Recently, the Centers for Disease Control and Prevention (CDC) announced updates to its mask-wearing recommendations, loosening guidance for a majority of the U.S. population. The agency now only recommends that individuals in high-risk areas wear a mask in indoor settings. Currently, around 70% of the U.S. population is in a low- or medium-risk county. As such, the CDC would no longer recommend that these individuals wear a mask indoors.
Category: News
New OTC COVID-19 Testing Coverage Guidance Published
The Departments of Labor (“DOL”), Health and Human Services (“HHS”), and the Treasury (collectively, “the Departments”) released additional guidance to assist group health plans in implementing the over-the-counter (“OTC”) COVID-19 testing coverage requirements previously discussed in FAQs Part 51. FAQs Part 52 were published on February 4, 2022, in response to stakeholder questions.
Briefly, the FAQs provide the following guidance:
- Group health plans have flexibility in establishing their direct coverage program.
- A plan will not be out of compliance with the direct coverage safe harbor because there is a temporary testing shortage, provided that the plan offers a direct coverage option.
- To prevent fraud and abuse, plans may limit reimbursements to established retailers and disallow the reimbursement of tests purchased from a private individual, online auction, or resale marketplace.
- The relief does not apply to COVID-19 OTC tests that are self-administered but require processing by a laboratory.
- If funds from a tax-advantaged account, such as an HSA or health FSA, are used to purchase an OTC test, these tests are not eligible for reimbursement from the health plan.
Additional Information
Q. Is there flexibility in how group health plans establish their direct coverage program to satisfy the requirements of the safe harbor in FAQs Part 51, Q2?
Yes, the guidance clarifies that group health plans will have significant flexibility in the design of their direct coverage program if the program provides adequate coverage through both a direct-to-consumer shipping mechanism and an in-person mechanism. Direct coverage for OTC COVID-19 tests means that a participant is not required to submit a claim to seek reimbursement from the plan for the purchase of the test. Instead, the plan makes systems and technology changes necessary to process the plan’s payment to the preferred pharmacy or retailer directly (including direct-to-consumer shipping programs) with no upfront out-of-pocket expenditure.
Regarding the direct-to-consumer shipping mechanism, this requirement can be met by:
- Any program which provides direct coverage of OTC COVID-19 test for enrollees in the health plan without the individual being required to purchase the test at an in-person location;
- Utilizing a pharmacy or other retailer’s online or telephone ordering system; and
- Paying all reasonable shipping costs and sales taxes in a manner consistent with how the plan covers other items supplied through mail order (for example, pharmacy benefits).
Adequate access to an in-person mechanism will depend on an examination of all relevant facts and circumstances. The guidance has clarified that such facts include:
- The locality of enrollees under the plan;
- Current utilization of the plan’s pharmacy network by enrollees (when utilizing the pharmacy network as part of the direct coverage option);
- How enrollees are notified of network retail locations; and
- Which tests are covered by the plan under the direct coverage option.
Plans are not required to provide coverage for all manufacturers of COVID-19 testing but may instead limit coverage to specific manufacturers that the plan has a contractual relationship with or from whom the plan is able to secure tests directly.
Q. Will a temporary testing supply shortage cause a plan to be out of compliance with the safe harbor in FAQs Part 51, Q2?
No, a plan will not be considered out of compliance due to a temporary testing supply shortage which impacts its ability to offer adequate coverage as long as the plan otherwise meets the requirements for the safe harbor.
Q. Is a plan permitted to address suspected fraud or abuse?
Yes. FAQs Part 51, Q4 specifically allowed for plans to address suspected fraud and abuse and this new guidance provides welcome suggestions on how this can be accomplished.
Plans are permitted to take reasonable steps to prevent and detect fraud and abuse by limiting reimbursements to tests purchased from established retailers and denying reimbursements for tests purchased from a private individual, online auction, or resale marketplace.
Plans may require documentation of the product and seller’s identity, such as:
- UPC codes;
- Serial numbers; or
- Original receipt.
If implementing such a limitation, the plan should communicate necessary information to the plan’s enrollees regarding retailers covered by the plan, as well as those tests or retailers which will be denied a reimbursement.
Q. Are COVID-19 tests which are self-administered, but require the sample to be sent to a laboratory for processing required to be covered by a plan pursuant to this guidance?
No. A test must be both self-administered and self-read (without the involvement of a healthcare provider) for a health plan to be required to cover it, pursuant to the requirements in FAQs Part 51. Importantly, a COVID-19 test which is not self-administered and/or not self-read but is prescribed by a physician and otherwise meets the requirements under the Families First Coronavirus Response Act (“FFCRA”) must be covered by the plan according to the FFCRA’s terms.
Q. How are health plan reimbursements affected by the usage of HSAs, health FSAs, and HRAs to initially purchase the tests?
While COVID-19 OTC tests are considered a qualified medical expense under the Internal Revenue Code, tests purchased from tax-advantaged accounts, such as HSAs, health FSAs, and HRAs, are not eligible for reimbursement by a health plan. IRS rules prevent an individual from being reimbursed more than once for the same medical expense (often referred to as “double dipping”).
Health plans may wish to notify enrollees not to utilize such tax-advantaged funds to purchase OTC COVID-19 test for which they will later seek reimbursement from the health plan.
Employer Action
Employers should:
- Discuss with carriers, TPAs, and PBMs how this new guidance affects any direct coverage options which have already been established.
- Communicate any limitations on OTC test points of sale.
- Consider notifying enrollees to avoid utilizing an HSA, health FSA, or HRA to purchase OTC COVID-19 tests that they wish the plan to later reimburse.
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
FAQs, Workplace Poster Issued for New California Supplemental Paid Sick Leave
The California Department of Industrial Relations has published answers to frequently asked questions and a poster employers must use in connection with the state’s new COVID-19 supplemental paid sick leave law. The law took effect Feb. 19, 2022, but it is retroactive to Jan. 1, 2022.
State Health Coverage Reporting Requirements for CY 2021
The IRS has made permanent an automatic 30-day extension to March 2, 2022 for furnishing Affordable Care Act Forms 1095-C (or 1095-B) to full-time employees and other individuals to demonstrate proof of health insurance coverage for each month in the 2021 calendar year.
The IRS has made permanent an automatic 30-day extension to March 2, 2022 for furnishing Affordable Care Act (“ACA”) Forms 1095-C (or 1095-B) to full-time employees and other individuals to demonstrate proof of health insurance coverage for each month in the 2021 calendar year (“CY”). Form 1094-C and all Forms 1095-C for the prior CY must be furnished to the IRS by March 31 each year (unless eligible for paper filing, then by February 28).
For ACA compliance, the IRS permits insurance carriers to post information on their website how plan members may access and receive a copy of the Form 1095-B in lieu of automatically mailing (or electronically issuing) statements to plan members. Insurance carriers must still prepare Forms 1095-B and file these forms with the IRS no later than March 31, 2022.
Currently five states (California, Massachusetts, New Jersey, Rhode Island, and Vermont) and the District of Columbia have enacted individual health insurance mandates with their own requirements for:
- furnishing information regarding health insurance coverage to residents of the state, and
- filing that information with certain state agencies.
These requirements and deadlines may (or may not) align with the federal requirements. Below is a chart summarizing the important deadlines related to 2021 coverage for employers with employees in individual mandate states. Some of these deadlines may change as states consider whether to extend relief similar to federal reporting.
| State | Deadline to Furnish Statements to Employee Residents | Deadline to File Statements with State Agency |
|---|---|---|
| California | January 31, 2022 | March 31, 2022. No penalties will be assessed if filed by May 31, 2022 |
| District of Columbia | March 2, 2022 | April 30, 2022 (30 days after federal deadline) |
| Massachusetts | January 31, 2022 | January 31, 2022 |
| New Jersey | March 2, 2022 | March 31, 2022 |
| Rhode Island | January 31, 2022 | March 31, 2022 |
| Vermont | N/A | N/A |
Important issues to consider regarding furnishing and issuing state-level MEC information are as follows:
- State residents: Employers with employees and other covered individuals residing in states with health coverage mandates should ensure the state-level health insurance distribution and state-level filing requirements are satisfied. Penalties may arise for late or incorrect filings with the state.
- Employers with fully insured plans: Carriers issuing policies in California, Massachusetts, New Jersey, and Rhode Island are generally obligated to issue health coverage statements to plan members residing in the respective state and to file the required health coverage information to that state agency. The District of Columbia also has reporting obligations for certain employers sponsoring fully insured plans. It is important to note that a carrier may not automatically furnish a member statement and file with a state agency for plan members residing outside of the policy issue/situs state.
- Employers with fully insured plans issued out-of-state: Employers should confirm that the carrier will adhere to the required state distribution and filing obligations for plan members that reside in a state with individual mandate reporting obligations.
- Employers with self-funded plans: Employers should confirm with their third-party administrator (“TPA”) or ACA form preparation vendor that the required state distribution and filing obligations for plan members that reside in a state with an individual mandate will be satisfied and whether any additional fees will be assessed.
Employer Action
Employers with employees and/or plan members residing in a state (and/or the District of Columbia) with individual mandate reporting requirements should confirm state individual mandate reporting requirements with their carrier, TPA or ACA vendor to ensure federal as well as state-level reporting obligations will be met.
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
Medicare Part D CMS Notification Reminder
Employers sponsoring a group health plan (whether insured or self-insured) need to report information on the creditable (or non-creditable) status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services. Employers with a calendar year plan must complete this reporting no later than Tuesday, March 1, 2022.
Employers sponsoring a group health plan (whether insured or self-insured) need to report information on the creditable (or non-creditable) status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). In order to provide this information, employers must access CMS’s online reporting system at:https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html.
As a reminder, notice must be provided by the following deadlines:
- Within 60 days after the beginning date of each plan year;
- Within 30 days after the termination of the prescription drug plan; and
- Within 30 days after any change in the creditable coverage status of the prescription drug plan.
For example, an employer with a calendar year plan (January 1 – December 31, 2022) must complete this reporting no later than Tuesday, March 1, 2022.
Additional guidance on completing the form is available at:https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosure.html.
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
Annual Out-of-Pocket Maximum Adjustments Announced for 2023
The Department of Health and Human Services published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023. The final rule includes caps on out-of-pocket dollar limits for non-grandfathered group health plans with plan years that begin in 2023.
On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”).
For purposes of employer-sponsored health plans, the final rule includes caps on out-of-pocket dollar limits for non-grandfathered group health plans with plan years that begin in 2023.
Change to the Out-of-Pocket Maximums
Under the final rule, non-grandfathered group medical plans will see an increase in the out-of-pocket maximum for plan years beginning on or after January 1, 2023 as follows:
- $9,100 for self-only coverage (up from $8,700 in 2022); and
- $18,200 for coverage other than self-only (up from $17,400 in 2022).
Note that different out-of-pocket limits apply to qualified high-deductible health plans, for purposes of making contributions to a health savings account (“HSA”). The 2023 HSA thresholds will likely be announced in June 2022.
Employer Action
Employers should update out-of-pocket limits for plan years beginning on or after January 1, 2023.
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
California Enacts Supplemental Paid Sick Leave for COVID-19
California has passed a new supplemental paid sick leave law requiring employers with more than 25 employees to provide up to 40 hours of paid leave for specific COVID-19-related reasons, and 40 additional hours if an employee or their family member tests positive for COVID-19. The law takes effect Feb. 19, 2022, but it is retroactive to Jan. 1, 2022. California previously had a similar law in effect that expired on Sept. 30, 2021
Additional Guidance Addresses ACA Preventive Care Mandate
The Departments issued guidance clarifying several Affordable Care Act preventive care coverage issues applicable to non-grandfathered group health plans.
As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying several Affordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans.
As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing.
FAQ 51 addresses preventive care requirements that relate to colonoscopies and coverage for female contraceptives as follows:
- Colonoscopy coverage. For plan years that begin on or after May 31, 2022, a group health plan (or carrier) must cover without any cost-sharing a follow-up colonoscopy conducted after a positive non-invasive stool-based screening test or direct visualization test (e.g., sigmoidoscopy, CT colonography).
- Contraceptives. The Departments have received a number of complaints and reports that covered individuals are being denied otherwise mandated contraceptive coverage. Examples include: denying brand name contraceptives when the provider determines the product is medically necessary for the individual, imposing onerous fail-first requirements before the plan will cover a medically necessary contraceptive product, and failing to provide an easily accessible, transparent and expedient exception process that is not unduly burdensome.
The Departments are reminding plans to comply with the contraceptive services coverage requirements. This includes the requirement that, if an individual and their attending provider determine that a particular service or FDA-approved, cleared, or granted contraceptive product is medically appropriate for the individual (whether or not the item or service is identified in the current FDA Birth Control Guide), the plan or issuer must cover that service or product without cost sharing.
The Departments are actively investigating complaints and may initiate enforcement or other corrective measures.
Employer Action
Employers should ensure their plans will comply with the additional coverage requirements for colonoscopies effective for plan years that begin on or after June 1, 2022. Plans should also review coverage of contraceptive services considering the Departments latest FAQ.
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
How to Pay Part A & Part B premiums
SOURCE: www.medicare.gov
Most people don’t get a premium bill from Medicare because they get their Medicare Part B (Medical Insurance) premium deducted automatically from their Social Security benefit payment (or Railroad Retirement Board benefit payment).
If you don’t get benefits from Social Security (or the Railroad Retirement Board), you’ll get a premium bill from Medicare. Get a sample of the Medicare bill.
| If you pay for: | You’ll get a bill: |
| Part B only | Every 3 months |
| Part A (Hospital Insurance) | Every month |
| Part D income-related monthly adjustment amount (Part D IRMAA) | Every month |
What if I get a premium bill from the Railroad Retirement Board?
Get more details if you’re a federal retiree. Get help paying premiums & costs
If you have limited income and resources, you may be able to get help from your state to pay your premiums and other costs, like deductibles, coinsurance, and copays. Learn more about help with Part A & Part B costs.
4 ways to pay your Medicare premium bill:
- Pay online through your secure Medicare account (fastest way to pay).
Log into (or create) your secure Medicare account to use this free service to pay by credit card, debit card, or from your checking or savings account.
How do I pay using my account?
Pay My Premium Now - Sign up for Medicare Easy Pay.
With this free service, we’ll automatically deduct your premium payments from your savings or checking account each month. Get details about Medicare Easy Pay. - Pay directly from your savings or checking account through your bank’s online bill payment service
Some banks charge a service fee. Get details so your payment goes through on time. - Mail your payment to Medicare.
Pay by check, money order, credit card, or debit card. Fill out the payment coupon at the bottom of your bill, and include it with your payment.- If you’re paying by credit or debit card, be sure to complete and sign the coupon. If you don’t sign the coupon, we can’t process your payment and it will be returned to you.
- Use the return envelope that came with your bill, and mail your Medicare payment coupon and payment to:Medicare Premium Collection Center
PO Box 790355
St. Louis, MO 63179-0355Include your payment coupon with your payment so we can apply your payment to your account. We can’t process your payment on time without the coupon. If you don’t have your payment coupon, write your Medicare Number on the check or money order.
When are Medicare premiums due?
All Medicare bills are due on the 25th of the month. In most cases, your premium is due the same month that you get the bill. Example of our billing timeline.
For your payment to be on time, we must get your payment by the due date on your bill. Submit your payment at least 5 business days before the due date, so we can get it on time.
What if your Medicare premium payment is late?
If you miss a payment, or if we get your payment late, your next bill will also include a past due amount.
If you get a Medicare premium bill that says “Delinquent Bill” at the top, pay the total amount due, or you’ll lose your Medicare coverage. Get a sample of the delinquent bill in English. [PDF, 2060 KB] (In Spanish.) [PDF, 2083 KB]Don’t risk losing your Medicare coverage
You can only sign up for Part A, Part B, and Part D at certain times. If you lose your coverage, you might have to wait to sign up again and pay monthly late enrollment penalties. How much are the penalties?
Talk to someone about your premium bill
For specific Medicare billing questions: Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
For questions about your Part A or Part B coverage: Call Social Security at 1-800-772-1213. TTY: 1-800-325-0778.
2022 Federal Poverty Guidelines Announced
The Department of Health & Human Services recently announced the 2022 Federal Poverty Level guidelines which, among other things, establish the FPL affordability safe harbor for purposes of the Affordable Care Act employer mandate.
The Department of Health & Human Services (“HHS”) recently announced the 2022 Federal Poverty Level (“FPL”) guidelines which, among other things, establish the FPL affordability safe harbor for purposes of the Affordable Care Act (“ACA”) employer mandate. For 2022, the FPL safe harbor is $108.83/month in the lower 48 states and DC, $136.06/month for Alaska, and $125.17/month for Hawaii.
As a reminder, a plan can use poverty guidelines in effect within 6 months before the first day of the plan year for purposes of using an affordability safe harbor. As the FPL guidelines were announced after the start of the calendar year, plans beginning on January 1, 2022 use $103.14/month for the lower 48 states and DC ($128.85/month for Alaska and $118.68/month for Hawaii), which is 9.61% of the applicable 2021 FPL. The increased threshold of $108.83/month for the lower 48 states and DC applies to plan years beginning on or after February 1, 2022.
Background and FPL Safe Harbor
Large employers may be subject to the employer mandate penalty under the ACA if they do not offer affordable, minimum value coverage to all full-time employees and at least one full-time employee receives a subsidy in the Marketplace. For affordability purposes, a large employer satisfies the FPL safe harbor with respect to an employee for a calendar month if the employee’s required contribution for the large employer’s lowest cost self-only coverage that provides minimum value does not exceed 9.5% (as indexed) of a monthly amount determined as the FPL for a single individual for the applicable calendar year, divided by 12.
2022 FPL Affordability Safe Harbor
For FPL affordability safe harbor purposes, the applicable FPL is the FPL for the state in which the employee is employed. The FPL is $13,590 for a single individual for every state (and Washington D.C.) except Alaska or Hawaii. So, if the employee’s required contribution for the calendar month for the lowest cost self-only coverage that provides minimum value is $108.83 (9.61% of $13,590/12, rounded down) or less, the employer meets the FPL affordability safe harbor.
Indexed Amounts
The following are the 2022 HHS poverty guidelines:
| 2022 Poverty Guidelines for the 48 Contiguous States and DC | |
| Persons in family/household | Poverty guideline |
|---|---|
| 1 | $13,590 |
| 2 | $18,310 |
| 3 | $23,030 |
| 4 | $27,750 |
| 5 | $32,470 |
| 6 | $37,190 |
| 7 | $41,910 |
| 8 | $46,630 |
| For families/households with more than 8 persons,add $4,720 for each additional person. |
| 2022 Poverty Guidelines for Alaska | |
| Persons in family/household | Poverty guideline |
|---|---|
| 1 | $16,990 |
| 2 | $22,890 |
| 3 | $28,790 |
| 4 | $34,690 |
| 5 | $40,590 |
| 6 | $46,490 |
| 7 | $52,390 |
| 8 | $58,290 |
| For families/households with more than 8 persons, add $5,900 for each additional person. |
| 2022 Poverty Guidelines for Hawaii | |
| Persons in family/household | Poverty guideline |
|---|---|
| 1 | $15,630 |
| 2 | $21,060 |
| 3 | $26,490 |
| 4 | $31,920 |
| 5 | $37,350 |
| 6 | $42,780 |
| 7 | $48,210 |
| 8 | $53,640 |
| For families/households with more than 8 persons, add $5,900 for each additional person. |
This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.
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