Health and Welfare

In March 2020, the President declared a national emergency effective March 1, 2020, due to the COVID-19 outbreak. The national emergency was extended for one year until February 28, 2022. On February 18, 2022, the President once again extended the national emergency until February 28, 2023.

The extended national emergency provides relief to health and welfare plans related to the following.

• COBRA notices (i.e., employer and employee), payment, and election
• HIPAA special enrollment requests
• Claims and appeals request and claims perfection

As clarified in Notice 2021-01, the Department of Labor, the Internal Revenue Service, and the Department of Treasury explained the disregarded period applies on a person-by person basis and cannot exceed one year, as follows:

• one year from the date an individual was first eligible for relief, or
• 60 days after the announced end of the National Emergency.

Employers should continue to monitor deadlines pursuant to prior guidance.

Group health plans and health insurance issuers must provide benefits for certain items and services related to testing for the detection and diagnosis of COVID-19, including over-the-counter (OTC) COVID-19 tests. The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act require that these services be provided without imposing cost-sharing requirements, prior authorization, or other medical management requirements.

On February 4, 2022, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued Frequently Asked Questions (FAQs). These FAQs provide additional guidance on the requirement to provide coverage for OTC COVID-19 tests without a prescription or individualized clinical assessment from a health care provider.

The FAQs provide guidance in the following areas.

• Limits on Coverage: Plans or issuers may limit reimbursement to the lesser of the actual price of the test, or $12 per test. Each covered participant, beneficiary, or enrollee may be reimbursed for at least 8 tests per 30-day period (or per calendar month). The plan or issuer must calculate the reimbursement based on the number of tests in a package.
• Direct-to-Consumer Coverage: Plans or issuers that provide direct coverage of OTC COVID-19 tests through both a pharmacy network and a direct-to-consumer program, and otherwise limits reimbursement for OTC COVID-19 tests from nonpreferred pharmacies or other retailers to the lesser of the actual price of the test, or $12 per test, will not be subject to enforcement action. To provide adequate access, the plan or issuer must make OTC COVID-19 tests available through at least one direct-to-consumer shipping mechanism and at least one in-person mechanism. The direct-to-consumer mechanism may include online or telephone ordering, but the plan or issuer must cover the cost of shipping.
• Impact of Supply Shortage: Plans or issuers will not be out of compliance if they temporarily cannot provide adequate access because of a supply shortage.
• Fraud or Abuse: Plans or issuers may take reasonable steps to prevent, detect, and address fraud and abuse. For example, a plan or issuer can require tests to be purchased from an established retailer, substantiate the purchase by carefully reviewing receipts and documentation, and require the individual to attest that the product will not be resold.
• Self-Collected Sample with Lab Processing: OTC COVID-19 tests must be self-administered and self-read without the involvement of a health care provider. The OTC COVID-19 coverage rules do not apply when an individual sends the specimen to be processed in a laboratory. These tests must be ordered by a health care provider.
• FSA/HRA/HSA: The cost of OTC COVID-19 tests purchased after January 15, 2022, are eligible for reimbursement from a group health plan or issuer.  Individuals may not seek reimbursement more than once for the same medical expense. When notifying individuals about any direct coverage or reimbursement, the plan or issuer must include a reminder stating that the same medical expense may not be submitted to a health flexible spending account FSA), health reimbursement arrangement (HRA), or health savings account (HSA).

Further developments, including any clarifying guidance will be shared.

The Child Health Savings Account Act of 2022 (H.R. 6507), introduced by Beth Van Duyne (R-TX) in the House of Representatives, would expand HSA contribution eligibility requirements by allowing parents to contribute and deduct up to $3,000 each year to their childrens’ HSAs.

The HSA will be treated as the parent’s HSA until the child reaches age 18. At that time, it would become the child’s HSA. As the bill is currently drafted, any distributions taken out of the HSA before the child’s 18^th birthday would be included in the parent’s taxable income. Nonqualified distributions would also be subject to an additional 20 percent penalty tax. Once the child turns 18, distributions would be considered qualified only if they were taken while the child was not a dependent on the parent’s insurance (the child could be treated as the parent’s dependent for certain permitted insurance, but not for the parent’s health plan).

If the child were to become disabled or die, the parent would no longer be able to make contributions, but could roll over any HSA assets to their own IRA or HSA, or to another child’s HSA.

If enacted, this legislation would become effective for tax years beginning after the date of enactment. Any progress of the bill through Congress will be monitored, and details provided as they become available.

The Family Plus Health Care Act of 2022 (H.R. 6508), introduced by Beth Van Duyne (R-TX) in the House of Representatives, aims to expand group health plan coverage by requiring plans to offer participants the option of enrolling their parents in the plan, as long as the parents are not eligible to enroll in either Medicare or Medicaid.

The cost of the parents’ group health plan coverage would be excluded from the gross income of the employee participating in the plan. Self-employed individuals would be allowed to claim a deduction for the amount that they paid to insure their parents.

The term ‘parent’ includes an individual’s biological parent, a stepparent, and a parent by adoption, but does not include a spouse’s parent. If enacted, this legislation would apply to any amounts paid or incurred after the bill’s date of enactment.

On January 10, 2022, the Department of Labor’s Employee Benefits Security Administration, issued a new set of FAQs. This latest set of FAQs address questions relating to COVID-19 testing and diagnosis that must be covered by group health plans and health insurance issuers without cost sharing pursuant to the Families First Coronavirus Response Act (FFCRA). The FAQs require group health plans (GHPs) and health insurance issuers (issuers) to reimburse a participant or direct pay a provider for the cost of over-the-counter COVID-19 tests beginning January 15, 2022. The FAQs also provide the following information.

On November 22, 2021, the Department of the Treasury released a Notice of Proposed Rulemaking (NPR) entitled, "Information Reporting of Health Insurance Coverage and Other Issues Under Internal Revenue Code Sections (IRC Secs.) 5000A, 6055, and 6056," that extend the applicable deadlines to furnish statements, clarify that certain Medicaid coverage is not minimum essential coverage, and provide a deadline to submit comments relating to 2016 proposed rules affecting reporting. Comments related to the NPR are due 60 days following the publication of the NPR in the federal register. The NPR provides as follows.

The IRS has issued Revenue Procedure (Rev. Proc.) 2021-45, which contains cost-of-living adjustments for taxable years beginning in 2022 for over 60 tax provisions, including the following health and welfare benefits.

The IRS has issued Notice 2021-58, which clarifies the application of extension under the “Joint Notification of Extensions of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak” and additional guidance issued by the Department of Labor’s Emergency Relief Notices. Moreover, this notice addresses the interaction between the Emergency Relief Notices and COBRA premium assistance available under the American Rescue Plan Act (ARPA).

The IRS has issued Notice 2021-46, which provides additional guidance affecting the application of the American Rescue Plan Act of 2021 on COBRA continuation coverage. The notice primarily focuses on state mini-COBRA provisions and the premium subsidy credit as follows.

Senator Ben Sasse (R-NE) recently introduced two bills aimed at providing more flexibility for the use of health savings accounts (HSAs). Senate bill 2113 proposes to expand permissible distributions from an employee’s health flexible spending arrangement or health reimbursement arrangement to the employee’s HSA. Senate bill 2099 proposes to make HSAs more broadly available by removing the requirement that individuals be enrolled in a high deductible health plan. Further details of these proposals have not yet been made available.