Category Archives: Healthcare

Get Out of ERISA Jail

Four questions to ask your clients about their plans.

If you’re a benefit communicator, you can keep your clients out of ERISA jail (metaphorical only) by helping them keep their plans⏤and required disclosures⏤up to date by asking these four questions. 

Will your plans cover COVID treatment and vaccines at 100% after July 10, when the emergency period ends?

Benefits for COVID treatment may be covered the same as any other illness after this date, but the federal government encourages plan sponsors to keep the 100% benefit in place. The 100% benefit for COVID vaccinations is required separately by the CARES Act. Plans that want to provide a lower benefit must notify participants 60 days in advance by issuing a new Summary of Benefits and Coverage (SBC) for each medical coverage option.

Did you describe the suspended (“tolled”) deadlines for filing claims, choosing COBRA, and making change of status notifications?

Some plan sponsors used a footnote in their annual enrollment SMMs to indicate the deadlines that were affected. The deadlines remain suspended for claims or status changes that occur before May 10, 2023. Because some plans allow claims to be filed up to a year after the date an expense is incurred, advise your clients to keep the tolled deadlines in their communications through the first half of 2024, and include the date the end effect of the emergency period ends.


You must request enrollment within 31 days* after the marriage, birth, or adoption…

* This deadline was extended on March 1, 2020, until the earlier of (a) one year after the original deadline, or (b) May 10, 2023. 

Will you extend the Special Enrollment Period for those who lose Medicaid coverage beyond the required 60 days?

With the end of COVID emergency period mandates, many people will lose their state-managed Medicaid coverage. This will drive lower-paid employees back into employer’s plans before the next open enrollment. Plans must allow eligible employees and dependents to enroll during the 60-day period after their Medicaid coverage ends. However, the federal government is encouraging plan sponsors to offer a more generous Special Enrollment Period window⏤ the 60-day period is a required minimum, not a maximum. Employers with a large group of lower-paid employees may want to communicate this opportunity to bring these eligible employees back into their plans through an organized mid-year campaign. 

Do your retirement plans change their required minimum distribution (RMD) dates with changes in the law?

Remember when you changed all the references in your retirement plan communications from “the year you reach age 70-1/2” to “the year you reach age 72?” You get to change them again. Under SECURE 2.0, the RMD rule applies at age 73 for participants who reach age 72 during this calendar year. And mark your calendar, because in 2032, that age jumps to 75. Plan sponsors will especially want to communicate this change to their vested terminated members. 

But have your client check their plan documents first! The language in some plans⏤especially defined benefit plans⏤is fixed on the original age 70-1/2 date. For some plan sponsors, that could result in different RMDs for their defined benefit and defined contribution plans⏤and the need for some carefully crafted communications to participants. 

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What changes mean for employer health plans.

The COVID-19 national emergency ended April 10, 2023. The COVID-19 public health emergency ends on May 11, 2023. 

These two emergencies brought relief in a number of areas including, but not limited to, hospital stays, data reporting, testing and diagnosis, Medicare, Medicaid, CHIP and timeframes for certain benefit elections under employer health plans. 

This summary deals with what the end of these emergencies mean to employer health plans. Although Medicare, Medicaid and CHIP are mentioned, this is because of possible tangential effects on employer health plans.

While researching these provisions, some situations appear to be in flux. Expect clarifications to be made if any of the following are materially changed.

1. COVID-19 diagnostic testing:

Employer health plans will no longer be required to cover COVID-19 diagnostic testing (including over-the-counter tests) at no cost. 

2. COVID-19 vaccinations: 

Health plans may impose cost sharing if a participant gets a vaccine from a provider that is not in the participant’s employer health plan’s network. (The Affordable Care Act allows health plans to require cost sharing of out-of-network preventive services.) 

3. Deadlines for key health benefit decisions:

During the national emergency, many employer health plans were required to give participants more time to make key decisions regarding employer health coverage. 

For example, participants and family members had more time to request a special enrollment to join employer health plans. Also, more time was allowed regarding electing and paying for COBRA continuation coverage, as well as submitting appeals to employer health plans.

For these events or circumstances, relief will continue for 60 days after the end of the public health emergency (July 23, 2023). After this date, it appears employer health plans may revert to their original timeframes. 

Interestingly, Questions and Answers published by the DOL emphasize that “…nothing in the Code or ERISA prevents a group health plan from allowing for longer timeframesfor employees, participants or beneficiaries to complete these actions, and group health plans are encouraged to do so.”

So it is possible some employer health plans may allow for longer timeframes than those required by law.

4. Telehealth: 

During COVID-19 public health emergency, many employer health plans expanded coverage of telehealth services. These provisions may change now the emergencies are over. Medicare will continue to keep in place telehealth services until December 2024. 

5. Medicaid and CHIP Coverage:

Coverage through Medicaid or the Children’s Health Insurance Program (CHIP), may end as states are able to resume Medicaid and CHIP eligibility reviews.

6. Doctor Visits:

During the pandemic, rules requiring patients to see a doctor to be prescribed controlled substances such as Adderall and Buprenorphine were waived. That being said the DEA proposed new regulations on when doctor visits would be required for the prescription of certain controlled substance as follows:

“The Drug Enforcement Administration (DEA) has proposed, but not finalized, rules allowing buprenorphine for opioid addiction, testosterone for gender-affirming care, or ketamine for depression, an initial 30-day supply via telemedicine.” However, a doctor’s visit would be required to refill these prescriptions. Prescriptions for Adderall and Oxycontin would require a doctor visit.

Due to push back from Congress and the general public, the DEA has extended pandemic rules until it finalizes new ones. At some point, the DEA will publish new regs setting parameters around prescriptions and when doctor visits are required.


–U.S. Department of Labor Blog, “Five Important Changes to Your Health Coverage Once the COVID-19 Public Health Emergency Ends” March 29, 2023

–Questions and Answers published by Department of Labor (DOL), Health & Human Services (HHS) and the Treasury, March 29, 2023

–POLITICO Pro, “What Goes Away When the Covid Health Emergency Ends this Week.” May 8, 2023

–All Things HR, “Federal Court Blocks Enforcement of Some ACA Preventive Health Services Requirements: What Plan Sponsors Should Consider.” Dickinson Wright, May 9, 2023

–SHRM, “Early End to National COVID-19 Emergency Won’t Change July 10 Deadline.”

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Leveraging Tax Day

Promote HSAs during tax season for a better return.

Tax Day in the U.S. is anticipated by those receiving refunds; dreaded by those who owe. April 15 is a national touchpoint that creates an opportunity to promote the multiple tax advantages of a health savings account (HSA).

HSAs make sense

When coupled with a High Deductible Health Plan (HDHP), an HSA is a great choice for many participants.* Some of the benefits of an HSA include:

Affordable. HDHPs have lower premiums and higher out-of-pocket costs. HSAs make these plans work.
Flexible. Participants have more control over how they spend their healthcare dollars on a variety of healthcare expenses such as dental, vision, and alternative medicine.
Portable. Participants own their HSA, allowing them to keep their savings when they change jobs or retire.
Valuable. Participants can build equity because an HSA acts as a long-term savings vehicle. (More so if employers contribute to participants’ HSAs.)
Deductible. HSAs allow participants to save pre-tax dollars on healthcare expenses, reducing their taxable income, which results in tax savings.

*Depending on individual circumstances and changes in tax laws, there could be limitations on and disadvantages to contributing to an HSA. Employers should encourage participants to consult a qualified financial advisor about the potential impact of participating.

HSAs make cents (and dollars)

There are more advantages than are commonly understood. Participants can benefit from these three and more:

  1. There is an April 15th loophole that allows participants to retroactively fund their HSA after they know their qualifying expenses from the previous year.
  2. Adult children who ARE covered under a parent’s health plan AND who are NOT claimed as a dependent on a parent’s tax return, can fund their own HSA.
  3. Qualifying expenses can be reimbursed years later. And HSA qualifying expenses are defined more broadly than an insurance company’s ⏤ ranging from aspirin to acupuncture (with a receipt). These HSA reimbursements are not taxed, unlike withdrawals from a 401(k), making HSAs potential rainy-day accounts.

Piggybacking on tax season messages

Tax season creates a timely opportunity to remind participants of the tax advantages that a health saving account benefit offers them.

Below are a few ideas to help get you started.

● Use tax season as a natural segue to a discussion of the tax benefits of an HSA, piggybacking your internal marketing efforts on other media messaging about tax deadlines.
● Remind potential participants that they have until April 15 of the current year to fund HSA dollars that can be used for qualified expenses incurred the previous year.
● Focus on a one or two-week campaign around April 15th for maximum impact, but don’t limit efforts to educate about the benefits of this valuable, but often overlooked, benefit all year long.

Need more ideas or help executing the ideas above? Contact Smith Communication Partners; participant communication is what we do.

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Easy Choices

Do simple names help employees make complex decisions?

HDHP/HSA: An Overview 

Since its inception in 2004, the adoption rate of the High-Deductible Health Plan (HDHP) has been growing. Today, approximately 30% of covered workers in the United States participate in an HDHP. Originally offered as an alternative to PPOs and HMOs, the HDHP was intended to incentivize consumer behavior in healthcare. Its plan design, which allows it to be paired with a tax-advantaged Health Savings Account (HSA), was distinct from existing medical plan options and the name alone made it easy for HDHPs to stand apart.

The Challenge of Naming a Plan

As acceptance has grown, so have the options. Employers are increasingly adding not just one HDHP, but multiple HDHPs. In these cases, quickly distinguishing one HDHP option from another through use of a descriptive plan name can be challenging. 

This is due, in part, to low understanding among employees of key medical plan features:

  • Premium: the amount the employee pays for the coverage each month
  • Deductible: the amount the employee pays for covered services before their insurance starts to pay
  • Copayment: a fixed dollar amount the employee pays for certain healthcare services
  • Coinsurance: the employee’s share of the costs of a healthcare service once coverage kicks in 
  • Out-of-Pocket Maximum: the most the employee pays during the plan year before the plan starts to pay 100% of the allowed amount

Generally, higher deductibles and out-of-pocket maximums result in lower premiums and multiple HDHPs are distinguished from each other by these amounts (rather than by features such as access to out-of-network providers).  

Comparing these multiple plans can be challenging for employees because there are many variables must be compared against one another.

  • How much will this cost me each month?
  • How much health care will my family use?
  • How much risk am I taking over the course of the year?
  • How much will my medications cost?
  • How much can I save in HSA over time?

These are not trivial one-to-one cost analysis. They are highly individualized and impactful for most employees’ health care budgets. Therefore, finding simple, easily understood names for the plans is also difficult and complicated.  

Common Approaches to Naming HDHPs

Metallic Plans (Platinum, Gold, Silver, Bronze)

This is likely the most familiar option, as it is employed by Similar to how they are used in the Olympics (or by jewelers), these metals distinguish plans by actuarial value with Platinum being the highest followed by Gold, Silver and Bronze. 

Metallic names seem to offer an immediate recognition of value. (Would you rather have an ounce of bronze or an ounce of Gold?) However, metallic names are problematic, because it’s not necessarily clear to the employee what that value means. 

It could easily be inferred that Platinum plans are most expensive, but that’s only true with regard to premiums. Yet, high premiums may be a waste of money for people who don’t use very much health care.  It could also be inferred that Bronze plans are worth less, but they could be a better deal for the employee based on their use of health care, and a greater ability to save money in an HSA. 

Deductible Amounts

Including the deductible amount in a plan’s name immediately conveys useful information about the underlying plan. However, as mentioned above, employees might not necessarily understand this concept. For example, some employees might be willing to pay higher premiums in exchange for a lower deductible because they may assume a lower deductible means “more” or “better” coverage.

Some employers use only the individual deductible in the name (which can cause confusion for those who choose family coverage), and some use both the individual and family deductible, (which can result in long or clunky names).

  • Single Deductible Approach: HSA $1,500 and HSA $3,000
  • Both Deductible Approach: HSA $1,500/$3,000 and HSA $3,000/$6,000

Comparative Descriptors

Another approach is to use descriptive terms that attempt to convey how the plans are different. However, these approaches have similar pros and cons as the metallic names; they have inherent meanings but might mislead employees.

  • HSA Premium and HSA Standard 
  • HSA Plus and HSA 
  • HSA High and HSA Low 
  • HSA and HSA Core 
  • HSA and HSA Basic
  • HSA and HSA Value 
  • HSA High Use and HSA Low Use

Non-comparative Descriptors

Another approach would be to use descriptors that merely indicate the two options are different without implying any comparison. These labels have no inherent meaning. Employees would have to learn what each means over time.

  • HSA Blue and HSA White
  • HSA 1 and HSA 2
  • HSA A and HSA B


There is no right or wrong approach to naming HDHPs. The metallic names, though simple and easy to understand, are imperfect. Other comparative and descriptive methods also fall short. Simplicity cannot be the ultimate concern. 

Employees need to understand the features of their health plans through effective communication and tools that help them model and compare the offered plans against their individual circumstances. Any name will work, if it is properly supported with information employees can usefully access and apply.

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