Guidance Issued on Broker Compensation Disclosure

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Beginning December 27, 2021, covered service providers (brokers and consultants) of ERISA-covered group health plans, regardless of size, must provide responsible plan fiduciaries information on direct and indirect compensation in writing.

On December 30, 2021, the DOL released Field Assistance Bulletin No. 2021-03, which provides guidance on this new broker transparency law. While many questions remain unanswered, there is some helpful relief and clarification. The following summarizes the key points.

On December 30, 2021, the DOL released Field Assistance Bulletin No. 2021-03, which provides guidance on this new broker transparency law. While many questions remain unanswered, there is some helpful relief and clarification. The following summarizes the key points.

Good Faith Relief

The DOL indicated that it expects that covered service providers will adopt various methods to make the required disclosure regarding their services and compensation in a way that complies. It will not treat them as having failed to make required disclosures to a responsible plan fiduciary as long as the person makes disclosures in accordance with a good faith, reasonable interpretation of the law. The DOL further indicated that a good faith and reasonable step for a group health plan service provider would be to take into account the DOL’s guidance on its regulation for pension plans, as applicable.

Covered Benefits

The covered group health plans include both insured and self-insured group health plans, including grandfathered health plans and stand-alone dental and vision benefits, but do not include qualified small employer health reimbursement arrangements. A covered group health plan also includes “excepted benefits” that are group health plans. While not expressly called out, this likely includes certain excepted benefits like EAPs and onsite clinics.

Effective Date

Only contracts or arrangements for services which are entered into, extended, or renewed on or after December 27, 2021 are required to comply with the disclosure requirements. The date on which a contract or arrangement is entered into between a broker and a plan fiduciary is considered to be the date the contract or arrangement was “executed.” For example, if a plan fiduciary enters into a new service contract with a broker on December 15, 2021 for the plan year beginning on January 1, 2022, the service contract will be treated as having been “executed” on December 15, 2021, which is prior to December 27, 2021, so that the contract is not subject to the new compensation disclosure requirements.

Also, pending further guidance, in the case of a broker that enters into a contract or arrangement with a plan fiduciary through use of a broker of record (“BOR”) agreement, the date the contract or arrangement will be considered entered into is the earlier of:

  • the date on which the BOR agreement is submitted to the insurance carrier; or
  • the date on which a group application is signed for insurance coverage for the following plan year provided that the submission or signature is done in the ordinary course and not to avoid its disclosure obligations.

Unknown Compensation

ERISA Sec. 408(b)(2)(B) requires covered service providers to make the required disclosures to responsible plan fiduciaries reasonably in advance of the date they enter into a contract or arrangement with a covered group health plan. The DOL recognizes that covered service providers may be unable to state with precision the amount of compensation they expect to receive for services, because the methodology by which certain components of their compensation is determined will depend on decisions or variables that are not known before, or even at the time, the contract or arrangement is entered into and, in fact, may change over the term of the contract or arrangement. The DOL takes the view that disclosure of compensation in ranges may be reasonable in circumstances when the occurrence of future events or other features of the service arrangement could result in the service provider’s compensation varying within a projected range. The DOL indicates that the following language in the preamble to the DOL’s final regulation for covered service provider disclosures to pension plan fiduciaries is relevant:

  • … such ranges must be reasonable under the circumstances surrounding the service and compensation arrangement at issue. To ensure that covered service providers communicate meaningful and understandable compensation information to responsible plan fiduciaries whenever possible, the DOL cautions that more specific, rather than less specific, compensation information is preferred whenever it can be furnished without undue burden.

No matter the methodology used to disclose compensation, the adequacy of the disclosure should be measured against a principal objective of the statutory provision which is to provide the responsible plan fiduciary with sufficient information about the compensation to be received by covered service providers to allow the fiduciary to evaluate the reasonableness of the compensation, and the severity of any associated conflicts of interest. The duties of prudence and loyalty in ERISA Sec. 404 apply to a responsible plan fiduciary’s decisions to hire service providers and to monitor service provider arrangements. What constitutes adequate disclosure for a specific compensation arrangement will depend on the facts and circumstances of the service contract or arrangement.

Covered Service Providers

The bulletin confirms that the definition of a covered service provider is not limited to service providers who are licensed as or who market themselves as “brokers” or “consultants.” Pending further guidance, the DOL’s enforcement policy will apply to parties who reasonably and in good faith determine their status as a covered service provider. Whether a person acts reasonably and in good faith depends on the facts of the particular situation. Service providers who reasonably expect to receive indirect compensation from third parties in connection with advice, recommendations, or referrals regarding any of the listed services in footnotes 1 and 2 should be prepared, if the DOL is auditing their compliance, to be able to explain how a conclusion that they are not covered service providers is consistent with a reasonable good faith interpretation of the statute.

Future Guidance

The DOL does not believe that comprehensive implementing regulations are needed. However, the department will monitor feedback from stakeholders to assess whether additional guidance may be necessary to assist covered service providers and plan fiduciaries in complying with the new disclosure requirements.

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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New PCOR Fee Announced

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The IRS recently released Notice 2022-04, announcing the adjusted applicable dollar amount used to determine the PCOR fee for plan years ending on or after October 1, 2021 and before October 1, 2022. The PCOR filing deadline is August 1, 2022 for all self-funded medical plans and some HRAs for plan years (including short plan years) ending in 2021.

On December 21, 2021, the IRS released Notice 2022-04, announcing that the adjusted applicable dollar amount used to determine the PCOR fee for plan years ending on or after October 1, 2021 and before October 1, 2022 is $2.79.

The PCOR filing deadline is August 1, 2022 for all self-funded medical plans and some HRAs for plan years (including short plan years) ending in 2021. Carriers are responsible for paying the fee for insured policies.

2022 Form 720, due August 1, 2022:

Plan YearAmount of PCOR Fee
February 1, 2020 – January 31, 2021$2.66/covered life/year
March 1, 2020 – February 28, 2021$2.66/covered life/year
April 1, 2020 – March 31, 2021$2.66/covered life/year
May 1, 2020 – April 30, 2021$2.66/covered life/year
June 1, 2020 – May 31, 2021$2.66/covered life/year
July 1, 2020 – June 30, 2021$2.66/covered life/year
August 1, 2020 – July 31, 2021$2.66/covered life/year
September 1, 2020 – August 31, 2021$2.66/covered life/year
October 1, 2020 – September 30, 2021$2.66/covered life/year
November 1, 2020 – October 31, 2021$2.79/covered life/year
December 1, 2020 – November 30, 2021$2.79/covered life/year
January 1, 2021 – December 31, 2021$2.79/covered life/year

Employer Action

For now, no action by employers with self-funded health plans (or an HRA) is required. We will send a reminder in Summer 2022 of the fee and additional information for filing and paying the PCOR fee with the IRS.

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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Final 2021 Instructions for Forms 1094-C and 1095-C Issued

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The IRS released final Instructions for Forms 1094-C and 1095-C for calendar year 2021 reporting.

Background

Applicable large employers (“ALEs”) must furnish Form 1095-C to full-time employees and file Form 1094-C and all 1095-Cs with the IRS. ALEs offering a self-insured group health plan must also furnish Forms 1095-C to covered employees or other primary insured individuals in the self-funded health plan (e.g., covered part-time employees, COBRA qualified beneficiaries).

ALEs, in coordination with their payroll or other reporting vendors, should have records to determine each employee’s status as an ACA FTE or not an ACA FTE for each month during 2021 in preparation to complete, furnish and file these forms for 2021.

As previously reported, the IRS issued a proposed rule that:

  • Makes permanent an automatic extension of 30 days to furnish IRS Forms 1095-C to individuals. Therefore, for calendar year 2021, the due date to furnish Form 1095-C to full-time employees and other individuals is March 2, 2022.

The instructions generally reinforce what is set forth in the proposed rule, with some new information as it relates to an individual coverage health reimbursement arrangement (“ICHRA”).

What’s New?

Other than what was previously announced, the changes included in the 2021 instructions are minimal.

New Codes for ICHRAs

If an ALE offers an ICHRA for 2021, the Form 1095-C has been modified to add new codes 1T and 1U for ICHRAs offered to the employee and spouse but not dependents.

2021 Penalties

The instructions reiterate that all ALEs and other employers that sponsor self-funded group health plans that fail to comply with the information reporting requirements may be subject to the general reporting penalty provisions for failure to file correct information returns and failure to furnish correct payee statements. Good faith relief is no longer available. However, penalties may be waived if the failure is due to reasonable cause and not willful neglect.

For 2021, the following penalties may apply:

  • Failure to file a correct return is $280/statement (total calendar year penalty not to exceed $3,426,000).
  • Failure to furnish a correct statement is $280/statement (total calendar year penalty not to exceed $3,426,000).

An employer that fails to both file and furnish a correct statement is subject to a combined penalty of $560/statement with a maximum penalty of $6,852,000.

Employer Action

Employers should begin preparing and ensure that statements are furnished to full-time employees and other individuals by March 2, 2022. If you are an employer with employees residing in a state with an individual mandate (e.g., California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont) the deadlines may be different than what is required by the IRS. Many states are still reviewing their policies in light of the recently announced federal delay.

Employers should be certain the statements are complete and accurate since the good faith relief is no longer available.

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Guidance on Prescription Drug Reporting

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On November 23, 2021, the Office of Personnel Management and the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) published interim final regulations under the Consolidated Appropriations Act, 2021 (“CAA”) that require group health plans to submit an annual report to the federal government on prescription drugs and health care spending. The reports for calendar years 2020 and 2021 are due on December 27, 2022, and the reports for subsequent calendar years are due on the following June 1.

The annual reporting requirement generally applies to all group health plans. It does not apply to excepted benefit plans, short-term limited duration insurance, and health reimbursement arrangements and certain other account-based plans.

Fully insured group health plans can transfer the reporting obligation to the insurance carrier by entering into a written agreement that obligates the carrier to perform the reporting function. The carrier will then be liable for any reporting violation.

A self-funded group health plan can also enter into a written agreement with a third-party administrator (“TPA”), or a pharmacy benefit manager (“PBM”) or other third party, to fulfill the reporting function, but the plan remains liable for any reporting violation.

According to the interim final regulations, the following information must be included in the annual report filed with the federal government:

  • Total healthcare spending, broken down by type of cost (hospital care, primary care, specialty care, prescription drugs, and other medical costs, including wellness services)
  • The 50 most frequently dispensed name-brand prescription drugs
  • The 50 prescription drugs that generated the highest total annual spending
  • The 50 prescription drugs with the greatest increase in total annual spending compared to the previous calendar year
  • Prescription drug rebates, fees and other remuneration paid by drug manufacturers to the plan in each therapeutic class of drugs, as well as for each of the 25 drugs that generated the highest rebate amounts
  • The impact of prescription drug rebates, fees and other remuneration on premiums and out-of-pocket costs

The interim final regulations contain standards and definitions that, for example, identify prescription drugs on a uniform basis regardless of dosage strength, package size, or mode of delivery.

Information in the report must be aggregated separately for each state in which coverage was provided under the plan, except as set forth in the following chart:

Type of Group Health PlanInformation Must Be Aggregated in the Report
Self-funded planFor the state in which the plan sponsor has its principal place of business
Fully insured plan (other than a plan described below)For the state where the insurance contract was issued
Health coverage provided through a group trust or multiple employer welfare arrangement (“MEWA”)For the state where the employer has its principal place of business, if the plan is sponsored at the individual employer level; orFor the state where the association has its principal place of business, if the association qualifies as the employer under federal ERISA law; orFor the state where the association is incorporated, if the association has no principal place of business and qualifies as the employer under federal ERISA law
Individual health insurance sold through an associationFor the issue state of the certificate of coverage

The Departments intend to compile and analyze the reports that it receives under the interim final regulations, and to publish its findings every two years to better understand prescription drug pricing trends and their effect on premiums and out-of-pocket costs.

Employer Action

While the deadline for calendar year 2020 and 2021 reporting is a year out (December 27, 2022), employers should start discussing next steps with brokers, carriers, TPAs and PBMs.

Fully insured plans. Employers should enter into written agreements with their insurance carriers and HMOs to transfer the reporting obligation and liability to the carrier.

Self-funded plans. Employers should enter into written agreements with TPAs, PBMs, or other third parties to ensure the vendor will provide the required reporting to the Departments. As the self-funded plan remains liable for reporting, employers should monitor the reporting efforts of the TPA or other third party to help minimize the exposure to liability for any reporting violation.

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Winter Action Plan to Battle COVID-19

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On December 2, 2021, the Biden administration issued a nine-pronged plan to combat COVID-19 as the winter months approach and the new Omicron variant poses risk of new infections. The plan covers:

  1. Boosters for adults
  2. Vaccinations to protect children and keep schools open
  3. Expanded free at-home testing
  4. International travel protections
  5. Workplace protections
  6. Rapid response teams to battle rising cases
  7. Supplying treatment pills to help prevent hospitalizations and death
  8. Continued commitment to global vaccination efforts
  9. Steps to ensure preparation for all scenarios

Aspects of this plan will affect employers and group health plans, as follows:

  • Expanded free at-home testing. The Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) are directed to issue guidance by January 15, 2022, to clarify that individuals who purchase over-the-counter (“OTC”) COVID-19 diagnostic tests can seek reimbursement from their group health plan or health insurance issuer to cover the cost of the OTC test during the public health emergency. The plan notes that, consistent with current guidance, group health plans are not required to cover testing for public health surveillance or employment purposes.
  • PTO for booster shots. While all federal employees currently receive paid time off to get booster shots, employers are called upon to provide the same paid time off for their employees, if they are not doing so already, including paid time off for family members getting their first, second, or booster shots.
  • Targeting outreach to Medicare beneficiaries. CMS is launching an initiative to get Medicare beneficiaries booster shots. CMS will be sending all Medicare beneficiaries a notice providing information on access to booster shots in their community as well as emails.
  • Protecting Workplaces to Keep Businesses Open. The administration is calling on businesses to move forward with requiring their workers to get vaccinated or be tested weekly. No new guidelines or requirements are part of this provision. The emphasis on encouragement is likely in response to the ongoing legal challenges to the federal vaccine mandates. Currently, the courts have issued an enforcement stay with respect to the OSHA Emergency Temporary Standard (“ETS”), applicable to private employers, and a nationwide preliminary injunction with respect to both the CMS interim final rule applicable to health care workers and the federal contractor mandate.

Future guidance is expected to clarify and implement the provisions outlined in this plan. We are monitoring this information and will report on developments.

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IRS Releases Proposed Regulations on ACA Reporting and Other Issues

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On November 22, 2021, the Internal Revenue Service (“IRS”) released proposed regulations that provide some relief with respect to ACA reporting requirements. The proposed rule:

  • Makes permanent an automatic extension of 30 days to furnish IRS Forms 1095-C (and 1095-B) to individuals. Effectively, this moves the due date for furnishing these forms to full-time employees and other individuals from January 31 to March 2 each year (or, if March 2nd falls on a weekend or holiday, the next business day).
  • Eliminates the good faith relief from reporting penalties associated with incorrect or incomplete reporting.
  • Creates an alternative method for furnishing individuals with IRS Form 1095-B (and, in some cases, IRS Form 1095-C) as proof of minimum essential coverage (MEC).

Therefore, with respect to Forms 1095-C for calendar 2021, applicable large employers (“ALEs”) have until March 2, 2022 (rather than January 31, 2022) to furnish these forms to full-time employees and other individuals.

It is important to note that the proposed rule does not extend the deadline to file completed Forms 1094-C and 1095-C (and Forms 1094-B and 1095-B) with the IRS. The due date remains March 31, 2022 (or February 28, 2022 for paper filing if filing fewer than 250 forms).

Please note, while the 2021 Forms 1094-C and 1095-C have been finalized, the instructions are not yet available. Once published, the instructions should be available on this website:https://www.irs.gov/forms-pubs/about-form-1095-c.

Below you will find additional details.

Automatic Extension of Time for Furnishing ACA Statements

Under the ACA, January 31 is the deadline to furnish IRS Forms 1095-C and 1095-B to certain individuals (such as full-time employees, in the case of IRS Form 1095-C) with respect to the preceding calendar year. The proposed regulations grant an automatic extension of 30 days in which to furnish these statements to individuals. The extension is automatic; employers or other reporting entities are not required to file a request with IRS, or to demonstrate reasonable cause to justify the extension.

Employers may rely on this relief for calendar year 2021 filings. This means Wednesday March 2, 2022 is the deadline to furnish individuals with a 2021 Form 1095-C or 1095-B.

While the IRS has provided the automatic extension of time to furnish the Form 1095-C (or Form 1095-B), if operating in a state with an individual mandate the timing to furnish proof of coverage to covered residents may be different. 

Elimination of Transitional Good Faith Relief

Since 2015, the IRS provided reporting entities with relief from penalties if those entities could show they made good faith efforts to comply with the information reporting requirements. This relief has been extended each year, with the IRS announcing that 2020 would be the last year that transitional good faith relief would be available.

The proposed rule confirms that the good faith relief from penalties for reporting incorrect or incomplete information on Forms 1094-C, 1095-C, 1094-B and 1095-B is no longer available after 2020. For 2021, penalties for incorrect or incomplete forms furnished to individuals can be $280/return. Additionally, incomplete or incorrect forms filed with the IRS may trigger a $280/return penalty.

While the reasonable cause exception remains available and may provide relief from penalties for entities that can show a reasonable cause for failing to timely or accurately complete their reporting requirements, with the elimination of the good faith relief employers will want to take steps to ensure the accuracy of their forms and filings.

Alternative Method for Furnishing ACA Statements

Under the ACA, IRS Forms 1095-C and 1095-B must be sent by first class mail to the last known permanent address of the individual. If no permanent address is known, the statement must be sent by first class mail to the individual’s temporary address. The statement may also be furnished electronically if certain requirements are met.

The proposed regulations would make permanent an alternative method for furnishing IRS Forms 1095-B (and, in some limited cases, IRS Forms 1095-C) to individuals, for as long as penalties under the ACA’s individual shared responsibility rules remain zero. The alternative method would be available to the following reporting entities:

  • Health insurance carriers and plan sponsors (other than ALEs) that are using IRS Form 1095-B to provide proof of MEC
  • ALEs with a self-funded group medical plan that are using IRS Form 1095-B or 1095-C to provide proof of MEC to individuals who are not considered “full-time” under the ACA for any month of the calendar year (i.e., non-full-time employees and non-employees covered under the plan during the calendar year)
  • Small employers (not ALEs) with a self-funded health plan that are using IRS Form 1095-B to provide proof of MEC

The alternative method is not available to ALEs that are furnishing IRS Form 1095-C to employees considered “full-time” under the ACA for one or more months of the calendar year. Further, the alternative method may not be available if operating in a state with an individual mandate where Forms 1095-C or 1095-B must be furnished to covered residents. Keep in mind, if the alternative method is used, the reporting entity must still file the Form 1095-B with the IRS.

The following steps must be followed by a reporting entity that elects to use the alternative method:

  • A clear and conspicuous notice that meets certain technical requirements must appear on the reporting entity’s website
  • The notice must state that covered individuals may receive a copy of IRS Form 1095-B (and, in some cases, IRS Form 1095-C) upon request, and informs them how the request may be made
  • The notice must appear in the same website location through October 15 (or the next business day) following the end of the calendar year
  • IRS Form 1095-B (or, in some cases, IRS Form 1095-C) must be furnished to the requesting individual within 30 days after the request is received; the ACA statement may be furnished electronically if certain requirements are met.

If the proposed regulations are finalized without change, the alternative method would be available to reporting entities that are furnishing IRS Forms 1095-B (and, in some cases, IRS Forms 1095-C) for calendar year 2021, as well as for future calendar years.

Employer Action

Employers should continue to monitor the status of the proposed rule.

  • With respect to furnishing Forms 1095-C for CY 2021, employers may rely on the proposed rule and must furnish these statements no later than March 2, 2022 (versus January 31, 2022).
  • Employers should take extra care that Forms 1094-C and 1095-C are complete and accurate as the transitional good faith relief is no longer available with respect to calendar year 2021 filings (and thereafter).
  • Determine whether your carriers will take advantage of the alternative furnishing method with respect to Forms 1095-B they issue.
  • If operating in a state with an individual mandate (California, District of Columbia, Massachusetts. New Jersey, Rhode Island and Vermont), and required to furnish covered residents with proof of coverage during the calendar year, ensure you continue to comply with state rules.

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Legapsi Associates, Inc. Merges with Imperial Coverage

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Legaspi Associates, Inc. has merged into Imperial Coverage, an innovative new insurance firm launched to help ensure clients are properly protected in all critical ways. The independent, full-service company offers comprehensive personal and business insurance solutions.

Mark Legaspi, who led his own firm for over two decades and brings 30 years of industry experience to Imperial Coverage, has been named CEO. “I’m thrilled to bring my experience in the insurance industry to Imperial Coverage, provide my clients with exceptional service and products, and expand our reach,” Legaspi said.

Particularly during these unprecedented economic challenges, ensuring proper coverage at the best possible price is critical. Imperial Coverage seeks to take the stress out of the insurance process, customizing coverage to ensure clients are protected to the highest level at the most competitive rates, coupled with excellent service.

Imperial Coverage offers a wide range of life, health, property and casualty, and business insurance products and services for individuals and businesses including general and professional liability, disability, term and permanent life (including indexing investment accounts), homeowners, auto, cybersecurity, medicare, and more. 

We invite you to take advantage of this new offering and reach out to Imperial Coverage for a complimentary review of your existing policies.

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2022 Cost of Living Adjustments

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The IRS recently released cost of living adjustments for 2022 under various provisions of the Internal Revenue Code (the Code). Some of these adjustments may affect your employee benefit plans.

Cafeteria Plans – Health Flexible Spending Arrangements

Annual Contribution Limitation

For plan years beginning in 2022, the dollar limitation under Code Section 125(i) for voluntary employee salary reductions for contributions to health flexible spending arrangements (health FSAs) increased from $2,750 to $2,850.

The Affordable Care Act (ACA) amended Code Section 125 to place a $2,500 limitation on voluntary employee salary reductions for contributions to health flexible spending arrangements, subject to inflation for plan years beginning after December 31, 2013.

Annual Maximum carryover

For cafeteria plans that permit the carryover option, the maximum unused amount from a health FSA plan year that begins in 2022 that can be carried over to the following plan year is $570.

In May 2020, the IRS issued Notice 2020-33 to increase the carryover limit for unused amounts remaining in a health FSA as of the end of a plan year from a maximum of $500 to 20% of the currently indexed health FSA contribution limit for plans that have adopted the carryover option.

Qualified Transportation Fringe Benefits

For calendar year 2022, the monthly exclusion limitation for transportation in a commuter highway vehicle (vanpool) and any transit pass (under Code Section 132(f)(2)(A)) and the monthly exclusion limitation for qualified parking expenses (under Code Section 132(f)(2)(B)) increased to $280.

The Consolidated Appropriations Act of 2016 permanently changed the pre-tax transit and vanpool benefits to be at parity with parking benefits.

Beginning with the 2018 calendar year, employers can no longer deduct qualified transportation fringe benefits; employees may still pay for these benefits on a tax-favored basis.

Highly Compensated

The compensation threshold for a highly compensated individual or participant (as defined by Code Section 414(q)(1)(B) for purposes of Code Section 125 nondiscrimination testing) increased from $130,000 to $135,000 for 2022.

Under the cafeteria plan rules, the term highly compensated means any individual or participant who for the preceding plan year (or the current plan year in the case of the first year of employment) had compensation in excess of the compensation amount as specified in Code Section 414(q)(1)(B). Prop. Treas. Reg. 1.125-7(a)(9).

Key Employee

The dollar limitation under Code Section 416(i)(1)(A)(i) concerning the definition of a key employee for calendar year 2022 increased from $185,000 to $200,000.

For purposes of cafeteria plan nondiscrimination testing, a key employee is a participant who is a key employee within the meaning of Code Section 416(i)(1) at any time during the preceding plan year. Prop. Treas. Reg. 1.125-7(a)(10).

Non-Grandfathered Plan Out-of-Pocket Cost-Sharing Limits

The 2022 maximum annual out-of-pocket limits for all non-grandfathered group health plans are $8,700 for self-only coverage and $17,400 for family coverage.

These limits generally apply with respect to any essential health benefits (EHBs) offered under the group health plan. Federal guidance established that starting in the 2016 plan year, the self-only annual out-of-pocket limit applies to each individual, regardless of whether the individual is enrolled in other than self-only coverage, including in a family HDHP.

Health Reimbursement Arrangements

Qualified Small Employer Health Reimbursement Arrangements

For tax years beginning in 2022, to qualify as a qualified small employer health reimbursement arrangement (QSEHRA) under Code Section 9831(d), the arrangement must provide that the total amount of payments and reimbursements for any year cannot exceed $5,450 ($11,050 for family coverage) (increased from 2021).

Excepted Benefit Health Reimbursement Arrangements

For plan years beginning in 2022, to qualify as an excepted benefit health reimbursement arrangement (EB HRA) under Code Section 54.9831-1(c)(3)(viii), the maximum amount that may be made newly available for the plan year for an excepted benefit HRA is $1,800 (unchanged from 2021).

Health Savings Accounts

As announced in May 2021, the inflation adjustments for health savings accounts (HSAs) for 2022 were provided by the IRS in Rev. Proc. 2021-25.

Annual contribution limitation

For calendar year 2022, the limitation on HSA contributions for an individual with self-only coverage under a high deductible health plan is $3,650. For calendar year 2022, the limitation on HSA contributions for an individual with family coverage under a qualifying high deductible health plan is $7,300.

Qualifying high deductible health plan

For calendar year 2022, a “qualifying high deductible health plan” is defined as a health plan with an annual deductible that is not less than $1,400 for self-only coverage or $2,800 for family coverage (unchanged from 2021), and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $7,000 for self-only coverage or $14,100 for family coverage.

Non-calendar year plans: In cases where the qualifying high deductible health plan renewal date is after the beginning of the calendar year, any required changes to the annual deductible or out-of-pocket maximum may be implemented as of the next renewal date. See IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-86 (Aug.16, 2004).

Catch-up contribution

Individuals who are age 55 or older and covered by a qualifying high deductible health plan may make additional catch-up HSA contributions each year until they enroll in Medicare. The additional contribution, as outlined in Code 223(b)(3)(B), is $1,000 for 2009 and thereafter.

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OSHA’s Emergency Temporary Standard: Guidance on Mandatory COVID-19 Vaccination/Testing

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On November 5, 2021, the Occupational Safety and Health Administration (OSHA) published its long-awaited Emergency Temporary Standard (ETS), which requires most U.S. employers with 100 or more employees to adopt a mandatory COVID-19 vaccination policy with an option to include an alternative weekly testing program.

The ETS is effective immediately and employers must begin their compliance efforts at once. Employers have until December 5, 2021, to comply with all of the requirements of the ETS, except for the weekly testing option for employees who have not been fully vaccinated. Employers have until January 4, 2022 to comply with the weekly testing option, though employers may begin complying earlier. OSHA anticipates the ETS will be in effect for six months from the date of publication in the Federal Register.

It is important to note that OSHA is seeking comments from the public on the ETS, and there is a possibility that the requirements may be expanded beyond their current parameters. In addition, multiple state attorneys general have filed lawsuits challenging the ETS. On November 6, 2021, a federal appellate court issued a temporary stay on enforcement of the ETS. The outcome of these legal challenge is unknown.

If the ETS survives legal challenge, its current provisions provide employers with a detailed roadmap of what compliance should look like. Notwithstanding the legal uncertainty, employers should take steps to prepare for compliance and monitor developments out of the courts.

Below you will find a summary of the important aspects of the ETS. The summary is not exhaustive and is not a substitute for legal advice.

Covered Employers

Private Sector

Private employers with 100 or more employees at any time during the effective period of the ETS, which begins on November 5, 2021, must comply. Employers must continue to comply for the entire duration of the ETS even if their employee count drops below 100. Though employers with fewer than 100 employees on November 5, 2021 are not subject to the ETS, if their headcount reaches 100 employees at any time while the ETS is in effect, the employer must promptly comply. It should be noted that private employers with fewer than 100 employees may be required to comply if a state OSHA program requires compliance.

“Employees” include all employees on an employer’s payroll including, but not limited to, temporary employees, part-time employees, remote employees and seasonal employees. Independent contractors are not counted as employees. Staffing agency employees are considered employees of the staffing agency and should be included in the staffing agency’s headcount.

State and Local Governments

State and local governmental employers with 100 or more employees in states that have state-approved OSHA programs must comply. State and local governmental employers are not typically covered by federal OSHA requirements; however, in order for a state to receive approval to adopt its own State Plan, it must extend federal OSHA requirements to state and local governmental employers. State Plans must fully adopt the ETS by December 5, 2021; thus, their compliance date will be later than November 5, 2021. While State Plans must adopt programs that are “at least as effective as federal OSHA’s requirements,” states can adopt programs that are more expansive or stringent than the federal requirements. Thus, it is possible that some states may lower the compliance obligation below the 100-employee threshold.

Federal Government

The ETS does not apply to employees of federal agencies, except for those employed by the U.S. Postal Service.

States Prohibiting Mandatory Vaccinations, Testing or Face Coverings

OSHA intends for the ETS to preempt or override any attempts by states or localities to prevent vaccination or mask mandates and intends to invalidate any State or local requirements that ban or limit an employer’s authority to require vaccinations, face coverings or testing.

Exempt Employees

Employees who work exclusively from home, who work exclusively outdoors, or who come into the workplace only when other employees (or customers) are not present are not covered by the ETS. However, if any such worker will be entering a covered workplace during times when other employees (or customers) are present, they must either be vaccinated or be able to present a negative test result obtained within seven days of entering the workplace.

Employees with medical conditions or sincerely held religious beliefs that prevent them from being vaccinated, undergoing weekly testing, and/or wearing a mask may be entitled to accommodations under Title VII of the Civil Rights Act or the Americans with Disabilities Act.

It is important to note that employees who have previously been diagnosed with COVID-19 are not exempt from compliance and must either be fully vaccinated or submit to weekly testing.

Full Vaccination

Employees are considered to be “fully vaccinated” two weeks after receiving a single Johnson & Johnson vaccine, or two weeks after receiving the second does of a two-dose vaccine series (i.e., Pfizer or Moderna). The ETS does not include booster shots and additional doses in the definition of fully vaccinated. The ETS provides a limited exception: employees who have completed the entire primary vaccination series by January 4, 2022 do not have to be tested even if they have not completed the two-week waiting period.

Testing

Employees who are not fully vaccinated must comply with the weekly testing requirements of the ETS. This includes unvaccinated employees, partially vaccinated employees and employees who are exempt from vaccination due to religious or disability-based restrictions. A COVID-19 test under the ETS is a test that is:

  • cleared, approved or authorized, including in an Emergency Use Authorization (EUA), by the U.S. Food and Drug Administration (FDA) to detect current infection with the SARS-CoV-2 virus (e.g., a viral test);
  • administered in accordance with the authorized instructions; and
  • not both self-administered and self-read unless observed by the employer or an authorized telehealth proctor.

Employees who fail to provide a weekly test result must be removed from the workplace until they can provide a negative test result.

Employers are not required to offer a testing option under the ETS. The ETS provides that employers that choose to adopt a mandatory vaccination-only policy may suspend or terminate employees who refuse to get vaccinated, unless their refusal is due to a medical condition or sincerely held religious belief that prevents them from being vaccinated, in which case reasonable Accommodations may have to be considered.

It is also important to note that the ETS does not require employers to pay for any costs associated with testing, although employers can choose to do so. Individual state or local laws may influence whether employers must cover the costs of testing. Group health plans are not required to cover COVID-19 testing for the purpose of the ETS.

Mask Requirements

Fully vaccinated employees are not required to wear masks. Any employee who is not fully vaccinated must wear a mask while in the workplace and when occupying a vehicle with another person for work purposes except:

  • when the employee is alone in a room with floor to ceiling walls and a closed door.
  • for a limited time while they are eating or drinking at the workplace, or for identification purposes in compliance with safety and security requirements.
  • when the employee is wearing a respirator or facemask.
  • where the employer can show that the use of face coverings in infeasible or creates a greater hazard that would excuse compliance (e.g., when it is important to see the employee’s mouth for reasons related to their job duties, when the work require the use of the employee’s uncovered mouth, or when the use of a face covering presents a risk of serious injury or death to the employee).

The ETS provides that a “face covering” means a covering that:

  • completely covers the nose and mouth;
  • is made with two or more layers of a breathable fabric that is tightly woven (i.e., fabrics that do not let light pass through when held up to a light source);
  • is secured to the head with ties, ear loops or elastic bands that go behind the head. If gaiters are worn, they should have two layers of fabric or be folded to make two layers;
  • fits snugly over the nose, mouth and chin with no large gaps on the outside of the face; and
  • is a solid piece of material without slits, exhalation valves, visible holes, puncture or other openings.

Employer Support for Vaccination

Employers are required to provide employees with up to four hours of paid time off (PTO) from work for each required dose for a primary vaccination. Booster shots are not considered part of the primary vaccination series. Employees cannot be required to use sick, vacation or PTO time to cover these four hours.

Employers are required to provide “reasonable time and paid sick leave” to employees who suffer side effects from receiving a vaccination and need time off to recover. Employees may use available PTO or paid sick time to cover these absences, but if employees don’t have enough accrued time to cover their absence, employers will have to pay for the remaining time off, and cannot advance PTO or sick leave which would result in the employee having a negative balance. The ETS does not require employers to provide PTO in connection with weekly testing, positive test results or quarantining or isolation. It should be noted that state or local laws may impose pay obligations under some of these scenarios.

Information to Provide to Employees

Employers must inform employees, in a language and at a literacy level the employee understands, about the key components of their compliance plan including, but not limited to:

  • requirements for COVID-19 vaccination
  • applicable exclusions from the written policy (e.g., reasonable accommodations for workers with disabilities or sincerely held religious beliefs)
  • information on determining an employee’s vaccination status and how this information will be collected
  • paid time and sick leave for vaccination purposes and recovery from side effects
  • employee obligations to provide prompt notification of positive COVID-19 tests and the employer’s removal practices when notified of a positive test result of COVID-19-positive employees from the workplace
  • testing and masking requirements
  • disciplinary consequences for employees who do not abide by the policy
  • vaccine efficacy, safety and the benefits of being vaccinated (by providing the Centers for Disease Control and Prevention (CDC) document “Key Things to Know About COVID-19 Vaccines”)
  • protections against retaliation and discrimination
  • OSHA’s prohibitions that impose criminal penalties for knowingly supplying false statements or documentation

Recordkeeping Requirements

Employers are required to keep a list of employee vaccination status that clearly indicates for each employee whether they are:

  • fully vaccinated
  • partially vaccinated
  • not fully vaccinated because of a medical or religious accommodation
  • not fully vaccinated because they have not provided acceptable proof of their vaccination status (includes employees who have chosen not to get vaccinated and have opted for weekly testing instead)

The following documents are considered acceptable for proof of vaccination:

  • the record immunization from a healthcare provider or pharmacy
  • a copy of the U.S. COVID-19 Vaccination Record Card
  • a copy of medical records documenting the vaccination
  • a copy of immunization records from a public health, state, or tribal immunization information system
  • a copy of any other official documentation that contains the type of vaccine administered, date(s) of administration, and the name of the healthcare professional(s) or clinic site(s) administering the vaccine(s).

Employers who have adopted a weekly testing option must maintain a record of each weekly test result for every employee subject to testing for the duration of the ETS. Test results are considered medical records under both the ETS and the Americans with Disabilities Act.

Employers must provide employees access to and copies of their individual test records upon request. In addition, upon request, employers must provide employees or employee representatives (such as union representatives) with the aggregate number of fully vaccinated employees at the workplace by the end of the next business day after the request. There is no limit on the number of times these requests can be made. Employers are also required to respond to requests from OSHA for certain records.

Positive Test of Employee/Close Contact with Positive Case

An employee who has tested positive must immediately be removed from the workplace until they either:

  • receive a negative result on a COVID-19 NAAT test following a positive result on a COVID-19 antigen test (NAAT tests are less likely to provide false positives);
  • meet the return-to-work criteria in the CDC’s isolation guidance; or
  • receive a recommendation to return to work from a licensed healthcare provider.

Employees who have tested positive for COVID-19 and returned to the workplace should be not subjected to weekly testing for 90 days following the date of their positive test.

The ETS does not require employees who have been exposed to someone diagnosed with COVID-19 to be quarantined; however, the CDC continues to recommend that unvaccinated employees be quarantined after close, prolonged contact with a COVID-positive person, and OSHA encourages employers to consider a quarantine protocol.

Employers are not required to contact trace under the ETS; however, the CDC continues to recommend contact tracing. Some state/local laws may also require contact tracing.

Employers must report each work-related COVID-19 fatality to OSHA within eight hours of learning of the fatality and each work-related COVID-19 in-patient hospitalization within 24 hours. OSHA has prepared a fact sheet explaining these reporting requirements.

Penalties

Employers that do not timely comply with the ETS may face penalties of $13,653 per violation for 2021 (2022 amounts not yet available). Willful or repeated violations can result in penalties of $136,532 per violation. States that operate their own OSHA plans must adopt maximum penalty levels that are at least as effective as federal OSHA.

Employer Action

Employers should prepare to comply and monitor developments out of the courts. If the ETS survives legal challenge, covered employers must have the following in place by December 5, 2021:

  • establish a vaccination policy. OSHA has a sample mandatory vaccination policy and a sample vaccination or testing/face covering policy which may be found athttps://www.osha.gov/coronavirus/ets2
  • determine vaccination status of each employee, obtain acceptable proof of vaccination and maintain records and a roster of vaccination status
  • provide support for employee vaccination
  • require employees to promptly provide notice of positive COVID-19 test or COVID-19 diagnosis
  • ensure employees who are not fully vaccinated wear face coverings when indoors or when occupying a vehicle with another person for work purposes
  • provide each employee information about the ETS; workplace policies and procedures; vaccination efficacy, safety and benefits; protections against retaliation and discrimination; and laws that provide for criminal penalties for knowingly supplying false documentation
  • report work-related COVID-19 fatalities to OSHA within eight hours and work-related COVID-19 in-patient hospitalizations within 24 hours
  • make certain records available

By January 2, 2022, employers must ensure employees who are not fully vaccinated are tested for COVID-19 at least weekly (if in the workplace at least once per week) or within seven days before returning to work (if away from the workplace for a week or longer).

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HHS Extends Public Health Emergency until January 16 2022

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On October 15, 2021, the Secretary of Health and Human Services (“HHS”) renewed the COVID-19 pandemic Public Health Emergency, effective October 18, 2021. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect.

Important Definitions

Emergency Period.

HHS issued a Public Health Emergency beginning January 27, 2020. This Emergency Period is now set to expire January 16, 2022 (unless further extended or shortened by HHS).

Outbreak Period.

The Outbreak Period started March 1, 2020.The end date is applied on a participant-by-participant basis and is the earlier of 1) one year after the date the participant was eligible for relief, and 2) 60 days after the announced end of the National Emergency.

While there are other temporary benefit plan provisions and changes that are allowed due to the Public Health Emergency, summarized below are only those provisions directly impacted by the Emergency Period extension.

Benefit Plan Changes in Effect Through the End of the Emergency Period

  • COVID-19 Testing. All group health plans must cover COVID-19 tests and other services resulting in the order for a test without cost-sharing (both in-network and out-of-network), prior authorization, or medical management and includes both traditional and non-traditional care settings in which a COVID-19 test is ordered or administered.
  • COVID-19 Vaccines. All non-grandfathered group health plans must cover COVID-19 vaccines (including cost of administering) and related office visit costs without cost-sharing; this applies, to both in-network and out-of-network providers, but a plan can implement cost-sharing after the Emergency Period expires for services provided out-of-network.
  • Excepted Benefits and COVID-19 Testing. An Employee Assistance Program (“EAP”) will not be considered to provide significant medical benefits solely because it offers benefits for diagnosis and testing for COVID-19 during the Emergency Period and therefore, will be able to maintain status as an excepted benefit.
  • Expanded Telehealth and Remote Care Services. Large employers (51 or more employees) with plan years that begin before the end of the Emergency Period may offer telehealth or other remote care services to employees (and their dependents) who are not eligible for other group health plan coverage offered by the employer.
  • Summary of Benefits and Coverage (“SBC”) Changes. Group health plans may notify plan members of changes as soon as practicable and are not held to the 60-day advance notice requirement for changes affecting the SBC during the plan year or for the reversal of COVID-19 changes once the Emergency Period expires, provided the plan members are timely made aware of any increase and/or decrease in plan benefits summarized on the SBC.
  • Grandfathered plans. If a grandfathered plan enhanced benefits related to COVID-19 for the duration of the Emergency Period (e.g. added telehealth or reduced or eliminated cost-sharing), the plan will not lose grandfathered status if the changes are later reversed when the Emergency Period expires.

Benefit Plan Changes in Effect Through the End of the Outbreak Period

On an individual basis, group health plans, disability, and other employee welfare benefit plans will disregard the period of one year from the date an individual is first eligible for relief, or 60 days after the announced end of the National Emergency, whichever occurs first, when determining the following:

  • COBRA. Timeframe for the employer to provide a COBRA election notice; the 60-day election period for a qualified beneficiary to elect COBRA; the COBRA premium payment deadlines (45 days for initial payment, 30-day grace period for ongoing payments); the deadline to notify the plan of qualifying events or disability determinations.
  • HIPAA Special Enrollment. 30 days (60 days for Medicaid/CHIP events) to request a special enrollment right due to loss of health coverage, marriage, birth adoption, or placement for adoption.
  • ERISA Claims Deadlines. Timeframe to submit a claim and appeal of an adverse benefit determination. For non-grandfathered medical plans, timeframe to request external review and perfect an incomplete request.
    • This includes claim deadlines for a health FSA or HRA that occur during the Outbreak Period.
  • Fiduciary Relief of Certain Notification and Disclosure Deadlines for ERISA Plans. A plan will not be in violation of ERISA for a failure to timely furnish a notice, disclosure, or document throughout the duration of the Outbreak Period if the plan and fiduciary operate in good faith and furnish the notice, disclosure, or document as soon as administratively practicable (which may include the use of electronic means such as email and text messages).

Employer Action

Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 testing and vaccinations and other required plan notifications. State and local emergency measures may expire at different times and could impact employee benefit plans (such as insured group health plans) and other state and/or local programs (such as paid leave) differently than the timeframes required under federally regulated program requirements.

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