of the employee’s share during leave, and the employee repays the employer upon return.
Your cafeteria plan may provide one or more of these payment options, as long as the options for employees on FMLA leave are offered on terms at least as favorable as those offered to employees not on FMLA leave.
How Does Prepayment Work?
Under the prepay option, employees are given the opportunity to pay, before starting FMLA leave, the contributions that will be due during the leave period. They can voluntarily elect to reduce their final pre-leave paychecks or make special salary reduction contributions to cover their share of the premiums for all or part of the expected duration of the leave. Prepay contributions could also be made on an after-tax basis.
During the leaves, your company would pay its share of the premium in the same manner as before. When an employee’s leave ends, the employee’s previous salary reduction election would resume for the rest of the plan year unless the employee makes a change in election permitted under IRS regulations upon return from leave.
Limitations of Prepayment
If an employee’s leave straddles two plan years, only the contributions for coverage during the first plan year can be prepaid on a pre-tax basis. This is due to the cafeteria plan “no-deferred-compensation” rule that generally prohibits the use of one year’s contributions to fund benefits in a subsequent year. However, a cafeteria plan with a grace period under its premium payment component could arguably allow employees taking an FMLA leave that straddles two plan years to make pre-tax prepayments for up to 2-1/2 months of coverage during the second plan year before the leave begins.
Conclusion
Understanding the options for medical coverage during unpaid FMLA leave is crucial for both employees and employers. While prepayment is a viable option, it’s essential to consider the specifics of your cafeteria plan and the IRS regulations to ensure compliance.
The IRS recently announced the 2025 limits for Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs). HSA contribution and plan limits will increase to $4,300 for individual coverage and $8,550 for family coverage. Changes to these limits will take effect January 2025.
HSAs are tax-exempt accounts that help people save money for eligible medical expenses. To qualify for an HSA, the policyholder must be enrolled in an HSA-qualified high-deductible health plan, must not be covered by other non-HDHP health insurance or Medicare, and cannot be claimed as a dependent on a tax return.
In a recent news release, the Internal Revenue Service (IRS) has reiterated important guidelines regarding the eligibility of health and wellness expenses for deductions and reimbursements under health Flexible Spending Arrangements (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and Medical Savings Accounts (MSAs).
What Qualifies as a Medical Expense? According to the IRS, for an expense to be considered a medical expense under Code § 213, it must be directly related to the diagnosis, cure, mitigation, treatment, or prevention of disease, or must affect the structure or function of the body. This definition excludes expenses that are solely for general health benefits.
The Risk of Nonmedical Reimbursements: The IRS warns that if health FSAs or other account-based health plans reimburse nonmedical expenses, it could result in all plan payments, including those for legitimate medical expenses, being included in participants’ taxable income.
Misleading Claims and the Importance of Diagnosis-Specific Documentation: The IRS has expressed concerns about companies misleading individuals by suggesting that a doctor’s note can transform general food and wellness expenses into medical expenses. However, without a clear connection to a diagnosis-specific treatment or activity, these expenses do not qualify as medical expenses.
Case in Point: The Denied Claim Highlighting the issue, the IRS shared an instance where an individual with diabetes was denied reimbursement for healthy food expenses through his health FSA. Despite obtaining a doctor’s note from a company that advertised such services, the claim was rejected because the food did not meet the criteria for a medical expense.
Guidance for Taxpayers: For those seeking clarity on what constitutes a reimbursable medical expense, the IRS points to its FAQs on nutrition, wellness, and general health expenses. These resources clarify that food or beverages purchased for health reasons, such as weight loss, can only be reimbursed if they do not fulfill normal nutritional needs, are used to alleviate or treat an illness, and are substantiated by a physician’s prescription.
Understanding the fine line between general wellness and medical care is crucial for taxpayers and plan administrators. As the IRS emphasizes, only expenses that meet the stringent criteria set forth in the Code will be considered for deductions and reimbursements, ensuring the integrity of health-related financial plans.
