Posts Categorized: Health Benefits

Proposed Rules for Expatriate Health Plan and Certain Excepted Benefits under ACA

in Affordable Care Act, Health Benefits

Newly proposed regulations address the application of the Affordable Care Act to expatriate health plans (whether insured or self-insured), travel insurance and certain other excepted benefits, effective for plan years beginning on and after January 1, 2017.  These regulations include proposed conforming amendments relating to the Expatriate Health Coverage Clarification Act of 2014 (EHCCA) which generally exempts expatriate health plans from many of the ACA requirements.  The proposed rules mainly reflect prior guidance as well as the requirements of EHCCA. It is important to remember that expatriates may still be subject to the individual mandate (but these plans may qualify… Continue Reading

Certain Mental Health/Substance Abuse Plan Provisions Raise Red Flags

in Health Benefits, Wellness Programs

The Department of Labor has provided sample mental health/substance abuse (MH/SA) plan provisions that require scrutiny to determine compliance with the federal Mental Health Parity rules (MHPAEA).  Here are some common red flags: Pre-Authorization or Pre-Service Notification requirements – Blanket requirements for all MH/SA services – Review required following a certain number of days of in-patient treatment – Medical necessity and prescription drug reviews that differ from those imposed on medical services (such as deferring to attending physicians for medical reviews but not MH/SA or requiring authorization every 90 days for prescriptions relating to MH benefits but not medical) –… Continue Reading

Reminder: Cash Rewards for Participating in a Wellness Program are Taxable

in Health Benefits, Tax Issues, Wellness Programs

The IRS Office of Chief Counsel has released a memorandum (Number 201622031) confirming that the following rewards and incentives result in additional taxable wages to the employee: – Cash rewards payable to an employee for participating in a wellness program (such as a program providing health screening); – The value of certain fringe benefits, such as gym memberships, for participating in a wellness program; and – Reimbursements of premiums for participating in a wellness program when the premiums were originally paid pre-tax through a cafeteria plan (this is similar to the issue previously addressed in Revenue Ruling 2002-3). Although the… Continue Reading

EEOC Issues Two Final Rules Regarding Employer Wellness Programs

in Health Benefits, Welfare Benefits, Wellness Programs

The EEOC issued two final rules today relating to wellness programs, as well as questions and answers, explaining how the ADA and Title II of GINA apply to employer wellness programs that request information from employees and their spouses.  These guidelines provide welcome direction to employers who have faced some uncertainty as to whether they could provide incentives for spouses who participate in their wellness programs and whether their wellness programs comply with the ADA. Here are links to these rules; more detailed information about the requirements of these new rules will be provided shortly. GINA Final Rules:  These FAQs… Continue Reading

Newly Released FAQs Address Health Plan Compliance Issues

in Affordable Care Act, Health Benefits

New FAQs (Part 31) have been issued highlighting various compliance issues and can be found at  The questions address a wide range of issues, including preventive care, coverage for clinical trials, required disclosures, the Women’s Health and Cancer Rights Act, rescissions, reference pricing and mental health parity requirements.  Here are a few highlights from these new FAQs: — Preventive care coverage, with no cost-sharing, includes coverage of bowel preparation medication prescribed for colonoscopies performed as screening procedures because the preparation is an integral part of the procedure. — When a plan uses reasonable medical management techniques in determining preventive… Continue Reading