This document provides an overview of consumer-driven health plans and cafeteria plans. It discusses key aspects of cafeteria plans including legal requirements, qualified benefits, contributions, elections, and flexible spending accounts. It also covers dependent care plans and their basic requirements. The document is authored by Larry Grudzien, an attorney specializing in employee benefits law, and is intended to educate about these types of benefit plans.
Review all of the requirements of the Employee Retirement Income Security Act of 1974. Training will go over which employers have to comply, which benefits are subject to ERISA, what documentation employers must provide, and penalties for noncompliance.
Covert Taxes: Spying Issues in Health & Welfare Benefitsbenefitexpress
Avoid a tax season surprise and make sure your benefits are actually beneficial to your employees. It’s time to ensure you’re keeping your plan non-taxable to your employees and tax deductible for you by learning:
- How to pass the Benefits Test
- Common pitfalls in nondiscrimination requirements
- Covered plans beyond basic health and disability insurance
- The best way to provide tuition assistance to employees
Get your maximum deduction come tax time while maintaining your top-tier benefits with this webinar, featuring advice from benefits attorney Larry Grudzien.
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives. However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees.
If ACA is repealed, there will be significant implications for FSAs. Devise your strategy to:
- Accurately catch employee election changes
- Manage rollover requirements
- Determine who pays first – HSA vs FSA
- Understand COBRA’s impact on an FSA
Get coaching from benefits attorney Larry Grudzien on how to prep now for the legislative impact on FSA administration.
Navigate New Legislation: The Road Into 2017benefitexpress
As new regulations kick in for 2017 and ACA reporting season is coming to a close, review all recent legislative changes. This webinar focuses on what you need to know for your 2017 benefits strategy.
Learn about new legislation from DOL, HHS, IRS, and EEOC. ERISA attorney Larry Grudzien will cover all relevant rulings since his previous webinar and host an interactive Q&A with the audience.
Open Forum: Achieve Compliance Success in 2017benefitexpress
As you begin next year’s benefits planning, are you sure your plan satisfies all requirements from the IRS, HHS, DOL, and more?
Come prepped with your benefits details in hand and check off:
Common errors in ERISA plans
Cafeteria plan pitfalls
Structuring your FMLA administration
Avoiding mishaps with MEWAs
Preparing a compliant COBRA strategy
In addition, get the legal answer for your plan questions from benefits attorney Larry Grudzien in this critical webinar.
With Department of Labor audits on the rise, this presentation reviews all the requirements under ERISA. This includes the requirements for plan documents, disclosures and reporting.
Review all of the requirements of the Employee Retirement Income Security Act of 1974. Training will go over which employers have to comply, which benefits are subject to ERISA, what documentation employers must provide, and penalties for noncompliance.
Covert Taxes: Spying Issues in Health & Welfare Benefitsbenefitexpress
Avoid a tax season surprise and make sure your benefits are actually beneficial to your employees. It’s time to ensure you’re keeping your plan non-taxable to your employees and tax deductible for you by learning:
- How to pass the Benefits Test
- Common pitfalls in nondiscrimination requirements
- Covered plans beyond basic health and disability insurance
- The best way to provide tuition assistance to employees
Get your maximum deduction come tax time while maintaining your top-tier benefits with this webinar, featuring advice from benefits attorney Larry Grudzien.
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives. However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees.
If ACA is repealed, there will be significant implications for FSAs. Devise your strategy to:
- Accurately catch employee election changes
- Manage rollover requirements
- Determine who pays first – HSA vs FSA
- Understand COBRA’s impact on an FSA
Get coaching from benefits attorney Larry Grudzien on how to prep now for the legislative impact on FSA administration.
Navigate New Legislation: The Road Into 2017benefitexpress
As new regulations kick in for 2017 and ACA reporting season is coming to a close, review all recent legislative changes. This webinar focuses on what you need to know for your 2017 benefits strategy.
Learn about new legislation from DOL, HHS, IRS, and EEOC. ERISA attorney Larry Grudzien will cover all relevant rulings since his previous webinar and host an interactive Q&A with the audience.
Open Forum: Achieve Compliance Success in 2017benefitexpress
As you begin next year’s benefits planning, are you sure your plan satisfies all requirements from the IRS, HHS, DOL, and more?
Come prepped with your benefits details in hand and check off:
Common errors in ERISA plans
Cafeteria plan pitfalls
Structuring your FMLA administration
Avoiding mishaps with MEWAs
Preparing a compliant COBRA strategy
In addition, get the legal answer for your plan questions from benefits attorney Larry Grudzien in this critical webinar.
With Department of Labor audits on the rise, this presentation reviews all the requirements under ERISA. This includes the requirements for plan documents, disclosures and reporting.
Review the requirements for offering HSAs. This will include what coverages must be offered, documentation to be completed, what rules the employer and employee must follow (including HSA employer contribution rules), and commonly made mistakes.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
How Medicare Affects Employer Health Coveragebenefitexpress
This presentation reviews the topic of Medicare and how it can affect Employers Health Coverage offerings, including: employer secondary rules, COBRA, notice requirements, and reporting requirements.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Proving Grounds: Answer the Call with Effective FMLA Administrationbenefitexpress
The DOL released a new employer guide to the Family and Medical Leave Act this year, but many employers have unanswered questions. Administrating FMLA is a tricky topic; learn to navigate the regulations with ease. From major regulatory changes to the day-to-day questions, HR and benefit managers have, ERISA attorney Larry Grudzien covers everything you need to know right now to legally administrate FMLA leave.
This webinar covers a basic review of the requirements under ERISA, including: what is an ERISA benefit, what documentation requirements have to be met, what disclosure requirements have to be met, what reporting requirements need to be met, what is a fiduciary, and what are other requirements.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
In today's multi-generational workforce, health and wellness benefits are weighted equally with salary expectations. This is why it's important for small and large businesses alike to embrace health and wellness benefits to recruit top talent as well as retain valued employees.
While offering these benefits has been shown to improve employee engagement and productivity, it comes with some challenges. This webinar reviews common questions human resources professionals confront when offering health and welfare benefits to employees.
Facilitated by ERISA attorney Larry Grudzien, this webinar covers the following:
- Questions Surrounding Tax
- Reporting Disclosures
- ERISA, COBRA & FMLA
- Workers Compensation
- Affordable Care Act (ACA)
Benefits are a critical piece of an employee compensation package, with health care benefits reigning most important. Whether you're already offering these benefits or considering adding them to your benefits offerings, view our webinar to learn more and remain competitive in the talent marketplace.
This presentation covers how Medicare affects employer health coverage in: Providing opt out amounts | Paying for Medicare for active employees | Electing COBRA
Independent Contractor or Employee: Avoiding the Game of Guess Whobenefitexpress
Uber is in the news for a multimillion dollar settlement following a dispute over whether their drivers are employees or independent contractors, and they aren’t the only ones. Misclassifying an employee as an independent contractor is one of the costliest mistakes an employer can make.
Sort out which your employees are and learn your options for reclassifying workers in the webinar you literally can’t afford to miss.
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
Latest and Greatest in HRA's and Cafeteria Plansbenefitexpress
This webinar covers:
• New guidance in the Health FSA carryover requirements
• Can individual premiums be reimbursed under HRA's or cafeteria plans?
• New rules on integrated HSA's and standalone HRA's
• When are health FSA's subject to Health Reform?
• New reporting and disclosure requirements
Medicare & Employer Health Coverage - a Coordination Conversationbenefitexpress
Let's talk about Medicare and Employer Health Coverage. The rules on coordinating Medicare and employer coverage can be complex. How it complements other programs (such as COBRA, HSAs and the ACA) are also areas of question for both employees and their employers.
The Marketplace: What Every Employer Should Knowbenefitexpress
This presentation helps assist employers in talking to their employees about the Marketplace. It will cover all you need to know about the Marketplace.
Cadillac Tax for Employers 101 - How to Avoid Penalties?benefitexpress
This webinar covers: what coverages are subject to the tax, how the excise tax is determined, what adjustments will be available in determining the tax, and who collects the tax.
Temporary Employees and the Employer Mandatebenefitexpress
This presentation reviews - when temporary employees become your employees, the factors the government uses to determine employment status, the steps you can take to avoid these employees becoming your employees, and consequences under Health Care Reform if it is determined that they are your employees.
Employee vs. Independent Contractor - How to Differentiate and Avoid Penalties?benefitexpress
This presentation reviews: which factors the IRS uses to determine common law employee status | how does this affect compliance with ACA | what penalties may apply.
Developments in Health and Welfare Plans in 2016benefitexpress
Kick off enrollment season with a comprehensive review of the legislative changes for 2016. This webinar focuses on what you need to know for successful enrollment and ACA reporting. Learn about new legislation from DOL, HHS, IRS, and EEOC. It’s a webinar you (and your compliance strategy) can’t afford to miss.
Review the requirements for offering HSAs. This will include what coverages must be offered, documentation to be completed, what rules the employer and employee must follow (including HSA employer contribution rules), and commonly made mistakes.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
How Medicare Affects Employer Health Coveragebenefitexpress
This presentation reviews the topic of Medicare and how it can affect Employers Health Coverage offerings, including: employer secondary rules, COBRA, notice requirements, and reporting requirements.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Proving Grounds: Answer the Call with Effective FMLA Administrationbenefitexpress
The DOL released a new employer guide to the Family and Medical Leave Act this year, but many employers have unanswered questions. Administrating FMLA is a tricky topic; learn to navigate the regulations with ease. From major regulatory changes to the day-to-day questions, HR and benefit managers have, ERISA attorney Larry Grudzien covers everything you need to know right now to legally administrate FMLA leave.
This webinar covers a basic review of the requirements under ERISA, including: what is an ERISA benefit, what documentation requirements have to be met, what disclosure requirements have to be met, what reporting requirements need to be met, what is a fiduciary, and what are other requirements.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
In today's multi-generational workforce, health and wellness benefits are weighted equally with salary expectations. This is why it's important for small and large businesses alike to embrace health and wellness benefits to recruit top talent as well as retain valued employees.
While offering these benefits has been shown to improve employee engagement and productivity, it comes with some challenges. This webinar reviews common questions human resources professionals confront when offering health and welfare benefits to employees.
Facilitated by ERISA attorney Larry Grudzien, this webinar covers the following:
- Questions Surrounding Tax
- Reporting Disclosures
- ERISA, COBRA & FMLA
- Workers Compensation
- Affordable Care Act (ACA)
Benefits are a critical piece of an employee compensation package, with health care benefits reigning most important. Whether you're already offering these benefits or considering adding them to your benefits offerings, view our webinar to learn more and remain competitive in the talent marketplace.
This presentation covers how Medicare affects employer health coverage in: Providing opt out amounts | Paying for Medicare for active employees | Electing COBRA
Independent Contractor or Employee: Avoiding the Game of Guess Whobenefitexpress
Uber is in the news for a multimillion dollar settlement following a dispute over whether their drivers are employees or independent contractors, and they aren’t the only ones. Misclassifying an employee as an independent contractor is one of the costliest mistakes an employer can make.
Sort out which your employees are and learn your options for reclassifying workers in the webinar you literally can’t afford to miss.
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
Latest and Greatest in HRA's and Cafeteria Plansbenefitexpress
This webinar covers:
• New guidance in the Health FSA carryover requirements
• Can individual premiums be reimbursed under HRA's or cafeteria plans?
• New rules on integrated HSA's and standalone HRA's
• When are health FSA's subject to Health Reform?
• New reporting and disclosure requirements
Medicare & Employer Health Coverage - a Coordination Conversationbenefitexpress
Let's talk about Medicare and Employer Health Coverage. The rules on coordinating Medicare and employer coverage can be complex. How it complements other programs (such as COBRA, HSAs and the ACA) are also areas of question for both employees and their employers.
The Marketplace: What Every Employer Should Knowbenefitexpress
This presentation helps assist employers in talking to their employees about the Marketplace. It will cover all you need to know about the Marketplace.
Cadillac Tax for Employers 101 - How to Avoid Penalties?benefitexpress
This webinar covers: what coverages are subject to the tax, how the excise tax is determined, what adjustments will be available in determining the tax, and who collects the tax.
Temporary Employees and the Employer Mandatebenefitexpress
This presentation reviews - when temporary employees become your employees, the factors the government uses to determine employment status, the steps you can take to avoid these employees becoming your employees, and consequences under Health Care Reform if it is determined that they are your employees.
Employee vs. Independent Contractor - How to Differentiate and Avoid Penalties?benefitexpress
This presentation reviews: which factors the IRS uses to determine common law employee status | how does this affect compliance with ACA | what penalties may apply.
Developments in Health and Welfare Plans in 2016benefitexpress
Kick off enrollment season with a comprehensive review of the legislative changes for 2016. This webinar focuses on what you need to know for successful enrollment and ACA reporting. Learn about new legislation from DOL, HHS, IRS, and EEOC. It’s a webinar you (and your compliance strategy) can’t afford to miss.
Medicare Rule Review: Overview of Secondary Payersbenefitexpress
Learn how the Medicare Secondary Payer Rules impact an employer’s health and welfare plans. This covers which employers are subject, what employers can do to comply, and the penalties that can be imposed for noncompliance.
Non-Qualified Deferred Compensation Programs for Private CompaniesSkoda Minotti
Paying annual bonuses may not keep the executives around after the bonus is paid. Should executives be rewarded if the employer is not doing well? How can employers attract and retain key executives while creating a system that will reward them if the company is profitable?
Rollovers: the impact it can have on your retirementAndrew Leeman
While leaving your money in your former employer's plan may be an option, one way to gain more control of your assets is to consolidate your retirement funds into a single individual retirement account (IRA). Email me with any questions: aleeman@ft.newyorklife.com
Webinar | Training the Technique: Advanced ERISA Compliancebenefitexpress
If your organization offers any form of retirement plan, chances are you have questions about ERISA. This advanced compliance training will go beyond the basics of the requirements of the Employee Retirement Income Security Act of 1974.
Attend our one-hour training to learn:
- Which employers are affected by ERISA regulations
- Which benefits plans are subject to ERISA
- What documentation employers must provide to prove
compliance
- Penalties for noncompliance
ERISA attorney Larry Grudzien will share industry inside knowledge to help participants ensure total compliance with ERISA regulations.
Health Care Reform and the Basics of BenefitsBeyondPay
This webinar will answer questions you have about the insurance you offer employees. It covers all things ACA and benefits administration, including COBRA, ERISSA, and HIPAA. Don't miss the latest ACA updates in 2016 to find out how they will affect you and your company.
This presentation covers all the compliance issues with HSA's as well as: which employees are eligible, contribution requirements, distributions requirements, and reporting requirements.
Wellness Workout: Cardio for Your Compliance Reviewbenefitexpress
In the race for top talent, wellness plans are no longer an option, they are a necessity. Like medical insurance and a 401(k), basic wellness benefits are expected by your prospective employees.
Learn how to structure a new plan or reform your existing program to optimize employee engagement and regulatory compliance.
This powerpoint goes into depth and explains FSAs, HRAs and HSAs, how they work together, who can participate, and what types of rules apply. It's a little boring, long, and somewhat detailed. However, you can use just portions of the slides if you'd like. The last 20 or so slides may be useful if an employer is offering high deductible health insurance plans, with an HSA - and already has an FSA in place This is a Continuing Education Course in California, under the Department of Insurance.
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives.
However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees. Engage your employees with a financial wellness benefit that works.
Key webinar takeaways:
- How different types of FSAs interact with benefit plans as a whole
- FSA and reimbursement limits for 2018
- Legal implications of offering an FSA to employees
- Best practices for administering a successful FSA benefit plan
Action Steps for Your Employee Benefits Plan During the Coronavirus PandemicQuarles & Brady
With the enactment of two new Coronavirus-related laws, plan sponsors of retirement, health and welfare plans have several "must-do" items to consider, along with several "optional" items. Join us for this informative webinar where we will discuss the different legal considerations plan sponsors and service providers (such as third party administrators, insurance brokers and pharmacy benefit mangers) should consider for their retirement, health and welfare plans.
We will discuss:
-What coronavirus testing must be covered by health plans
Important changes to "over the counter" drugs and medicine
-Addressing layoffs and furloughs, and how to survive the benefit costs
-Best practices for distribution and loan options for those who have been affected
-Delaying, repaying and fixing 2020 required minimum distributions
-How to treat paid leave under your retirement plans
Employee Benefits and Human Resources: The Year in Review and a Look at What’...Winston & Strawn LLP
2016 included significant legislative, regulatory, enforcement, and case law developments in the employee benefits and human resources area, and 2017 promises to be a year of change. Therefore, it is important to stay up-to-date on the latest legal developments, threats, and best practices.
Steve Flores and Christine Matott from our Employee Benefits & Executive Compensation Practice, Rob Newman and Alessandra Swanson from our Privacy & Data Security Practice, and Cardelle Spangler from our Labor & Employment Practice, reviewed important compliance deadlines and areas of potential risk. The discussion examined the following important areas:
Significant plan fiduciary litigation
DOL Conflict of Interest Rules
Affordable Care Act developments, including reporting and enforcement
Updates on HIPAA enforcement, including the latest on OCR’s audits, recently released guidance, and case settlements
Recent changes to employee privacy laws, including state breach notification laws and EU data transfer laws
New overtime rules, EEOC LGBT protections, and ban the box rules
Webinar: Mid-Year Election Changes for Cafeteria Plansbenefitexpress
Let's talk about cafeteria plans. When can participants make election changes?
While cafeteria plans can be a great option for employees wishing to pick and choose benefits based on cost, when and how to facilitate election changes outside of open enrollment can be tricky to navigate for employers. As the use of cafeteria plans continue to grow, we take a deeper look at the rules and regulations of these plans, particularly as they pertain to mid-year election changes.
COVID-19 Health & Welfare: Compliance for Employersbenefitexpress
As part of our continuing ERISA Compliance series, we covered such compliance topics and more in our April 9th webinar discussing COVID-19 and updates from the IRS and DOL concerning the Families First Coronavirus Response Act.
Plan Sponsor Webinar: Navigating COVID-19 for Employersbenefitexpress
In this webinar, we take a deeper look into how the novel coronavirus is not only affecting the way we live, but changing the way we work. From remote work environments, FMLA, contract agreements and more, we discuss how to navigate the changing workforce during this time of uncertainty, and answer questions to help you make the best decisions for the health and safety of your employees.
Part of our ERISA Compliance Series, this webinar is hosted by ERISA Attorney Larry Grudzien and moderated by chief marketing officer Julia Goebel. This webinar will discuss the top wage and hour issues that may be unknowingly lurking within your company.
The Affordable Care Act touches the lives of most Americans. In fact, nearly 21 million will be at risk if Obamacare is struck down, and may even lose health insurance completely if the law is ruled unconstitutional. This webinar will discuss what the outcome may be if ACA is repealed.
Watch our free one-hour webinar reviewing the rules for the new Individual Coverage HRA and the new Excepted Benefit HRA (ICHRA and EBHRA).
In June 2019, Treasury, DOL and HHS released final regulations that are effective for plan years beginning on or after January 1, 2020. These regulations created two new HRAs, Individual Coverage HRAs (ICHRA) and Excepted Benefit HRAs (EBHRA).
These new HRAs will be subject to ERISA and COBRA, but will not be subject to the nondiscrimination rules under Code Section 105(h). Any employer can offer these new HRAs to their employees. They can be offered to common law employees, but cannot be offered to self-employed individuals, partners and more than 2% S-Corporation shareholders.
Facilitated by ERISA attorney Larry Grudzien, and moderated by Chief Marketing Officer Julia Goebel, this webinar will cover the following:
-Why are these new HRAs so important?
-Which employees can be included or excluded
-What documentation is needed to be completed by employers to adopt them
-What reporting and disclosure requirements must be met
-What types of expenses can be reimbursed
-The pros and cons of establishing and participating in these new HRAs for employers
How to Administer Wellness Programs in Today's Regulatory Environmentbenefitexpress
Are you struggling to make sense of the recent legislative updates surrounding employer sponsored wellness programs? Perhaps you are trying to decide whether to continue with current wellness plans, modify your plans without guidance from the EEOC, postpone new wellness programs or discontinue them all together.
It’s a complicated landscape ripe with several options for “next steps” for employees and plan sponsors of wellness plans in 2019 — with perhaps the biggest barrier of all being that employers cannot measure the risk of wellness plans at this time.
To help guide you through this maze of options, watch our one-hour webinar on-demand to learn what rules remain after the EEOC’s regulations were found invalid and what rules have to be met in 2019 in order to offer a valid wellness program.
How to administer wellness programs in today's regulatory environment
This webinar covers:
Requirements under HIPAA
Requirements under the Internal Revenue Code
Requirements under ERISA
Requirements under GINA
Requirements under ADA
Requirements under ACA
HIPAA Training: Privacy Review and Audit Survival Guidebenefitexpress
HIPAA Privacy Overview for Employers. Review a helpful checklist of requirements an employer must adopt to stay compliant with HIPAA and to survive an audit by Health and Human Services (HHS).
Webinar | Texas vs. United States - The Repeal of ACA?benefitexpress
Recently a Federal District Court held in Texas, et al. v. United States of America, et al. that the individual mandate in the Patient Protection and Affordable Care Act (ACA) is unconstitutional, and that the other provisions in the ACA are invalid because they are inseverable from the individual mandate.
Our ACA compliance webinar reviews:
- What the Federal District Court decided.
- The basis for the decision.
- The impact of the decision.
- What may happen over the next months or year.
- What Congress may do to address the situation.
Healthcare Check-in: The Latest Developments in Health and Welfare Plansbenefitexpress
We work in an exciting industry – which means quick changes are the norm, and adaptability is a necessity. Keep your compliance plans up to date with a download of all legislative changes since our last update webinar. This webinar covered legislation that's passed in the last six months, what's on the way, and what it means for your organization.
Webinar | From Analysis to Action: How Personalization Can Lower Employer Cos...benefitexpress
Personalization is everywhere – from Amazon to Spotify, and is now the expectation for consumers. Personalization in benefits elections is also the new normal, thanks to decision support tools and data analytics. Modern decision support tools draw on data points including demographics, preferences and medical need, all highly relevant towards personalization ... as opposed to the "one-size fits all" modeler of the past that relied on strict business rules.
Using data to advise clients can be a game changer for a broker. With analytics, you can quantify your benefit plan suggestions based on hard evidence, and advise based on unbiased data versus mere opinion. But where does this data come from? And how do you know which data to use?
This webinar shows how decision support tools can provide data to simplify health benefit decisions, allowing employees to feel more confident in their decisions, leading to lower costs for employers and client retention for brokers as a result.
In this webinar, brokers will learn how decision support analytics can reinforce their role as a trusted adviser by:
• Helping employer clients understand which health plans and programs are being used and which ones are the most cost-effective
• Minimizing the number of employees who are over-insured or under-insured, helping to save on annual and long-term costs for healthcare premiums, leading to better client retention over time
• Supporting healthy employee behaviors, resulting in lower health care expenses overall
Webinar | COBRA Pitfalls: Common Mistakes and How to Avoid Thembenefitexpress
Leaving the organization isn't the end of the benefits cycle for employees. This webinar focuses on how to avoid one of the most common compliance pitfalls in benefits ... COBRA administration.
Some of the top takeaways were:
• The basics of successful COBRA administration
• Required notices associated with COBRA coverage
• How Medicare interacts with COBRA for employees and dependents
• Penalties for noncompliance
Smooth and successful off-boarding of departing employees is as important as well-planned on-boarding of new hires. Log on to your roadmap for a smooth ride into COBRA compliance.
Webinar | Clients Calling “Mayday”? Design a Benefits Technology Strategy to ...benefitexpress
Benefits administration can be a delicate, and even difficult balancing act for employers. From managing costs and administrative demands, to maintaining compliance, and integrating with workforce wellness plans, it’s not surprising that three in four employers called “mayday” and turned to benefits administration outsourcing in 2017. With the administrative difficulty level rising, and advisory competition increasing, it is now critical to become the partner of choice to relieve this distress. But how?
Join Scott Evans, chief product officer at benefitexpress, this May Day, as he guides benefits advisers through the top considerations for building, buying or borrowing benefits administration technology solutions to offer clients. If you and your clients have benefits technology questions, Scott has answers.
Webinar takeaways include:
• How to assess your readiness: learn and identify the benefits administration business model that is right for you
• Key criteria for evaluating potential benefits technology partners, plus a valuable checklist
• How to create a benefits technology strategy for your business which is seen as an imperative – not a “value-add” – by your clients
• Tips for staying competitive in a changing market, using your solutions portfolio
Factors of Self-Funding: Evaluating the Pros and Consbenefitexpress
In a changing healthcare landscape, employers are increasingly considering taking the funding of their healthcare benefits into their own hands. If you're one of them, this webinar is the one-hour guide you must see.
Participants will learn:
- The legal implications associated with self-funding
- Common administrative pitfalls
- Solving employee issues involved in self-funded plans
- A full overview of laws and regulations governing self-funding
Our compliance expert will weigh in during a compact, one-hour guide.
Healthcare check in the latest developments in health and welfare plansbenefitexpress
We work in an exciting industry—which means quick changes are the norm, and adaptability is a necessity.
Keep your compliance plan up-to-date with a download of recent legislative changes.
We'll cover legislation that's passed, what's on the way, and what it means for your organization.
Topics Covered Include:
• IRS Information Letters
• Tax Reform Legislation
• Wellness Regulations - EEOC, AARP
• Comprehensive Guidance on QSEHRAs
• ACA: Elimination of Individual Mandate Penalty
• Employer Tax Credit for Paid Family and Medical Leave
• DOL Annual Adjustments to Employee Benefit Plan Penalties
• “Good Faith” Penalty Relief
• Final Disability Claim Regulations
• Cadillac Tax Updates
• And More!
Presented by Larry Grudzien, Attorney at Law
Piece of Cake: Perfecting the Recipe for ACA Compliancebenefitexpress
Repeal and replace efforts have come and gone - it's time to prepare to comply with the Affordable Care Act for another year.
With chatter and speculation surrounding the ACA, it's easy to lose track of what's required of employers. Our one-hour refresher course covers:
- How to fill out form 1095-C
- Important filing dates
- Common compliance errors
- Penalties for noncompliance
Make this year’s ACA reporting a piece of cake.
68% of employees would prefer to enroll online
...but only 38% of employers believe that.
Join our panelists in a discussion about the benefits of switching to a digital enrollment platform - complete with examples and case studies to support successful online enrollment.
Puzzling Precedents: Piecing Together MEWAsbenefitexpress
The convenience of a Multiple Employer Welfare Arrangement comes with an additional regulatory burden. It takes a deep understanding of compliance requirements to keep both your employees and your bottom line healthy when it comes to MEWA.
Skip the struggle with complicated legal briefs and sort out your strategy in this one-hour seminar with our benefits attorney.
CDHP 101: Behind the Wheel of Consumer-Driven Plans
1. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 1
2. CDHP 101: Behind the Wheel of
Consumer-Driven Plans
Larry Grudzien
Attorney at Law
3. Lawrence (Larry) Grudzien, JD, LLM is an attorney practicing exclusively in the field
of employee benefits. He has experience in dealing with qualified plans, health and
welfare, fringe benefits and executive compensation areas. He has more than 35
years’ experience in employee benefit law.
Mr. Grudzien was also an adjunct faculty member of John Marshall Law School’s
LL.M. program in Employee Benefits and at the Valparaiso University’s School of
Law. Mr. Grudzien has a B.A. degree in history and political science from Indiana
University, J.D. degree from Valparaiso University School of Law and LL.M. degree
in tax from Boston University School of Law. He is a member of Indiana and Illinois
Bars.
About Larry
3
Larry Grudzien
ERISA Attorney
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC
5. • A written plan for employees who may choose between cash and qualified benefits
• Essential Features:
Cash Requirement
Salary Reduction
Election Requirement
• Types of Plans:
Premium Only Plans (POP)
Health Flexible Spending Accounts
Dependent Care Assistance Plans
Source: Code §125(a) &(d)
Statutory Definition
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6. • Employee completes election form for salary reduction
• A designated portion of the employee’s salary is reduced every pay period to
pay for his or her portion of premium and/or expenses
• Employer collects amounts and pays premium for employee coverage
• Employer reimburses employee’s medical and dependent care expenses
• Both employer and participant saves FICA and FUTA taxes on contributions
How Cafeteria Plans Work
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7. Employee Advantages
• Tax Savings on Income Tax and FICA
• Flexibility in Choosing Benefits
• More Benefit Choices May Be Available
• Uniform Coverage Rule
Employee Disadvantages
• Elections Irrevocable Except for “Change in Status”
• “Use or Lose it Rule”
Advantages & Disadvantages
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8. Employer Advantages
• Tax Savings on FICA and FUTA Taxes, State Unemployment Insurance and Workers’ Compensation Taxes
• Improved Recruitment and Retention
• Cost Savings in Providing Flexible Benefit Structure
• Impact of Employee Premium Increases Softened
• Increase in Employee Awareness of Benefit Costs
Employer Disadvantages
• Initial Setup Costs
• Ongoing Administration Expenses
• Expense Relating to Communication of Benefit Program to Employees
• Uniform Coverage Rule
Advantages & Disadvantages
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9. Written Plan Required
Contents
• Description of Benefits
• Eligibility Rules
• Procedures Governing Elections
• Manner in Which Contributions Are Made
• Maximum Employer Contributions
• Plan Year
Source: IRS Reg. §§ 1.125-1, Q&A-3, 1.125-2, Q&A-3.
Legal Requirements of Cafeteria Plans
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10. • Reporting & Disclosure Requirements
• ERISA Coverage
• Nondiscrimination Requirements
Eligibility to Participate
Contribution and Benefits
Key Employee Concentration
Source: Code §125(b)&(c), IRS Reg. §1.125-1, Q & A-19
Legal Requirements of Cafeteria Plans
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11. Any employer can sponsor a cafeteria plan
• No minimum size requirement
• No required form of ownership
Eligible Individuals
• Only employees of plan sponsor or controlled group member may participate
• Former employees may participate if active employees predominate
• Some workers may be excluded under plan terms if discrimination rules are not
violated
Sponsorship & Participation
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12. A “qualified benefit”: does not defer compensation and is excludable from gross income under Code
Qualified Benefits include:
• Health Plan premiums
• Dental Plan premiums
• Vision Plan premiums
• AD&D premiums
• Disability Premiums
• DCAPs
Source: Code §125(f), IRS Reg.§1.125-1, Q&A-5, IRS Reg §1.125-2, Q&A-4.
Qualified Benefits
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• Health FSAs
• Group Term Life Insurance premiums
• Paid Vacation Days
• 401(k) Salary Deferrals
• Adoption Assistance Benefits
• Retiree Group Term Life premiums
13. The following benefits are not “qualified benefits” that may be offered through a cafeteria plan:
• Educational Assistance
• Qualified Scholarships and Fellowships
• Qualified Tuition Reductions
• No Additional Cost Services
• Qualified Employee Discounts
• Working Condition Fringe Benefits
• Transportation Fringe Benefits
Qualified Benefits
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• Qualified Moving Expense Reimbursements
• On Premises Gyms/Athletic Facilities
• Meals and Lodging Furnished by Employer
• Dependent Group Term Life Insurance
• Medical Savings Accounts
• Long Term Care Insurance
• Benefits that Defer Compensation
14. Some benefits may or may not be includable in cafeteria plans:
• Individual Health Insurance Policies,
• Hospital Indemnity and Cancer Insurance Policies,
• Health Insurance Coverage for Domestic Partners
Qualified Benefits
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15. • Employee Contributions
• Post & Pre-Tax
• Non-Elective Employer Contributions
• Opt-Out and Cash-Out Provisions
Cafeteria Plan Contributions
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16. • Employee agrees to reduce salary on a pre-tax basis to pay for benefits under
the plan
• Such contributions are considered employer contributions for tax purposes
(from the IRS view)
• The employee gives up the right to the amount of salary reduced before
becoming entitled to it thus avoiding constructive receipt
• This arrangement allows an employee to pay for coverage in a tax-advantaged
manner
Source Code §125(a), IRS Reg. §1.125-1, Q&A-1, IRS Reg. §1.125-2, Q&A-2
Employee Contributions
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17. • Contingent Contributions
• Matching Contributions
• Flex Credits
• Variations
Non-Elective Employer Contributions
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18. Plan document must contain procedures describing the election period:
• Period during which elections can be made
• Period for which elections are effective
Note: Plan does not have to allow election changes
In general, elections must be:
• Made in advance before the beginning of the period of coverage
• Irrevocable
• Made on a prospective basis
Source: Code §125(d)(2), IRS Reg. §1.125-1, Q&A-7, IRS Reg.§1.125-2, Q&A-5.
When must elections be made?
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19. • Annual open enrollment-needs to be occur before the first day of the
subsequent plan year
• Enrollment periods for new hires
• Special mid year elections
When must elections be made?
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20. • General Irrevocability Rule
• 14 Events that are Recognized by the IRS as Permitting Mid-Year Election
Changes
• Other Events That Might Permit Mid-Year Election Changes
• Administrative Requirements To Implement A Mid-Year Election Change
Source: Code §125(d)(2), IRS Reg. §1.125-1, Q&A-6, 8, and 15, IRS §1.125-2, Q&A-6
Mid-Year Election Changes
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21. • Change in status
• Cost changes with automatic increases or decreases
• Significant cost changes
• Significant coverage curtailment (with or without loss of coverage)
• Addition or significant improvement of benefit package options
• Change in coverage under another employer’s plan
• Loss of coverage under group health plan of governmental or
educational institution
• HIPAA special events
Events that Permit Mid-Year Election Changes
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• COBRA qualifying events
• Judgments, decrees or orders
• Entitlement to Medicare or Medicaid
• FMLA leaves of absence
• Enrollment in the Marketplace
• Reduction of hours
23. • A program that provides coverage under which eligible health care, dependent care and adoption
expenses may be reimbursed
• Subject to maximums and reasonable conditions set by IRS regulations and plan provisions
• Employees pay pre-tax salary reductions into a flexible spending account
• Employees receive reimbursement for certain qualified eligible expenses from their flexible spending
account
• Remember the “Use it or Lose It Rule”
What is a Flexible Spending Account?
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24. • Health Care FSA – Reimburses eligible medical, dental and/or vision care
expenses not reimbursable elsewhere
• Dependent Care FSA – Reimburses eligible child care or elder care expenses
• Adoption Assistance FSA – Reimburses eligible adoption expenses (less
common, reimbursements subject to Social Security and Medicare taxes)
Types of Flexible Spending Accounts
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25. • Considered a self-insured medical reimbursement plan - Code Sections 105
and 106 apply
• Considered a group health plan subject to COBRA and HIPAA
• Considered an employee welfare benefit plan - ERISA applies
• Subject to nondiscrimination rules - IRC Section 105(h)
Legal Framework for Health Care FSAs
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26. • There is a coverage period usually 12 months (often calendar year to coincide
with income taxes)
• During coverage period, pre-tax salary reductions are taken from the
employees pay check and are credited to the FSA
• Participant submits claims for reimbursement of incurred eligible health care
expenses
How Healthcare FSAs Work
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27. • Must be elected prior to effective date of coverage period
• Elections are generally irrevocable
• Cafeteria plan mid-year election rules apply so generally a change in status is
required to change an election
• Plan documents can be more restrictive that than the regulations
Healthcare FSA Elections
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28. • General irrevocability rule - no change required for the plan year
• 5 events are recognized by the IRS as permitting mid-year election changes for health FSAs
• Other events are recognized permitting mid-year election changes
• Administrative requirements that must be met to implement a mid-year election change
• 5 Events for Mid-Year Election Changes:
Change in status
COBRA qualifying events
Judgments, decrees or orders
Entitlement to Medicare or Medicaid
FMLA leaves of absence
Mid-Year Election Changes
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29. • Must be an eligible expense under a written accident or health plan
• Must be for health care (medical, dental or vision)
• Must be incurred during the coverage period
• Must be incurred by covered employee, spouse or eligible dependent
• May not include any expense for which employee actually claims a federal
income tax deduction
• Expenses can not be reimbursable from another source
• Reimbursement of insurance premiums is prohibited
• There must be adequate claims substantiation
Legal Requirements for Eligible Expenses
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30. • Office visit to doctor to treat illness or injury
• Prescription drugs (OTC drugs cannot)
• Hospital room and board
• Surgery
• Covered dental treatment
• Eye exams, eye glasses, contact lenses, if medically necessary and prescribed by
doctor
• There are many others - IRS Publication 502 lists medical services and equipment that
are generally eligible. There are exceptions
• Must not be reimbursable elsewhere
Examples of Eligible Expenses
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31. • Cosmetic treatments
• Illegal operations or treatments
• Qualified long term care services
• Insurance premiums
Examples of Services that Are Not Eligible
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32. Unused salary reductions can not be carried over to the next plan year
• An employee will lose salary reduction contributions that are not submitted for reimbursement
• IRS does not impose any taxes on forfeited employee contributions
• Plan document determines how employer may use forfeited contributions
• Most plans allow a short “run-out” period for submitting expenses from the previous year
Forfeitures from participants’ health and/or dependent care FSAs may be:
• retained by the employer
• used to defray administrative expenses
• used to reduce salary reduction contributions for the next year on a “reasonable and uniform basis”
• returned to employees on a “reasonable and uniform basis,” consistent with detailed requirements
included in the proposed rules
“Use It or Lose It” Rule
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33. Carryover and Grace Period Rule
• It modifies the “use-it-or-lose-it" rule for “qualified benefits” under a cafeteria plan
• An employer may amend its cafeteria plan document to provide for a grace period of up to 2-1/2
months immediately following the end of each plan year to use amounts deferred in the
previous plan year but remain unspent or allow the carryover of up to $500 to the next plan
year
Uniform Coverage Rule
• At any time during the coverage period, the participant must be allowed withdraw the entire
amount
• If the participant does not have sufficient amount to cover the withdraw, the employer must still
reimbursement the amounts
Additional Rules
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34. Health FSA claims must be substantiated with two items:
• a written statement from an independent third party providing that the medical expense has been incurred
and the amount of the expense
• a written statement from the participant providing that the medical expense has not been reimbursed and
that the participant will not seek reimbursement from any other health plan coverage
Third party statement
• Requirement:
Verifies that the expense has incurred
Ensures that advance reimbursements of future or projected expenses is not made
• Originals or copies, faxes or scanned copies or originals should satisfy requirement.
• Credit card receipts or canceled checks do not satisfy requirement
Claim Substantiation
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35. Participant Statement
• It must provide:
the expense has not been reimbursed
the employee will not seek reimbursement under any other plan covering health benefits
the expense was incurred for the participant or an eligible dependent
• Language should be added to new and annual enrollment forms
• Must obtained contemporaneously with or after the expense has been incurred
Claim Substantiation
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36. • For 2017 annual contributions limit for salary reduction contributions is $2,600
per plan year per employer and $2,650 for 2018
• Maximum contribution limits should be carefully observed to ensure that
participants are treated on a uniform and consistent basis
• The minimum amount a participant can submit for reimbursement - $50
• Reimbursement minimum should be specified in the plan document
Plan Limits on Annual Contributions and Reimbursement Amounts
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37. Dependent Care Plans
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38. • Salary reduction plan permitted under Code §129
• Not considered an ERISA welfare plan
• Also considered a flexible spending account under Code §129
• Needs to comply with Code §125 requirements
• Basic Requirements:
Plan terms must be in writing
Must be for the exclusive benefit of employees
Purpose must be to provide employees with dependent care assistance
Reimbursement must be for employment related expenses
Does not need to be funded
Must meet applicable non-discrimination rules
DCAP Plans
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39. • Subject to “Use it or Lose it Rule” Remember “grace Period changes
• Unlike a health FSA, a DCAP is not subject to the “uniform coverage” rule
• COBRA does not apply, but employer may allow employee to continue to the end of the year
• Expenses must be “employment related”
• Expense must be for one or more qualified individuals
• Care provided must be for the “well being and protection” of the qualified individual
• All rules applicable to health FSAs apply to DCAP reimbursement except the “uniform coverage”
requirement and COBRA
• Some of the reimbursable expenses under a DCAP:
Babysitter inside or outside your home
Day camp for school age children during vacation
Day care center that meets state and local regulations
What Expenses are Reimbursed Under a DCAP?
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Eldercare for a dependent provided they
spend at least 8 hours inside your home
Sick child care facility
40. Some of the expenses that cannot be reimbursed under a DCAP:
• Expenses due to unpaid or volunteer work
• Payments made to an employee’s child under age 19
• Day care center that does not comply with local and state requirements
• Educational expenses for kindergarten or above
• Expenses for overnight camp
• Incidental expense billed separately from dependent care expenses
What Expenses Are Not Reimbursed Under a DCAP?
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41. Employers are allowed to reimburse for what they believe are “reasonable
expenses”
DCAP reimbursement claims require the following:
• Written statement from independent third party
• Statement must indicate the amount of the expenses
• Written certification by the participant that the expense has not reimbursed by
another plan
• The name, address, and tax id of the provider should be included on the
statement
Claim Substantiation
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42. • Under Code §129 the maximum amount is the lesser of $5000 if married and
filing jointly and $2,500 if married and filing separately or a single parent
• If annual earned income is less than the above the earned income becomes the
maximum
• Employers should make employees aware of the annual maximum in all
employee communication material
• Employers are not responsible if a married couple violates by the annual
maximum by “double dipping” in their respective plans
What Are the Annual Plan Maximums?
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43. • In general, elections are irrevocable
• Mid-year election rules apply
• Election changes, especially the “significant cost rule”, are less stringent than
health FSA rules
• Some Election Changes do not apply
• Some mid-year changes are not allowed to avoid “double dipping”
What Election Changes Are Allowed During the Plan Year?
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45. • Provided in Rev. Ruling 2002-41 and IRS Notice 2002-45
• Considered an employee welfare benefit plan under ERISA
• Considered an employer sponsored self-funded health plan subject to IRC 105(h)
• Are financed by the employers (no pre-tax salary reduction contributions)
• Reimburse participants for medical expenses up to a maximum dollar amount for any
plan year
• Allow unused amounts to be carried forward to the next plan year
• Reimburse participants for medical expenses
• Can be used with high-deductible group health plans
What is an HRA?
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46. • Employer controls what medical expenses are reimbursed
• Employer controls the amount of the reimbursement each year
• HRAs can be used to provide retiree medical benefits
• Employer can reimburse premiums or just expenses
• Employees can lose right to receive reimburse once leave employment unless
elect COBRA
Why would an employer consider establishing an HRA?
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47. • Plan Document
• Enrollment form
• Summary Plan Description (SPD)
• Expense Reimbursement Form
• Form 5500, if required
• Summary of Benefits and Coverage
• Summary Annual Report (if required to file Form 5500)
What documents are needed to establish them?
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48. • Yes, To reimburse medial expenses or premiums, the HRA must be integrated with a group health plan an
insured health plan
• An employer can designate which expenses it will reimburse under the HRA
• No group health plans is needed for reimbursing dental, vision and retiree expenses or premiums
• Two integration methods are provided
• First method is with a group health plan that does not provide minimum value
• Second method is with group health plan that provides minimum value
• For expenses or premiums to be reimbursed, dependents must be covered by group health plan of the
employer or spouse’s employer.
• Employees (and former employees) must be offered the opportunity to permanently opt-out of and waive
future reimbursements from the HRA at least annually.
• And on termination of employment, the HRA must either be forfeited or it must allow the employee to
permanently opt out and waive future reimbursements.
Does an HRA have to be used with a group health plan?
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49. • The employer determines which employees will participate in the plan
• An employer may exclude any employee as long as the plan passes the
nondiscrimination tests of Code §105(h)
• Self-employed individuals, partners and more than 2% shareholders of a S
Corporation may not participate
Who is Eligible to Make or Receive Contributions?
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50. Yes, HRAs are considered a self-funded welfare plan and must meet all of the
ERISA requirements:
• Written plan requirement
• Trust requirement, if HRA is funded
• Claims procedures
• Reporting and Disclosure
• Fiduciary requirements
Must the ERISA requirements be met?
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51. Can an employee participate in an Health FSA in the same month?
• Yes, it is possible
• FSA and HRA cannot reimburse the same medical expense
• If expense can be covered by both, plan must specify that FSA must be exhausted first
• If plan does not specify, HRA must be exhausted first
• Employer may designate only certain expenses can be reimbursed by HRA
Do the Health FSA rules apply to HRAs?
• No, because HRAs contain only employer contributions
• Use-it- or-lose rule does not apply
• Uniform coverage rules does not apply
Other Questions
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52. What contributions are permitted and how are they treated for tax purposes?
• Reimburse participants for medical premiums or expenses up to a maximum dollar amount specified by
the employer for any plan year.
• Reimburse participants for all eligible medical expenses or only those specified by the employer.
• Any contributions to HRA are deductible by the employer and any reimbursements for expenses are not
taxable to the employees.
What expenses can be reimbursed?
• The Plan can reimburse medical expenses and/or premiums.
• Employer can reimburse any medical expense under Code § 213(d) or just those expenses it specifies in
the plan.
• Can include dental, vision, prescription drug and preventive care expenses.
Other Questions
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53. Can HRAs reimburse premiums for individual coverage?
• No. HRAs are prohibited after 2013.
• HRAs of small employers given relief until the end of 2016.
• Certain small employers will be allowed under a qualified small employer HRA.
Can unused amounts be carried to future years?
• Yes, an employer may allow carryover, but is not required to do so.
• Employer may specify the carryover amount and period.
• Any amount allowed to be carried over will be considered an expense on the
employer’s balance sheet.
Other Questions
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54. Once contributions are made, can they be forfeited?
• Yes, an employer may specify events in which the employee loses the right to continue
to use any amounts set aside in an HRA.
• An employer can provide that amounts will be available after termination of
employment or death.
• Employee can continue to use HRA if he or she elects COBRA.
Must benefits be funded?
• No. The DOL has not required employers to fund contributions that are promised.
• They can be paid from the employer’s general assets.
Other Questions
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55. • Under Code §105(h), a plan is discriminatory for eligibility unless it benefits:
70 percent or more of all employees
80 percent of employees eligible to benefit, as long as 70 percent or more employees are eligible to
benefit under the plan
a nondiscriminatory classification of employees
• An HRA is discriminatory for benefits if the type and amount of benefits available to highly
compensated participants are not also available on the same basis to other participants.
• The comparison is based on benefits subject to reimbursement, rather than actual benefit
payments or reimbursements under the plan, and on dollar amounts, rather than percentages
of pay.
• These nondiscrimination rules do not apply to retiree benefits if certain conditions are met.
Are there any nondiscrimination rules?
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56. When can distributions be made?
• An employer decides when establishing the plan:
What medical expenses or premiums may be reimbursed under the plan
When reimbursements will be made
Whether any contributions will be made available for reimbursements in future years
Under what circumstance employees will lose the right to receive reimbursement
Who substantiates if paid for medical expenses?
• The employee submits claims to the employer or to a TPA selected by the employer.
• Procedures for submitting claims similar to procedures under a Health FSAs.
Other Questions
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57. • What happens to an individual’s HRA upon his or her death?
The employer may design a plan to allow a deceased employee’s spouse and other dependents to continue
participation in the plan without electing COBRA.
If not, COBRA will be available to spouse and other dependents.
• May the employer place any restrictions on the withdrawals?
Yes. An employer may place restrictions on what expenses will be reimbursed, the amount of the reimbursement and
when the reimbursement will be made.
• Does COBRA apply?
Yes HRAs are subject to COBRA requirements.
Qualified beneficiaries will have access to unspent HRA balance and will be entitled to additional HRA accruals that
active employees receive.
Each qualified beneficiary will have an independent right under COBRA to continue coverage that was available
immediately preceding the qualifying event.
Other Questions
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58. • How is the COBRA premium determined?
The premium must be actuarially determined or, alternatively, the applicable premium may be determined by using a
“past-cost” method.
A plan is permitted to charge a qualified beneficiary up to 102% of the applicable premium.
• When electing COBRA, must the employee be given a separate election?
It will depend on whether an employee has to participate in the HRA to participate in the group health plan.
An employer can provide a separate election.
• What reporting is required?
They are subject to the ERISA reporting requirements.
Subject Form 5500 requirements- exempt if unfunded and have under 100 participants.
Must provide and Form 1095-C if plan is not integrated with a group health plan of the employer.
Section 111 Reporting -$5,000 or more
Other Questions
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59. What disclosures are required to participants?
• Separate SPD
• Separate SBC
• Employees (and former employees) must be offered the opportunity to permanently opt-out of and waive
future reimbursements from the HRA at least annually.
Why would an employer participate in an HRA?
• An employer has complete control in:
what medical expenses will be reimbursed
what unused amounts will be carried over
for what period of time unused amounts will be carried over
• An employer can decide from year to year what amounts they will contribute.
• HRAs can work with Health FSAs.
Why would an employer participate in an HRA?
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60. • ERISA requirements will still apply
• Nondiscrimination requirements apply
• Claim substantiation is still required
• Possible funding issues
• May reduce savings in going to higher deductible health plan
• COBRA application
Why would an employer not participate in an HRA?
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61. Qualified Small Employer HRA
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62. Effective Date
• Employers may adopt this HRA plan design starting with plan years that begin
on or after January 1, 2017
Eligible Employers
• For an employer to qualify to offer this plan design, an employer must:
Employ less than 50 full time employees and full time equivalent employees This
determined in the previous calendar year
Not offer a group health plan
Offer the HRA on the same terms to all eligible employees
Qualified Small Employer HRA
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63. • Excludible Employees
Employers may design this plan to exclude certain employees from participating:
• Part-time and seasonal employees
• Employees under age 25
• Union employees
• Certain non resident aliens
• Reimbursement Limit
$4,950 for 2017, $5,050 for 2017 for single
$10,000 for 2017 is $10,250 for 2018 for family per plan year
• Proration of Limit
It is prorated for those employees who work part of the year or short plan year.
Qualified Small Employer HRA
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64. Reimbursable expenses
• The plan may be designed to reimburse for all Section 213(d) medical expenses and/or
individual health insurance premiums.
Condition to receive tax-free reimbursements
• An employee must show proof that they are covered under a minimum essential health plan
when enrolling.
• After enrollment, the employee must provide the following as proof of continued coverage in
order to receive tax-free reimbursement:
Explanation of Benefits (EOB) for S213(d) medical expenses
Monthly Premium bill for Individual health insurance premium expenses
• Participants may be taxed on their reimbursements if the participant is not covered by their
minimum essential coverage for any month during the plan year.
Qualified Small Employer HRA
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65. • An employer must provide an annual written notice 90 days in advance of the plan year or the
employee’s initial eligibility date.
• This notice must be provided to all eligible employees.
• The notice must contain:
The amount of HRA benefit available
Instruct employees to provide the amount of HRA benefit available to the public exchange if the
employee is applying for a premium tax credit
Benefits for plan year could be prorated if participate in plan less than 12 months
Warn employees that their reimbursements may be taxable if the employee does not have minimum
essential coverage for any month
• Failure to provide this notice can trigger a penalty of $50 per employee, up to $2500 per year.
Notice Requirement
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66. The HRA’s benefit amount must be reported on the employee’s W-2.
This HRA is not subject to COBRA.
Other matters
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67. Health Savings Accounts (HSAs)
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68. What is an HSA?
• Tax-exempt trust or custodial accounts created exclusively to pay for the qualified medical
expenses of the account holder and his or her spouse and/or dependents
Source: Code §223
Can an HSA be outside employment relationship?
• Yes. Individuals can set up a HSA on their own or through an employer
• Must still meet statutory requirements:
Trust or custodial account
Participate in a high deductible health plan
Meet contribution limits
Health Savings Accounts
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69. • Eligible individuals are those employees who are covered only by a high-deductible health plan
• Individuals enrolled in Medicare are not eligible to make contributions to an HSA
• Eligibility is determined on a month by month basis
• An individual who is covered under:
a spouse’s or dependent’s employer’s health plan
a comprehensive major medical individual insurance policy
a health FSA or HRA unless coverage under such HRA or FSA is limited to “permitted benefits” or specific benefits
not provided by the high-deductible health plan
Can an individual covered under “other coverage” still be eligible?
• Yes. If individual is eligible for other “permitted coverage” or “permitted insurance” in addition to a high
deductible health plan, they can still be eligible to make or receive a contribution to an HSA
Who is not eligible to make or receive contributions?
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70. • Worker’s Compensation
• Automobile Insurance
• Insurance for a specified disease or illness.
• Insurance that pays a fixed amount per day of hospitalization
• Coverage for accident, disability, dental, vision and long-term care
What is permitted coverage or insurance?
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71. Can first dollar preventative care be included in a high-deductible plan?
• Yes. This is permissible under a HDHP
• Preventative care is defined as including the following:
Periodic health evaluations
Routine prenatal and well-child care
Child and adult immunizations
Tobacco cessation programs
Obesity weight-loss programs
Certain screenings
Can first dollar prescription drug coverage be provided?
• No - Notice 2004-28 - No coverage below deductible limits provided under a HDHP
First Dollar Coverage
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72. • No, unless expenses under FSA and/or HRA are limited to dental, vision and/or
preventive care benefits (“Limited Purpose Health FSA or HRA”)
• If an employee suspends participation in a HRA for the year (Suspended HRA”)
• FSA or HRA pays expenses above the deductible of the HDHP (“Post-
Deductible Health FSA or HRA”)
• HRA pays or reimburses expenses incurred after retirement (“Retirement
HRA”)
• Provided in Revenue Ruling 2004-45
Can an employee participate in a FSA/HRA and HSA in the same year?
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73. A health plan that in the case of individual coverage has an annual deductible is
at least $1,300 for 2017 and $1350 for 2018 and in the case of family coverage
has an annual deductible of $2,600 for 2017 and $2,700 for 2018
Maximum out-of-pocket expense limit on covered expenses can not exceed
$6,550 for 2017 and $6,650 for 2018 in the case of individual coverage and
$13,100 for 2017 and $13,300 for 2018 in the case of family coverage. Out-of-
pocket expenses include deductibles, co-payments, and other amounts (other
than premiums) that the individual must pay for covered benefits under the plan.
What is a “High Deductible Health Plan”?
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74. • Employee Contributions: Contributions are deductible (within limits) in
determining adjusted gross income.
• Employer Contributions: These contributions (including salary reduction
contributions made through a cafeteria plan) are excludable from gross income
and wages for employment tax purposes to the extent the contribution would be
deductible if made by the employee.
• Other Contributions: Contributions may be made by family members and other
third parties. These contributions are deductible by the eligible individual to the
extent the contributions would be deductible if made by the individual.
What contributions are permitted and how are they treated for tax purposes?
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75. • Yes They are treated as employer contributions and are excluded from the
employee’s income
• Code Section 125 has been amended to allow HSAs to be offered under
cafeteria plans
• These contributions are not subject to:
the "use or lose it rule"
the "uniform coverage rule”
the mandatory 12 month period of coverage requirement
Note, a health FSA may allow a participant who makes HSA contributions to start or stop his or her election
and to increase or decrease his or her election at any time. All of the other cafeteria plan rules would apply.
Can salary deferral contributions be made?
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76. • The maximum aggregate annual contribution that an individual can make to a
HSA is $3,400 for 2017 and $3,450 for 2018 in the case of individual coverage
and $6,750 for 2017 and $6,900 for 2018 in the case of family coverage.
• Annual contribution limits for individuals who have attained age 55 by the end of
the taxable year is $1,000 in 2009 and thereafter.
• Contributions, including catch-up contributions, cannot be made once an
individual is enrolled in Medicare.
What are the limits for contributions?
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77. • Any contributions exceeding the limits are not deductible.
• Contributions made by an employer over the limits are included in the
employee’s income.
• Excise tax applies to contributions in excess of the maximum contribution
amount. The excise tax is generally equal to 6% of the cumulative amount of
excess contributions that are not distributed from the HSA to the contributor.
• If the excess contributions for a taxable year and the net income are paid to the
individual before the due date of tax return (including extensions) for filing, then
the net income is included in the individual’s gross income for the taxable year
in which the distribution is received but the excise tax is not imposed on the
excess contribution and the distribution of the excess contributions is not taxed.
What happens if the limits are exceeded for any year?
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78. • When must contributions be made for any year?
By the due date of the individual’s tax return (excluding extensions)
• Are there any nondiscrimination rules?
Yes. If an employer makes contributions to employees’ HSAs, the employer must make available
comparable contributions (e.g. same amount or the same percentage of deductible) on behalf of all
employees with comparable coverage during the same period (e.g. single/family).
The comparability rule may apply separately to part-time employees (i.e., employees who are
customarily employed for fewer than 30 hours per week). The comparability rule does not apply to
amounts transferred from an employee’s HSA, health FSA, or MSA or to HSA contributions made
through a cafeteria plan.
• What happens if an employer does not comply with the above comparability rule?
The employer is subject to an excise tax equal to 35% of the aggregate amount contributed by the
employer to HSAs of the employer for that period.
Health Savings Accounts
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79. • Distributions for qualified medical expenses of the individual and his or her spouse or dependents
generally are excludable from gross income.
• Amounts in a HSA can be used for qualified medical expenses even if the individual is not currently eligible
for contributions to the HSA.
• Qualified medical expenses generally are defined as under Code § 213(d) and include expenses for
diagnosis, cure, mitigation, treatment, or prevention of disease, including prescription drugs, transportation
primarily for and essential to such care, and qualified long term care expenses.
• General rule is health insurance premiums cannot be paid from HSA. Exceptions are long-term care,
COBRA, Medicare Part A and B, Medicare HMOs, and employer-sponsored health insurance.
• Distributions from a HSA that are not for qualified medical expenses are includible in gross income.
• These taxable distributions are also subject to an additional 10% tax unless made after death, disability, or
the individual attains the age of Medicare eligibility (i.e., age 65).
When can distributions be made?
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80. Who substantiates that if paid for medical expenses?
• It is the individual participant because he or she claims treatment on Form 1040
• Trustee or custodian is not permitted to substantiate claims
• The employer is not permitted to substantiate
What happens to an individuals HSA upon his or her death?
• Any balance remaining in the decedent’s HSA is includible in his or her gross estate.
• If the HSA holder’s surviving spouse is the named beneficiary of the HSA, then, after the death of the HSA
holder, the HSA becomes the HSA of the surviving spouse and the amount of the HSA balance may be
deducted in computing the decedent's taxable estate, pursuant to the estate tax marital deduction.
• If, upon death, the HSA passes to a named beneficiary other than the decedent’s surviving spouse, the
HSA ceases to be a HSA as of the date of the decedent's death, and the beneficiary is required to include
the fair market value of HSA assets as of the date of death in gross income for the taxable year that
includes the date of death.
Other Questions
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81. Company Background - Services
81
Eligibility
Enrollment
Integration
Self Service
Communications
EE Call Center
Decision Support
Retiree H&W Admin.
COBRA
Direct Billing
Total Rewards
Reimbursements (HSA / FSA)
Commuter Benefits
Dependent Verifications
ACA & Other Compliance Svc.
We help participants understand and use
their benefits wisely so that they can be
accountable for their healthcare.
We enable you, as the plan sponsor, to
enable and deliver your benefits strategy.
benefit wise. relationship driven.
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82. Company Background – Book of Business
82
Clients & Services Supported
226
Administration Participants 1,500,000+
3,952Technology Clients
Reimbursement / COBRA clients 187
Average client size - participants 4,100
Mid/Large Administration clients
ACA 1095 Forms Generated 250,000
250 employees serving our clients from two services
center; Schaumburg, IL and Rancho Cordova, CA.
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83. Some of Our Partners
83Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC
85. Contact Information
85
Larry Grudzien
Attorney at Law
(708) 717-9638
larry@larrygrudzien.com
www.larrygrudzien.com
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