Health & Welfare

Agencies Release FAQs on Updated 2021 Summary of Benefits and Coverage Template

HHS, DOL and IRS (collectively, the "Agencies") have released FAQs discussing the recently updated version of the Summary of Benefits and Coverage ("SBC") template and related materials (i.e., instructions, coverage examples guides and narratives, and the optional SBC Coverage Examples Calculator) to be used by group health plans and health insurers beginning in 2021.

Cafeteria Plan Need Not Provide Mid-Year Election Changes

The IRS has reiterated, in IRS Information Letter 2019-0028, that while a Section 125 cafeteria plan may allow participants to make a mid-year pre-tax contribution election change because of the occurrence of certain events (informally called change in status or qualifying events), the plan is not required to make this option available.

New Laws Impact ACA and Employer-Sponsored Health Plans

President Trump has signed into law a spending package which includes the Further Consolidated Appropriations Act, (the "Act"), and contains a number of provisions related to employer-sponsored group health plans and the Affordable Care Act ("ACA"). Below is a summary of the key provisions found in the Act:

Federal Circuit Court Determines ACA's Individual Mandate is Unconstitutional

The Fifth Circuit Court of Appeals, in Texas v. United States, has upheld a district court ruling that the individual mandate provision of the Affordable Care Act ("ACA") is unconstitutional. However, the Fifth Circuit has sent the case back to the district court for it to reconsider how much of the remainder of the ACA should also be invalidated.

IRS Issues Qs&As on the ACA's Individual Shared Responsibility Provisions

The IRS has issued a set of Qs&As explaining the Individual Shared Responsibility provisions of the ACA after the elimination of the individual shared responsibility penalty.

IRS Extends Deadline for ALEs to Furnish ACA Reporting Forms to Employees

The IRS has issued Notice 2019-63, which provides an automatic deadline extension for Applicable Large Employers' ("ALEs") reporting obligations under the Affordable Care Act's ("ACA"s) Employer Mandate for the 2019 tax year.

IRS Releases 2020 Limits for Welfare Benefit Plans: Health FSA and HSA Limits Increase

The IRS has released the 2020 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination tests.

IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules

The IRS has issued proposed regulations to clarify the application of the ACA's employer shared responsibility provisions under Section 4980H of the Internal Revenue Code (the "Code") and certain nondiscrimination rules for self-funded plans under Code Section 105(h) to Individual Coverage Health Reimbursement Arrangements ("ICHRAs"). Background. The ACA's employer shared responsibility ...

Genetic Testing May Include Medical Expenses

The IRS has ruled, in Private Letter Ruling 201933005, that portions of the cost of a genetic testing service may be considered medical expenses and may, therefore, be reimbursed by a health care Flexible Spending Account ("FSA"). An employee purchased a private company's DNA ancestry and health testing services and submitted his DNA sample. His DNA sample was then tested and the company provided ...

Agencies Issue Final FAQs on Mental Health Parity Implementation

HHS, DOL and IRS have issued final FAQs on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act ("MHPAEA"). The MHPAEA requires that the financial requirements (e.g., coinsurance and copays) and treatment limitations (e.g., visit limits) imposed on mental health or substance use disorder ("MH/SUD") benefits cannot be more restrictive than the predominant ...