Kathleen Cahill Slaught (Chair)
Seyfarth Shaw LLP
560 Mission Street
San Francisco, CA 94105
Renée B. Appel
Alan B. Cabral
Benjamin J. Conley
Liz J. Deckman
William B. Eck
James M. Hlawek
Stanley S. Jutkowitz
Edward J. Karlin
Gregory A. Markel
Danita N. Merlau
Kelly Joan Pointer
Suzanne L. Saxman
Richard G. Schwartz
Benjamin F. Spater
Michael W. Stevens
Kaley M. Ventura
§ 1.1 Want to Put More Away in Your 401(k)? Qualified Plan Limits Generally Remain Constant in 2021
Seyfarth Synopsis: Many of the limitations that apply to tax-qualified plans, including 401(k) and 403(b) plans, are subject to cost-of-living increases. The IRS just announced the 2021 limits. The annual employee salary deferral contribution limits are not changing, but there are a few adjustments for 2021 that employers maintaining tax-qualified retirement plans will need to make to the plans’ administrative/operational procedures.
In Notice 2020-79, the IRS recently announced the various limits that apply to tax-qualified retirement plans in 2021. Notably, the “regular” 401(k) contribution limit and the “catch-up” contribution limit are not changing, and will remain at $19,500 and $6,500, respectively, for 2021. Thus, if you are or will be age 50 by the end of 2021, you may be eligible to contribute up to $26,000 to your 401(k) plan in 2021. These same limitations apply if you work for a governmental or tax-exempt employer and participate in a 403(b) plan.
The annual plan limits that did increase for 2021 include:
- the maximum that may be contributed to a defined contribution plan (e.g., 401(k) or 403(b) plan) in 2021, inclusive of both employee and employer contributions, will increase by $1,000 to $58,000; and
- the maximum annual compensation that may be taken into account under a plan (the 401(a)(17) limit) will increase from $285,000 to $290,000.
The Notice includes numerous other retirement-related limitations for 2021, including a $6,000 limit on qualified IRA contributions (unchanged) and adjustments to the income phase-out for making qualified IRA contributions. Other dollar limits for 2021 that are not changing include the dollar limitation on the annual benefit under a defined benefit plan ($230,000), the dollar limit used to determine a highly compensated employee ($130,000), and the dollar limit used when defining a key employee in a top-heavy plan ($185,000).
Individuals should check their plan contribution elections and consult with their personal tax advisor before the end of 2020 to make sure that they take full advantage of the contribution limits in 2021. Although many limits are not changing, employers who sponsor a tax-qualified retirement plan should still consider any necessary adjustments to plan administrative procedures and participant notices to ensure proper administration of the plan in 2021.
Employers who sponsor defined benefit pension plans (e.g., cash balance plans) also should be sure to review the new limits in the IRS Notice and make any necessary adjustments to plan administrative/operational procedures.
Sarah Touzalin and Richard G. Schwartz
§ 1.2 The Supreme Court Wrestles (Again) With The Constitutionality Of The Affordable Care Act (ACA)
Earlier today, the Supreme Court heard oral arguments on the most recent challenge to the Affordable Care Act. The case has the potential to invalidate the entire law. While the Court’s decision isn’t expected soon, the oral arguments may provide some clues as to which way the Justices are leaning. We stress, however, that statements made during oral argument are not binding, and Justices remain free to rule as they deem appropriate.
On November 10, 2020, the Supreme Court heard oral argument on the constitutionality of the ACA. The case is captioned California v. Texas, No. 19-10011.
The case was brought by a group of state attorneys general in the wake of the 2017 Tax Cuts and Jobs Act, which reduced the individual tax for failure to maintain health insurance coverage to $0. The Trump Administration chose not to defend the law, but the lower courts granted leave to other states’ attorneys general and to the House of Representatives to defend the law. The arguments in the case addressed the following three issues:
- Do the plaintiff states have standing to challenge the constitutionality of the individual mandate?
- If so, did Congress’s actions in “zeroing out” the penalty for the mandate render the mandate an unconstitutional exercise of Congressional power?
- If so, is the mandate severable from the remainder of the ACA, or should the entire law fall?
The Court had previously ruled in 2012 that the ACA’s individual mandate was constitutional, as it represented an exercise of the lawful power of Congress to tax, and provide citizens with a reasonable choice of purchasing approved health insurance or paying a tax as a penalty. In that ruling, however, five Justices found that Congress cannot rely on its Commerce Clause power to enact the ACA. In other words, the Court upheld the mandate only by finding that the mandate was a tax, not a penalty. So, the question before the Court at present is whether the mandate can truly be considered a tax if it generates no revenue.
The Court under Chief Justice Roberts has shown an aversion to wading into politically sensitive rulings, given the current politically polarized climate. And this case has a complicated political overlay. The Court’s ruling here takes on heightened significance in the wake of the recent election in which Republicans appear to have maintained control of the Senate, because that takes away the Democrats’ avenue to “cure” the challenged provision by simply implementing a tax above $0 to enforce the individual mandate.
There are two ways that the Court can avoid a finding of unconstitutionality.
First, there is the issue of Article III standing. As we have previously opined, https://www.beneficiallyyours.com/?s=california+texas, there is a substantial question whether there is a sufficient injury traceable to the actions of the defendants to justify a lawsuit on the merits. The November 10 oral argument focused on whether an injury could be said to have occurred because of increased reporting requirements, Medicaid payments by the state and the ACA restriction on what health policies an American can purchase in the marketplace. But a failure to purchase insurance does not directly cause injury—the tax penalty is $0. Justice Thomas described this issue in terms that we all can understand given our COVID times. He asked whether an American could sue in federal court to challenge a mask mandate that is not enforced. Justice Gorsuch and some of the more liberal Justices, however, expressed some concern that if the Court were to grant standing in this case, it would open the door to more challenges to federal law.
Look for the Court to limit any finding of standing to the peculiar facts of California v. Texas, given the concern about the federal judicial chaos that could result from a broader ruling on standing.
Second, there is the issue of severability. It is true that the individual mandate remains a part of the ACA, and it does state that all Americans “shall” purchase compliant insurance. It is also true that the constitutionality of that mandate is based on Congress’s taxing power that now is exercised at $0. It is true as well that a future Congress might increase the tax above $0, which might explain why the 2017 reduction to that level was not accompanied with a repeal of the individual mandate.
Justice Thomas pressed the attorney for the House of Representatives on how he could argue that the mandate is severable when, in 2012, he had argued that it was the “heart and soul” of the law. On the other hand, many Court observers honed in on statements from Chief Justice Roberts and Justice Kavanaugh, both of whom seemed to express reservation at “reading into” Congressional intent rather than simply looking to the actions taken by Congress in zeroing out the individual mandate (while leaving the rest of the law intact). Justice Alito offered a hypothetical involving a plane that is presumed to be incapable of flight without a crucial instrument, but that then continues flying without issue once that instrument is removed.
While it is impossible at oral argument to discern how nine Justices will rule, hints from the arguments suggest the Court may have the votes to find standing (in a limited way) and declare only the individual mandate (and not the remainder of the law) to be unconstitutional as long as it is enforced by a $0 tax. We anxiously await the decision of the Court, and its reasoning.
Mark Casciari and Benjamin J. Conley
§ 1.3 No, You Cannot Invest Your Retirement Plan to Save the Planet!
Seyfarth Synopsis: On October 30, 2020, the Department of Labor (“DOL”) released a final regulation amending the fiduciary regulations governing investment duties under the Employee Retirement Investment Security Act of 1974 (“ERISA”). This final regulation is clear that an ERISA fiduciary should not consider “non-pecuniary” factors such as environmental, social or corporate governance (“ESG”) or sustainability factors when considering an investment or investment strategy. Under the final rule, investment fiduciaries must evaluate investments and investment strategies solely based on pecuniary factors. The final regulation is generally effective 60 days after it is published in the Federal Register.
The DOL proposed this regulation on June 23, 2020, which is discussed in our July 1, 2020 post, Can You Invest Your Retirement Plan to Save the Planet? ERISA investment fiduciaries have been faced with the dilemma of whether social investing concepts have a role when investing ERISA plan assets. It appears that the DOL has answered this question. Specifically, social investing concepts only have a role if they potentially impact the risk of loss or opportunity for return of the proposed investment.
The DOL received numerous comment letters and objections critical to its proposed regulation, including claims that it was unnecessary rulemaking, reflected antiquated views, and provided too short a comment period. Despite the extensive comments it received, the final regulation is substantially the same as the proposed regulation. References to ESG were removed from the final regulation because the DOL did not want to narrow or limit the application of the final regulation. Under the final regulation, challenges remain for fiduciaries who consider non-pecuniary factors when making investment decisions.
The final regulation limited pecuniary factors to those factors that a fiduciary prudently determines are expected to have a material effect on the risk and/or return of an investment in light of the plan’s investment horizon, investment objectives and funding policy. While many investors may believe that a company that incorporates ESG principles to manage its risks and create opportunities offers an inherently less risky investment, the DOL does not appear to be willing to accept the argument that ESG in and of itself could be a pecuniary factor.
The final rule continues to provide for “tie breakers,” even though the preamble questions whether there could be a true tie-breaker situation. In such a situation, fiduciaries must document: why pecuniary factors were not sufficient to select the investment or investment course of action; how the selected investment compares to available alternatives; and how the non-pecuniary factors considered were consistent with the interest of the participants in their plan benefits. The DOL indicated in the preamble that whether an investment could increase plan contributions — e.g., investing the assets of a multiemployer plan in projects that will employ union members and increase contributions to the plan — was not a pecuniary interest. The same is true for adding an investment in response to interest expressed by plan participants.
For individual account plans that allow plan participants to choose from a range of investment alternatives, the regulation prohibits a fiduciary from considering or including an investment fund solely because the fund promotes, seeks or supports one of more non-pecuniary goals—e.g., an ESG focused fund. But, it does not prohibit including an ESG focused fund in the investment line-up. The final regulation, however, prohibits qualified default investment alternatives (QDIAs) with investment objectives or principal investment strategies that “include, consider, or indicate the use of one or more non-pecuniary factors.” This prohibition could be interpreted to cast a wide net.
The regulations would make it difficult or impossible for plan fiduciaries to consider non-pecuniary factors (e.g., religious tenets, ESG factors, etc.) when selecting investment options under an ERISA participant-directed defined contribution plan. A potential solution could be offering a brokerage window, which can provide access to individuals who wish to invest their accounts according to non-pecuniary factors such as religious tenets. Brokerage windows have their pros and cons. In addition, a fiduciary’s duties and responsibilities with respect to a brokerage window are not settled.
Historically, the DOL’s position on the role of ESG in ERISA plan investing has shifted with changes in administrations. With these final regulations, there is no doubt that the DOL has clearly shifted against marketplace trends. But, with a Biden administration coming onboard, calls for the SEC to address ESG disclosures and a Senate task force aimed at overhauling corporate governance, questions remain on whether the door on the role of ESG investing is closed. For information on ESG in the broader marketplace and what it means from a company perspective, see our alert series here, here, here and here.
If you are concerned about an existing non-pecuniary investment or investment strategy (e.g., an ESG or sustainability investment) or are interested in such an investment or strategy, be sure to contact your Seyfarth employee benefits attorney.
Linda Haynes and Candace Quinn
§ 1.4 Happy New Year! The IRS Grants Permission to Celebrate New Year’s Eve
Seyfarth Synopsis: The IRS has announced that the due date for contributions to a single-employer defined benefit pension plan due in 2020, previously extended to January 1, 2021, by the CARES Act, will be considered timely if made no later than January 4, 2021.
Under the funding rules for qualified defined benefit pension plans, plan sponsors generally must make any minimum required contributions no later than 8-1/2 months after the plan year to which they relate. For calendar year plans, this means that the minimum required contribution is due no later than September 15th of the year following the applicable plan year. Plans with a funding shortfall for the prior plan year also must make quarterly minimum required contributions (for a calendar year plan, these contributions are due April 15th, July 15th, October 15th and the following January 15th).
The CARES Act, enacted in late March 2020 in response to the COVID-19 pandemic, delayed the timing of any annual and quarterly minimum required contributions due in 2020 (i.e., attributable to the 2019 plan year for calendar year plans) until January 1, 2021. As a practical matter, because January 1, 2021, is a national holiday and banks will not transfer funds on that date, the delayed contributions were actually due no later than December 31, 2020. IRS Notice 2020-82, just issued on November 16th, effectively extends the deadline to the first business day after the new year, i.e., January 4th. The guidance is welcome news for plan sponsors who wish to make contributions in calendar year 2021 rather than 2020.
Subsequent to the issuance of the IRS Notice, the PBGC followed suit and revised its guidance to incorporate the extension for contributions due in 2020 to January 4, 2021 for PBGC purposes.
§ 1.5 Final Rule regarding Transparency in Coverage for Health Care Services
Seyfarth Comments: The final Transparency in Coverage Rule was published jointly by the Departments of Health and Human Services, Treasury, and Labor on November 12, 2020. The Rule aims to increase transparency in cost-sharing for patients by requiring non-grandfathered group health plans and insurance issuers to publish certain healthcare price information estimates. The Rule takes effect January 11, 2021, with staggered effective dates for required disclosures through January 1, 2024.
The Transparency in Coverage Rule attempts to execute on the Trump Administration’s executive order on Improving Price and Quality Transparency in American Healthcare to Put Patients First, issued on June 24, 2019. The final Rule requires certain disclosures regarding prices and cost-sharing information for certain healthcare items and services provided by non-grandfathered group health plans and insurance issuers. The Rule generally applies to traditional health plan coverage, and does not apply to account-based group health plans (such as HRAs, including individual coverage HRAs, or health FSAs), excepted benefits, or short-term limited-duration insurance.
The Rule requires two categories of disclosures: disclosures to the public, and disclosures to plan participants.
For plan years beginning on or after January 1, 2022, group health plans and insurance issuers will be required to publicly disclose health care pricing information on an internet website, which must be updated monthly. In general, plans and issuers will have to disclose:
- In-network provider negotiated rates for covered items and services;
- Historical data showing billed and allowed amounts for covered items or services, including prescription drugs, furnished by out-of-network providers; and
- Negotiated rates and historical net prices for prescription drugs furnished by in-network providers.
Under the participant disclosure requirements, group health plans and issuers must provide certain personalized cost-sharing information to participants and beneficiaries in advance and upon request. The disclosures must be available both using an internet-based self-service tool and on paper if requested. The required disclosures must include the following information:
- The estimated cost-sharing liability for a requested covered item or service;
- Accumulated amounts, including unreimbursed amounts the participant or beneficiary has paid toward meeting his or her individual deductible and/or out-of-pocket limit (and if enrolled in other than self-only coverage, amounts incurred toward meeting the other than self-only coverage deductible or out-of-pocket limit);
- In-network negotiated rates for covered items and services;
- Out-of-network allowed amounts, or any other rate that provides a more accurate estimate of what the plan or issuer will pay for the requested covered item or service;
- Lists of covered items and services that are part of a bundled payment arrangement;
- Notice of items and/or services subject to a “prerequisite,” which is defined as concurrent review, prior authorization, and step-therapy or fail-first protocols that must be satisfied before the plan or issuer will cover the item or service (not including medical necessity determinations or other medical management techniques); and
- A disclosure notice that includes: balance billing provisions, possible variations in actual charges, a disclosure that the estimated cost-sharing liability is not a guarantee, the application of copayment assistance and/or third-party payments, and any other information deemed appropriate. A model notice is available on the Department of Labor’s website: https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/transparency-in-coverage-draft-model-disclosure.pdf
- Due to the extensive nature of the required disclosures, the Departments include a staggered schedule for providing the required participant disclosures under the Rule. For plan years beginning on or after January 1, 2023, plans must make this information available for 500 items and services listed in the Rule, and for plan years beginning on or after January 1, 2024, plans must make the information available for all items and services.
A group health plan may satisfy the disclosure requirements by entering into a written agreement with its third-party administrator (TPA), whereby the TPA will provide the information required by the Rule. Notably, if the TPA fails to provide the information required by the Rule, the plan remains responsible for noncompliance.
A plan or issuer will not fail to comply with the disclosure requirements if, while acting in good faith and with reasonable diligence: i) it makes an error or omission and corrects the information as soon as practicable; or ii) its internet website is temporarily inaccessible, provided it makes the information available as soon as practicable.
The extensive disclosures required by the Rule have been greeted with much criticism, in particular by the insurance industry. Litigation and other challenges to the Rule are anticipated. In particular, there are concerns that the Rule will impede the ability of service providers and drug companies to negotiate prices. Accordingly, the final Rule contains a severability clause so if a court holds any provision of the Rule to be unlawful, the remaining provisions will survive.
Seyfarth will continue to track further developments regarding the Rule. Also, be sure to sign up for our blog, Beneficially Yours, for further discussion of employee benefits topics and updates at https://www.beneficiallyyours.com/.
§ 1.6 SCOTUS Upholds Arkansas PBM Law Against ERISA Preemption Arguments
Seyfarth Synopsis: The Supreme Court unanimously upheld Act 900, an Arkansas law regulating Pharmacy Benefit Managers (PBMs). The opinion could be used as a framework for states to attempt to indirectly regulate ERISA plans via statutes or regulations that affect plan costs.
We previously addressed the Supreme Court’s consideration of Rutledge v. PCMA, which featured a pharmaceutical industry group’s challenge to Arkansas Act 900. The Act (a) regulated the price PBMs paid for certain prescription drugs, (b) created an appeal process whereby pharmacies could challenge a PBM’s rate of reimbursement, and (c) permitted pharmacies to decline to sell drugs at reimbursement rates below acquisition cost. As noted in our prior posts, PCMA (as supported by many amicus briefs from ERISA groups) argued that the law “relate[s] to an employee benefit plan” and, insofar as it applies to self-funded ERISA plans is preempted and thus impermissible. These ERISA groups argued that piecemeal state regulation undermines a central purpose of ERISA: to create one national private sector benefit plan jurisprudence, resulting in administrative savings and ultimately more plan benefits.
In an 8-0 Opinion (Justice Amy Coney Barrett not participating), the Court unanimously ruled in favor of Arkansas. The Court found that, while the Act can be said to be connected to increased plan costs and operational inefficiencies, “ERISA does not pre-empt state rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substantive coverage.” The Court added: “[C]ost uniformity was almost certainly not an object of pre-emption.” Finally, the Court said that ERISA plans are not essential to the Act’s operation, meaning that it has no exclusive reference to ERISA plans.
Justice Thomas alone concurred in the Opinion. He continued his disagreement with the Court’s ERISA preemption “connection with or reference to” standard. He would replace that standard with one that addresses whether any ERISA provision governs the same matter as the state law, and has a “meaningful,” presumably direct, relationship to the plan in light of ERISA’s text.
Implications for ERISA Plan Sponsors
The Court’s Opinion could be problematic for ERISA plan sponsors, who typically prefer a uniform administrative scheme across state lines. Many PBM agreements contain provisions permitting PBMs to charge additional fees or limit the scope of their services where states impose more restrictive regulations or guidelines. The Opinion will embolden states and localities to be more aggressive in their regulation of pharmacy benefits. We should expect these jurisdictions to argue that, after Rutledge, there is no preemption because they are simply regulating plan costs.
In any event, Rutledge leaves open the possibility that preemption will apply if the cost regulation is “so acute that it will effectively dictate plan choices.” And, state law that provides a cause of action or additional state remedies for claims allowed by ERISA, or directly amends ERISA plan terms or the ERISA scheme that governs plan administration, remain preempted.
Stay tuned to this blog for further updates on this important issue of benefit plan administration.
Mark Casciari, Benjamin J. Conley and Michael W. Stevens
§ 1.7 Changes to HIPAA Privacy Rules on the Horizon
Seyfarth Synopsis: The Department of Health and Human Services (HHS) has proposed changes to the required Privacy Notice under the HIPAA privacy regulations. If finalized, these would be the first significant changes to the HIPAA rules since the HITECH changes effective back in 2013.
The press release issued by HHS on December 10, 2020, states its intention to empower patients, improve coordinated care, and reduce regulatory burdens in the health care industry. HHS notes that the medical crises brought on by the opioid and COVID-19 epidemics have heightened the need to make these updates. While many of the changes directly affect health care providers and their patients, several provisions will also have an impact on employer-provided health plans. The Notice of Proposed Rulemaking is voluminous, but includes such things as an expansion of the definition of health care operations and the minimum necessary rule, changes to the required HIPAA Privacy Notice, shortened time frames to respond to individuals requests regarding their rights to their PHI, and disclosures of applicable fees for access to PHI. The Notice also provides long-awaited additional guidance on Electronic Health Records.
For more detailed information on the impact of these proposed changes on covered entity health plans, please see our Legal Update here. Also, click here for our Legal Update discussing these proposals and health care providers.
§ 1.8 HHS Proposes Changes to HIPAA Privacy Rules Affecting Group Health Plans
Seyfarth Synopsis: The Department of Health and Human Services (HHS) has issued a Notice of Proposed Rulemaking (NPRM) to modify the HIPAA Privacy Rule that protects the privacy and security of individuals’ protected health information (PHI) maintained or transmitted by or on behalf of HIPAA covered entities, such as employer-sponsored health plans. One of the stated purposes of the NPRM is to address some of the HIPAA Privacy Rule provisions that may limit care coordination and case management communications among individuals and healthcare providers.
Click here for our related blog post on this topic. While this Update will focus on the NPRM’s impact on health plans, click here for our separate Legal Update addressing some of the changes that apply to health care providers.
Under the NPRM, some of the changes that would affect employer-sponsored health plans include:
- Individual Care Coordination and Case Management. A health plan is permitted to use or disclose PHI for its own health care operations. (In addition, a health plan may disclose PHI to another covered entity for that entity’s health care operations in certain situations.) In order to encourage better, lower cost health care, the NPRM would revise the definition of “health care operations” to clarify that health plans can conduct care coordination and case management activities not only at the population level across multiple enrolled individuals, but also at the individual level. The NPRM also adds an exception to the minimum necessary rule for disclosures to, or requests by, a health plan for care coordination and case management activities that are at the individual level.
- Business Associate Disclosures of PHI. The NPRM would clarify that a business associate is required to disclose PHI to the covered entity so the covered entity can meet its access obligations. However, if a business associate agreement provides that the business associate will provide access to PHI in an electronic health record (EHR) directly to the individual or the individual’s designee, the business associate must then provide such direct access.
- Limited Disclosure When Individual is Not Present. The HIPAA Privacy Rule provides that if an individual is not present, or the opportunity to agree or object to the use or disclosure of PHI cannot be provided because of the individual’s incapacity or emergency circumstance, the health plan may disclose PHI that is directly relevant to the person’s involvement with the individual’s care or payment if the covered entity determines in its professional judgment that disclosure is in the best interest of the individual. The proposed rule would modify the standard under which that the determination is made, to be based on a good faith belief that the disclosure is in the best interests of the individual. This standard will allow health plan administrators to be better able to rely on this permitted disclosure circumstance by removing the inference that it only applied to providers when using a “professional” standard.
- Privacy Notice. The proposed rule would require changes to the notice of privacy practices. The NPRM requires a notice of privacy practices to include the following header:
“THIS NOTICE DESCRIBES:
– HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
– YOUR RIGHTS WITH RESPECT TO YOUR MEDICAL INFORMATION
– HOW TO EXERCISE YOUR RIGHT TO GET COPIES OF YOUR RECORDS AT LIMITED COST OR, IN SOME CASES, FREE OF CHARGE
– HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY, OR SECURITY OF YOUR MEDICAL INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION, INCLUDING YOUR RIGHT TO INSPECT OR GET COPIES OF YOUR RECORDS UNDER HIPAA.
YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH [ENTER NAME OR TITLE AT [PHONE AND EMAIL] IF YOU HAVE ANY QUESTIONS.”
In addition, the notice would have to describe the right of access to inspect and obtain a copy of PHI at limited cost or, in some cases, free of charge.
- Faster Access to PHI. Under the NPRM, a health plan would have to act on a request for access to inspect or obtain a copy of PHI in a shorter timeframe, namely 15 days after receipt of the request. Other time frames would be shortened as well.
- Electronic Health Record (EHR). The NPRM adds (i) a definition of EHR, (ii) requirements applicable to EHRs, including the right of an individual to direct his or her health plan to submit a request to a health care provider for electronic copies of PHI in an EHR; and (iii) a documentation requirement for EHRs.
- Fee Disclosures. Finally, the NPRM would require health plans to post fee schedules on their website for common types of requests for copies of PHI and, upon request, provide individualized estimates of fees for copies.
Comments on the NPRM will be due on or before 60 days after the NPRM is published in the Federal Register, which means comments will likely be due in mid-February.
§ 1.9 I Am Not Throwing Away My [COVID] Shot!
COVID-19 vaccines are finally here! Employers have a lot to think about in how this new tool in the fight against COVID-19 applies in the workplace, and whether it should be a mandatory aspect of employment. Check out the labor and employment considerations about the extent to which an employer should implement a vaccine policy, here and here.
Employers offering vaccine programs can also implicate ERISA as well when paying for (or mandating) the vaccine distributed to those employees not already covered under the employer’s group health plan. Check out this Legal Update here for thoughts on the benefits considerations employers face with their COVID-19 vaccine programs.
Getting the vaccines is the first step, but employers have decisions to make about what to do next. Keep tuned to our blog for future updates.
Benjamin J. Conley, Diane Dygert and Jennifer Kraft
§ 1.10 Yes, I Know it’s a Pandemic, But What About ERISA?!?!?!?
Benefits Implications in Employer-Sponsored COVID Vaccine Programs
Synopsis: Now that we have two approved vaccines (and several more on the horizon) employers are starting to explore whether they should require their employees to get vaccinated in order to report to work. There has been a lot of discussion on this topic by our labor & employment brethren and we direct you to those articles here and here for information about the extent to which an employer should implement a vaccine policy. This update explores the significance of mandating a vaccine versus offering voluntary vaccine coverage, and how that distinction may implicate additional requirements under ERISA.
Background: Why ERISA May Apply to Vaccination Programs
When employers pay for the provision of medical care to their employees, they are offering group health plan coverage (insured or self-funded) and they create an ERISA-governed welfare benefit plan. Group health plans are also subject to other federal statutes such as the Internal Revenue Code, the Affordable Care Act and the recent CARES Act. [See our post here on the CARES Act and vaccine requirements.] This framework leads to two critical questions in analyzing a vaccination program under ERISA:
- Is an Employer-Paid Vaccine Program “Medical Care”?
The EEOC has recently opined that the vaccine itself is not a medical examination. Fair enough; we didn’t think so. But, the questions that inevitably accompany the administration of the vaccine — for example, questions about allergies or auto-immune disorders—would constitute a medical examination and, therefore, must be job related. This doesn’t directly impact the analysis of whether we are dealing with a health plan here, but does highlight the government’s view that there is some aspect of the delivery of medical care present.
- If the Vaccine Program is for the Employer’s Benefit (i.e., mandatory) does ERISA still apply?
Arguably though, a mandatory program, as opposed to a voluntary inoculation program, is not offered for the employee’s own health. Section 3(1) of ERISA defines the term “employee welfare benefit plan” as a plan maintained by an employer to the extent it “is established or is maintained for the purpose of” providing medical benefits or benefits in the event of sickness. If an employee is receiving a COVID-19 vaccine through a mandatory program, arguably, it is not “for the purpose of” providing a medical benefit. That is an incidental benefit. Instead the vaccine is being provided to ensure the health and safety of those around the employee — co-workers, clients, customers or vendors. Under this argument, employers providing the vaccine through a mandatory program would not need to do so through an ERISA benefit plan. The DOL adopted this view in a nearly 25-year-old advisory opinion, albeit on the topic of mandatory workplace drug testing programs.
Why This Matters: Significance of ACA Requirements
The above questions are significant because the Affordable Care Act requires that all group health plans comply with certain requirements, including offering no-cost preventive services (e.g., colonoscopies, mammograms, etc.). A stand-alone COVID vaccination program, if offered on a voluntary basis, would not comply with those mandates. Accepting that the regulatory agencies might afford enforcement discretion given the circumstances, the IRS/DOL and HHS did provide a potential roadmap to “cure” this (technical) noncompliance in guidance issued earlier this year involving COVID testing.
There, the agencies seemed to suggest that COVID testing would be considered a group health plan, subject to the ACA mandates. This should not matter for employees enrolled in the employer-sponsored medical plans, because those individuals already have access to such free preventive care (as the health plan is required to offer it). So under earlier agency guidance, the two benefits could be considered a compliant, bundled offering.
For all other employees though, the agencies offered another “fix”. This informal guidance indicated that if such testing were to be “offered under” another type of benefit that is exempt from these ACA requirements, it would also benefit from the exemption. The two examples offered included an Employer Assistance Program (EAP) or an onsite clinic. This should, for most employers, offer a relatively simple solution. First, we would expect that once vaccines are available, many employers will offer an onsite vaccination program. For those that do not, most employers offer some form of EAP to their entire workforce (without regard to whether such persons are enrolled in the employer’s health coverage).
While the agency guidance was in the context of testing (not vaccinations), we believe it would be reasonable to assume the same exemption applies. Further, we assume this “bundling” could be offered without extensive additional efforts. Assuming a summary plan description already exists for the EAP (or onsite clinic), this could be as simple as adding a few lines to such document noting that the COVID vaccination program is a component of the offering.
Parting Shots (Pun Intended)
While uncertainty remains about whether the government would consider a mandatory COVID-19 vaccine program to be an ERISA plan, it is clear that the CARES Act mandates all group health plans to provide coverage for the COVID-19 vaccine. So, employer health plans will need to start covering the vaccine. Providing a COVID-19 vaccine program as an extension of the employer’s EAP should be permitted assuming the agencies carry forward COVID testing guidance (and we believe they would as they have every incentive to do so). While it is unclear whether such an approach would be necessary only for voluntary programs, or for mandatory programs as well, this offers a simple solution for employers to provide this benefit to the greatest number of its employees, while still ensuring compliance with ERISA.
Keep your eye on this space for developing news about vaccine programs.
Benjamin J. Conley, Diane Dygert and Jennifer Kraft
On December 27, 2020, President Trump signed into law the $2.3 trillion coronavirus relief and government funding bill. In addition to other provisions, the law specifically adds $284 billion to the already successful Paycheck Protection Program (“PPP”) previously enacted under the CARES Act. PPP loans will be available both to first-time borrowers and some second-time borrowers, but different criteria apply to each group.
While the Small Business Administration (“SBA”), the federal agency principally responsible for administering the PPP, has yet to announce details and guidance specifically relating to this supplemental funding, the following key details of the program are described in the new law, itself:
- The following groups of first-time borrowers are eligible for PPP loans:
- borrowers that had been eligible for PPP loans are expected to be eligible
- not-for-profits (including churches and, for the first time, trade associations and other organizations exempt from tax under section 501(c)(6) of the Internal Revenue Code), subject to satisfaction of certain criteria (such as, employing no more than 300 employees, not being primarily engaged in political or lobbying activities)
- businesses that previously elected to take the Employee Retention Tax Credit
- news organizations (which were not previously eligible), subject to satisfaction of certain criteria (such as, employing no more than 500 employees per physical location or otherwise meeting the applicable SBA size standard, certifying that the proceeds of the PPP loan will be used for the business involved in production or distribution of locally focused or emergency information)
- certain hotel and food service operators with fewer than 300 employees per location and that fall within NAICS code 72
- A borrower that received funding in the initial round is eligible to receive a second round of funding if it meets the following eligibility criteria: (i) has fewer than 300 employees, (ii) has used or will use the full amount of the first PPP loan, and (iii) has experienced a 25% decline in gross receipts in at least one 2020 quarter when compared to the same quarter in 2019. The maximum loan size for second time borrowers is limited to $2,000,000.
- Borrowers that returned PPP loans in the first round may reapply for a PPP loan in this second round.
- Funds have been earmarked for distribution to (i) live venues, independent movie theaters and cultural institutions, (ii) “very small businesses” through community-based lenders like Community Development Financial Institutions and Minority Depository Institutions, and (iii) low income and underserved communities.
- Emphasis will be placed on minority and women owned businesses.
- Proceeds from PPP loans will be forgiven if not less than 60% of the loan proceeds were used to pay qualifying expenses which (in addition to employee wages, mortgage interest, rent and utility costs previously approved under PPP1) now include expenditures for worker protection and facility modification to comply with COVID-19 health guidelines, certain qualifying supplier costs and specified software and cloud computing costs and accounting payments.
- Reversing the IRS, the new law makes it explicit that businesses that had their PPP loan forgiven can continue and deduct the business expenses that were paid with the loan proceeds (this applies both to new PPP loans and outstanding PPP loans).
- The law provides for a simplified forgiveness process on loans of up to $150,000.
- The amount forgiven does not have to be reduced by the amount of any Economic Injury Disaster Loan Advance (up to $10,000) received.
While most borrowers remain eligible to borrow up to a maximum of 2.5 times average monthly payroll costs, hotel and food service operators that fall within NAICS code 72 are now eligible to borrow up to 3.5 times monthly payroll costs.
PPP loans will be made available until March 31, 2021. Borrowers will be able to choose a covered period of eight to twenty-four weeks during which to spend PPP loan proceeds on qualified expenses.
In addition, the law provides $20 billion for new Economic Injury Disaster Loans for businesses in low income communities, $43.5 billion for SBA debt relief payments and increases the refundable employee retention credit from $5,000 per employee for all of 2020 to $7,000 per employee per calendar quarter through the second quarter of 2021 by changing the calculation from 50% of wages paid up to $10,000 per employee for all 2020 calendar quarters to 70% of wages paid up to $10,000 per employee for any quarter through the second quarter of 2021.
Regulations are directed to be issued within 10 days of passage of the law. Seyfarth is actively monitoring all aspects of federal COVID-19 business stimulus funding legislation. Additional updates will be provided as guidance becomes available and is published. Visit our Beyond COVID-19 Resource Center for more information.
Edward J. Karlin, Stanley S. Jutkowitz, and Suzanne L. Saxman
§ 1.12 Stimulus Redux: What It Means for Welfare Benefit Plans
Seyfarth Synopsis: On December 27, 2020, President Trump signed the Consolidated Appropriations Act, 2021 which includes several provisions affecting employer-sponsored benefit plans, and provides voluntary relief related to the COVID-19 public health emergency that employers may choose to offer. Given the length and complexity of the Act, this Legal Update summarizes some of the key provisions affecting health and welfare plans.
Flexible spending arrangements (FSAs)
The Act contains several provisions intended to provide flexibility for participants in flexible spending account programs.
- Mid-year election changes. For plan years ending in 2021, a plan may allow participants to change the amount of their contributions to health or dependent care FSAs prospectively, without regard to any change in status.
- Carryover of account balances. A plan may allow participants to carry over any unused amounts or contributions remaining in a health or dependent care FSA from the 2020 plan year to the 2021 plan year, or from the 2021 plan year to the 2022 plan year.
- Grace Period Extension. For plan years ending in 2020 or 2021, plans may extend their grace period to 12 months after the end of the plan year.
- Unused Health FSA Account Balances. A plan may allow an employee who terminates his or her participation in a health care FSA during the 2020 or 2021 calendar year to continue to receive reimbursements from unused account balances through the end of the plan in which such participation ended (including any applicable grace).
- Dependent Care FSA & Aging Out. To qualify as an employment-related expense which is reimbursable from a dependent care FSA, the expense must be for care for a “qualifying individual” – which means a dependent who has not attained age 13. For dependents who aged out of eligibility during the pandemic (specifically, during the last plan year with a regular enrollment period ending on or before January 31, 2020), plans may extend the maximum age from 13 to 14.
Plan sponsors that want to take advantage of any of these relief provisions must adopt a plan amendment by the end of the first calendar year beginning after the end of the plan year in which the change takes effect. (For example, if mid-year election changes are allowed in 2021, a calendar year plan must be amended by December 31, 2022.) In addition, the plan must be operated in accordance with the amendment terms as of the effective date of the amendment.
A section of the Act called the “No Surprises Act” protects plan participants from surprise medical bills for certain emergency and non-emergency services rendered by out-of-network providers.
Emergency Services. If a plan provides any benefits with respect to “emergency services”, then the plan must cover such emergency services without the need for any prior authorization, regardless of whether the provider is in-network or out-of-network. With respect to services provided by out-of-network providers:
- The cost-sharing amounts for such services cannot be greater than if the services were provided by an in-network provider, and are calculated as if the total amount charged was equal to the median of contracted rates;
- A plan must make an initial payment or issue a notice of denial of payment to the provider within 30 days after receiving the provider’s bill, and must pay a total amount equal to the amount by which the out-of-network rate exceeds the cost-sharing; and
- Any cost-sharing payments made by the participant or covered beneficiary must be counted toward the plan’s in-network deductible or out-of-pocket maximum.
- With respect to an item or service furnished by an out-of-network provider, the Act provides for a 30-day open negotiation period to agree on the out-of-network rate to be paid, and an independent dispute resolution (IDR) process to resolve disputes. The IDR process will be run by independent entities with no affiliation to the plan or provider.
Non-Emergency Services. If a plan provides any coverage of non-emergency services performed by out-of-network providers at an in-network facility, the plan must cover such services under requirements similar to the emergency services requirements described above. The participant shall only be required to pay the in-network cost for out-of-network care provided at in-network facilities, unless the out-of-network provider notifies the patient of its out-of-network status and estimated charges 72 hours prior to receiving the out-of-network services, and the patient consents. In this case the out-of-network provider may balance bill the patient.
Air Ambulances. If a plan would cover air ambulance services from an in-network provider, the plan must cover such services provided by an out-of-network provider, under the parameters set forth above for emergency services.
Mental Health and Substance Use Disorder Benefits
In an attempt to strengthen parity between medical benefits and mental health benefits, plans and insurers that provide both medical/surgical benefits and mental health or substance use disorder (“mental health”) benefits and that impose non-quantitative treatment limitations (NQTLs) on mental health or substance use disorder benefits are required to perform and document comparative analyses of the design and application of NQTLs. Beginning February 10, 2021, these analyses must be made available to the DOL, HHS or IRS upon request.
The Act also requires the agencies to issue a compliance program guidance document to help plans comply with the mental health benefit requirements and to finalize guidance and regulations relating to mental health parity no later than 18 months after enactment (i.e. by June 27, 2022).
Gag Clauses. The Act prohibits “gag clauses” regarding price or quality information. Plans may not enter into agreements with health care providers (or a network of providers), third-party administrators or other service providers that would restrict the plan from:
- providing provider-specific cost or quality of care information to referring providers, plan sponsors, participants, beneficiaries or individuals eligible to become participants or beneficiaries;
- electronically accessing de-identified claims information for each participant or beneficiary in the plan, upon request and consistent with the HIPAA privacy rules, GINA and the ADA; or
- sharing this information, or directing that such information be shared, with a business associate, consistent with the HIPAA privacy rules, GINA and the ADA.
The Act requires group health plans to submit an annual attestation to HHS that the plan is in compliance with these requirements.
Cost Sharing Disclosure. For plan years beginning January 1, 2022, plans must include the following information on any identification card issued to participants and beneficiaries:
- Any applicable deductibles and out-of-pocket maximum limits.
- A telephone number and website address through which participants can obtain plan-related information.
Good Faith Estimates. For plan years beginning January 1, 2022, plans that receive a health care provider’s good faith estimate of expected charges for providing a service to a participant must furnish the participant a notice – in most cases within one business day of receiving the provider’s notice – that contains specified coverage information. For example, the plan’s notice to a participant must state:
- Whether the provider is a participating provider with respect to the scheduled service and, if so, the contracted rate for the service based on relevant billing and diagnostic codes.
- A good faith estimate of how much the health plan will pay for the items and services included in the provider’s estimate.
Loss of Network Provider Status. For plan years beginning January 1, 2022, if a plan has a contractual relationship with a health care provider or facility and either the contract or benefits provided under the contract are terminated while the individual is a “continuing care patient”, the plan must notify each such patient of the termination and permit the patient to elect to continue receiving benefits from the provider. Continuing care patients include those who are: undergoing a course of treatment for a pregnancy or serious condition, scheduled to undergo non-elective surgery or receive postoperative care, or receiving treatment for a terminal illness.
Reporting on Pharmacy Benefits
By December 27, 2021, and annually thereafter, plans will be required to submit to the DOL, IRS and HHS a report with specific information on the benefits paid for prescription drugs provided to participants and beneficiaries, including:
- The dates of the plan year, number of participants and beneficiaries, and each state in which coverage is offered.
- The 50 brand prescription drugs most frequently dispensed and the total number of paid claims for each drug.
- The 50 most costly prescription drugs by total annual spending.
- The 50 prescription drugs with the greatest increase in plan expenditures over the preceding plan year.
- Average monthly premium paid by the employer and by participants and beneficiaries.
- Impact of rebates, fees and other remuneration paid by drug manufacturers on premiums and out-of-pocket costs.
Within 18 months after the first pharmacy drug reports are received, the agencies will post a report on the internet on prescription drug reimbursement under group health plans, with pricing and premium trends.
Student Loan Repayments
Although the Act did not extend further relief for the actual repayment of student loans, it did extend the ability for employers to provide tax-preferred payments to employees for student loans. [See link here for our earlier post about the CARES Act relief on this.] The Act extends the ability of employers to make these payments under IRC Section 127 of up to $5250 per employee for five more years through December 31, 2025.
Disclosure of Compensation for Service Providers
Effective in 2012, employee benefit plan fiduciaries were required to get fee disclosures from service providers pursuant to ERISA Section 408(b)(2). However, service providers for welfare plans were temporarily exempt from that requirement until further guidance was issued. The Act ends that reprieve and extends the fee disclosure rules to group health plans, which means that service providers will have to comply with the fee disclosure rules, effective December 27, 2021.
Deductible Medical Expenses
Expenses incurred for medical care are deductible on an individual’s income tax return to the extent they exceed 7.5% of adjusted gross income. That was scheduled to increase to 10% beginning in 2021. The Act makes the 7.5% threshold permanent.
Plans will likely need assistance from their TPAs and pharmacy benefit managers complying with the new reporting and disclosure requirements. Please feel free to reach out to your Seyfarth benefits attorney for help with appropriate amendments to plans and service agreements. Also watch for additional Legal Updates addressing specific employee benefit provisions of the Act and related guidance.
Diane V. Dygert and Joy Sellstrom
§ 1.13 Stimulus Redux: What It Means for Retirement Plans
Seyfarth Synopsis: On December 27, 2020, President Trump signed the Consolidated Appropriations Act, 2021 (the “Act”), which includes several changes that impact tax-qualified retirement plans (both defined benefit and defined contribution plans, including certain multiemployer plans). This Legal Update summarizes the key changes impacting retirement plans. See our parallel Legal Update for a description of the health and welfare-related provisions of the Act.
Partial Plan Terminations
Typically, whether a partial termination has occurred (which would require a plan to fully vest affected participants) is based on applicable facts and circumstances, and there is a rebuttable presumption that a turnover rate of at least 20% creates a partial termination. Under the Act, however, a plan will not experience a partial termination under the Code during any plan year that occurs during the period that begins on March 13, 2020 and ends on March 31, 2021, if the number of active participants covered by the plan on March 31, 2021 is at least 80 percent of the number of active participants covered by the plan on March 13, 2020.
Observation. The Act’s bright line rule should be helpful to plan sponsors who experienced high turnover, furloughs and layoffs among its employee population in 2020 due to the COVID-19 pandemic.
Disaster Relief Provisions
The Act includes a number of disaster relief provisions that allow defined contribution plan participants who reside in a qualified disaster area and who have sustained an economic loss by reason of a qualified disaster to take a tax-favored withdrawal or distribution from a retirement plan, borrow more money from a plan or suspend loan repayments on new or existing plan loans.
A “qualified disaster area” under the Act is generally any area where a major disaster was declared by the President during the period beginning on January 1, 2020, and ending on February 25, 2021, if the period during which such disaster occurred (the “incident period” as specified by FEMA), began on or after December 28, 2019, but on or before December 27, 2020 (i.e., the date of the enactment of the Act). Notably, the disaster relief under the Act does not apply where the President has declared a disaster only on account of the COVID-19 pandemic.
- Tax-Favored Disaster Withdrawals. A participant may take a tax-favored withdrawal from defined contribution plan (including an IRA) of up to $100,000, free from the 10% penalty that normally applies to early withdrawals. When determining whether the $100,000 limit has been exceeded, you take into account all plans maintained by the employer and members of its controlled group. For an individual affected by more than one qualified disaster, these limits apply separately to each qualified disaster.
A qualified disaster distribution must be made on or after the first day of the incident period of a qualified disaster and before June 25, 2021 (180 days after the date of the enactment of the Act). A participant who takes a tax-favored disaster withdrawal may elect to include the distribution in taxable income ratably over a three-year period and/or re-contribute the distribution to an eligible retirement plan within such three-year period. A participant who chooses to repay is treated as having received the distribution in an eligible rollover distribution, and then directly transferring it tax-free to the eligible retirement plan.
- Re-contribution of Certain Hardship Withdrawals. The Act allows a defined contribution plan participant who took hardship withdrawal that was intended to be used to purchase or construct a principal residence to re-contribute the distribution to an eligible retirement plan in the event that it could not be used for such purpose on account of the occurrence of a qualified disaster in the area where the home was located or was to be constructed.
In order to be eligible for this relief, the participant must have received the hardship withdrawal during the period beginning on the date that is 180 days before the first day of the incident period of the qualified disaster, and ending on the date that is 30 days after the last day of the incident period. A participant who meets the requirements for this relief must re-contribute the hardship withdrawal during the period that begins on or after the first day of the incident period of a qualified disaster and before June 25, 2021 (i.e., 180 days after the date of the enactment of the Act).
- Plan Loans: Increase in Limit and Extension of Period to Repay. Certain “qualified individuals” (defined below) may now borrow more from their defined contribution retirement plans, and have additional time to repay new or existing plan loans if the requirements below are satisfied.
- Increase in Limit for New Loans. For a qualified individual, the limit on plan loans is increased to the lesser of $100,000, or 100% of the participant’s vested account balance, instead of the $50,000 and 50% vested account balance limits that normally apply under law. This applies for loans made from December 27, 2020 to June 25, 2021 (the 180-day period beginning on the date of the Act’s enactment).
- Extension of Period to Repay for New and Existing Loans. The Act also provides some relief for new and existing loans, delaying repayments for plan loans outstanding on or after the first day of the incident period of the disaster by one year (or if later, June 25, 2021), provided the payment is otherwise due on or before and ending on the date which is 180 days after the last day of such incident period. This additional year is disregarded for purposes of applying the maximum 5-year term that applies to a general purpose loan, or the maximum term that applies to a home loan (pursuant to the terms of the plan and loan agreement). When payments recommence, they are reamortized to reflect the delay in repayment and any interest accrued during the suspension period.
A “qualified individual” is defined under the Act as an individual whose principal place of residence at any time during the incident period of a qualified disaster is located in the qualified disaster area, and such individual has sustained an economic loss by reason of the qualified disaster.
- Plan Amendment Deadline. Plan sponsors have at least until the last day of the first plan year beginning on or after January 1, 2022 (i.e., December 31, 2022 for calendar year plans) to amend their plans to provide for this disaster relief. Plan sponsors of governmental plans would have an extra two (2) years to amend their plans to provide for this relief (i.e., until December 31, 2024 for calendar year governmental plans). (These are the same amendment deadlines that apply under the CARES Act).
- Observations. The disaster relief provisions under the Act are reminiscent of distribution and loan relief issued for prior disasters, including the relief provided recently under the CARES Act, which made it easier for certain individuals to access retirement plan money in light of the coronavirus pandemic. Similar to the loan relief issued for past disasters, these provision appears to be optional. However, it would be helpful if we heard from Treasury and/or IRS with respect to whether these provisions are optional, and also with respect to the type of certification/documentation that may be necessary for plan administrators to obtain from participants requesting the disaster relief provided for under the Act.
Pension Plan Asset Transfers for Retiree Medical
Under Code Section 420, sponsors with overfunded pension plans may transfer excess pension assets to a Code Section 401(h) account in the pension plan to prefund retiree medical benefits. A “qualified future transfer” under Code Section 420 can prefund up to 10 years of future medical benefits, but these transfers must meet a number of requirements, e.g., the plan must be 120 percent funded at the outset and it must remain 120 percent funded throughout the transfer period. The Act allows employers to make a one-time election during 2020 and 2021 to end any existing transfer period for any taxable year beginning after the date of election. Assets previously transferred to a Code Section 401(h) account that were not used as of the election effective date are required to be transferred back to pension plan within a reasonable amount of time. Assets transferred back to plan are treated as a taxable employer reversion, unless the amount is transferred back to the applicable Code Section 401(h) account before the end of the five-year period beginning after the original transfer.
Observation. The market changes due to the COVID-19 pandemic may have caused plans that have been consistently over 120 percent funded to fall below 120 percent, and plan sponsors may face a requirement to address large market losses in order to get back to the 120 percent funding threshold. The Act may be welcome relief for pension plans that are using surplus assets to offset retiree welfare costs.
Money Purchase Pension Plan CARES Act Distributions
The Act amends the CARES Act to reflect that the in-service coronavirus distributions allowed under the CARES Act are also permitted to be made from money purchase pension plan assets. See our prior blog post and legal update for information on coronavirus distributions under the CARES Act.
Observation. Under the Act, this treatment is retroactive to the date of the passage of the CARES Act (i.e., March 27, 2020). However, because coronavirus distributions under the CARES Act must be made before December 31, 2020, this provision was likely enacted too late in the year to allow for many plans and participants to take advantage of the clarification. The Act did not extend the deadline for taking a coronavirus distribution beyond 2020.
In-Service Distributions from Certain Multiemployer Plans
The Act allows in-service distributions at age 55 from certain multiemployer plans in the construction industry for employees who were participants in the plans on or before April 30, 2013. (The general rule for pension plans is that in-service distributions are permitted at age 59-1/2.) In order for this provision to apply, the multiemployer plan trust must have (1) been in existence before January 1, 1970, and (2) received a favorable determination letter before December 31, 2011, at a time when the multiemployer plan provided that in-service distributions may be made to employees who have attained age 55.
The Act is lengthy and there is a lot to digest. We hope that Treasury and IRS will issue additional guidance pertaining to these provisions. For further information and updates, continue to follow our blog.
Christina M. Cerasale and Sarah J. Touzalin
§ 1.14 You May Even Get a Vaccine Before Needing to Go to the Notary; the IRS Has Extended Remote Witnessing of Participant Elections
Seyfarth Synopsis: The IRS has extended the remote notarization relief that gives plans and participants greater flexibility for participant elections, including spousal consents, that must be signed in person and witnessed by a notary or plan representative in order to be valid. The IRS has also requested comments on this relief, including comments as to whether this relief should be made permanent.
As described in our prior post, Notice 2020-4 provides relief from the rule in Treasury Regulation Section 1.401(a)-21(d)(6) that requires the signature of an individual making an election to be witnessed in the physical presence of a plan representative or a notary public. That relief was set to expire on December 31, 2020. In recognition of the continued public health emergency caused by the COVID-19 pandemic, the IRS has issued Notice 2021-3, which extends relief from this physical presence requirement through June 30, 2021.
This extended relief means that physical presence is not required for any participant election witnessed by:
- A notary public in a state that permits remote notarization; or
- A plan representative using live audio technology, provided the requirements detailed in our prior post are satisfied.
Notably, Notice 2021-3 also requests comments on this relief, including comments as to whether this relief should be made permanent, and what, if any, procedural safeguards are necessary in order to reduce the risk of fraud, spousal coercion, or other abuse in the absence of a physical presence requirement.
Plan administrators that have already taken advantage of this guidance can continue to benefit from the changes that were put in place through June 30, 2021. Meanwhile, plan administrators that have not yet adopted remote witnessing procedures may consider making these administrative changes in light of the continuing pandemic and indications from the IRS that this guidance may be made permanent.
Irine Sorser and Liz J. Deckman
§ 1.15 SBA Posts Interim Final Rules Implementing Changes to First Draw and Second Draw Loans under the Paycheck Protection Program
On January 6, 2020, the Small Business Administration (“SBA”) issued its much anticipated Interim Final Rules (“IFR”) under the $2.3 trillion coronavirus relief and government funding act, the Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act (the “Act”), which was signed into law on December 27, 2020. In addition to other provisions, the Act adds $284 billion to the Paycheck Protection Program (“PPP”), establishes changes to the existing PPP, and creates a second draw to the PPP.
This update summarizes the key details of the guidance issued by the SBA.
Changes to Existing PPP; First Draw PPP Loans
The Act and IFR expand the set of eligible borrowers under the PPP to include housing cooperatives (but not condominiums), certain 501(c)(6) trade organizations (discussed below), and nonprofit destination marketing organizations, that employ no more than 300 employees.
The Act and IFR also expand the set of eligible borrowers to print, and radio and television, broadcast organizations, both businesses and nonprofits, that employ no more than 500 employees per location (or, if applicable, the size standard established by SBA regulations).
Though the 501(c)(6) trade organizations included are 501(c)(6) organizations generally, professional sports teams or organizations that devote significant activities to lobbying (defined as (i) more than 15 percent of the total activities of the organization, or (ii) more than $1,000,000 during the tax year ended February 15, 2020) are not eligible. Public companies, other than news organizations, and companies that are permanently closed are not eligible for PPP loans under the Act.
Under the first draw PPP, the maximum amount a borrower can borrow is the lesser of (i) $10 million; and (ii) the amount yielded by a payroll-based formula, which is, in general, 2.5 times average monthly payroll costs in 2019 or 2020, less pro rata payroll costs in excess of $100,000.
2. Permitted Uses
The list of permitted expenditures of PPP funds is also expanded. In addition to the uses previously permitted, current and future PPP borrowers are permitted to use PPP funds for certain software, human resources, accounting, property damage repairs related to public disturbances occurring in 2020, and PPE used to comply with health and safety guidelines. Expenses for group life, disability, vision and dental insurance are also included. Note however, that the relative percentages of expenditures required for forgiveness have not been changed, so a borrower must spend at least 60% of loan proceeds on payroll costs to remain eligible for full forgiveness.
Importantly, under the Act and IFR, expenses paid for with PPP loan proceeds are tax deductible, which reversed the IRS position.
3. Loan Forgiveness
PPP loan forgiveness has also been changed in three important ways. First, Economic Injury Disaster Loans (EIDL) advances (which are up to $10,000) are no longer deducted from a borrower’s forgiveness amount.
Second, PPP borrowers can select a covered period that ends at any point between 8 weeks and 24 weeks after loan disbursement, without having to choose between 8 and 24 weeks (although earlier guidance indicated that subject to certain conditions a covered period of less than 24 was permissible).
Third, PPP borrowers with loan amounts up to $150,000 may submit a one-page forgiveness application, without additional documentation. However, borrowers must maintain all relevant documentation.
With the new legislation, Congress and the SBA have addressed many of the concerns of borrowers under the PPP.
Second Draw PPP Loans
The SBA is authorized to guarantee PPP loans under the second draw program established by Section 311 of the Economic Aid Act (the “Second Draw PPP Loans”) under generally the same terms and conditions available under the PPP.
(a) General Eligibility Requirements
The eligibility requirements for Second Draw PPP Loans are narrower than the eligibility requirements for First Draw PPP Loans. A borrower is eligible for a Second Draw PPP Loan only if: it has 300 or fewer employees; experienced a revenue reduction in 2020 relative to 2019; has received a First Draw PPP Loan, and has used, or will use, the full amount of the First Draw PPP Loan on or before the expected date on which the Second Draw PPP Loan is disbursed to the borrower, and the full amount of its First Draw PPP Loan was spent on eligible expenses; and it is not an ineligible entity.
The revenue reduction requirement may be satisfied by comparing the borrower’s quarterly gross receipts for any one quarter in 2020 with the receipts for the corresponding quarter of 2019. If a borrower was in operation in all four quarters of 2019, it is deemed to have experienced the required revenue reduction if it experienced a reduction in annual receipts of 25% or greater in 2020 compared to 2019 and the borrower submits copies of its annual tax forms substantiating the revenue decline.
A borrower that did not experience a 25% annual decline in revenues, or that was not in operation in all four quarters of 2019, may still meet the revenue reduction requirement under the quarterly measurement.
(b) Business Concerns with More than One Physical Location
Unlike under the CARES Act, where any single business entity that is assigned a NAICS code beginning with 72 (including hotels and restaurants) and employs not more than 500 employees per physical location is eligible to receive a First Draw PPP Loan, in the case of Second Draw PPP Loans, the limit on employees per physical location is reduced to 300.
(c) Affiliation Rules
As a general matter, the same affiliation rules that apply to First Draw PPP Loans apply to Second Draw PPP Loans, with reduced size requirement. Business concerns with a NAICS code beginning with 72 will continue to qualify for the affiliation waiver for Second Draw PPP Loans if they employ 300 or fewer employees. Eligible news organizations with a NAICS code beginning with 511110 or 5151 (or majority-owned or controlled by a business concern with those NAICS codes) may qualify for the affiliation waiver for Second Draw PPP Loans only if they employ 300 or fewer employees per physical location.
(d) Excluded Entities
Generally, an entity that is ineligible to receive a First Draw PPP Loan under the CARES Act is also ineligible for a Second Draw PPP Loan. In addition, the Economic Aid Act also prohibits several categories of borrowers from receiving a Second Draw PPP Loan, including an entity primarily engaged in political activities or lobbying activities, certain entities organized under the laws of, or with other special ties to, the People’s Republic of China or the Special Administrative Region of Hong Kong, a person or entity that receives a grant for shuttered venue operators under section 324 of the Economic Aid Act, and a publicly traded company.
2. Other Key Terms
- SBA will guarantee 100% of Second Draw PPP Loans and the SBA may forgive up to the full principal loan amount.
- No collateral will be required.
- No personal guarantees will be required.
- The interest rate will be 1%, calculated on a non-compounding, non-adjustable basis.
- The maturity is five years.
3. Maximum Loan Amount
In general, the maximum loan amount for a Second Draw PPP Loan is equal to the lesser of 2.5 months of the borrower’s average monthly payroll costs or $2 million. The Economic Aid Act also provided tailored methodologies for certain categories of borrowers, e.g., for borrowers assigned a NAICS code beginning with 72 at the time of disbursement, the maximum loan amount is equal to 3.5 months of payroll costs rather than 2.5 months. In addition, businesses that are part of a single corporate group may not receive more than $4,000,000 of Second Draw PPP Loans in the aggregate. First Draw PPP Loans and Second Draw PPP Loans use the same approach to determining “payroll costs”.
4. Documentation Requirements
The PPP application form was revised on Friday, January 8, 2021. It is available here.
As a general matter, the documentation required to substantiate an applicant’s payroll cost calculations is generally the same as documentation required for First Draw PPP Loans. An applicant will not be required to submit additional documentation if such applicant (i) used calendar year 2019 figures to determine its First Draw PPP Loan amount, (ii) used calendar year 2019 figures to determine its Second Draw PPP Loan amount (instead of calendar year 2020), and (iii) submits its application for the Second Draw PPP Loan to the same lender as the lender that made the applicant’s First Draw PPP Loan. However, the lender may always request additional documentation, if the lender concludes that it would be useful in conducting the lender’s good-faith review of the borrower’s loan amount calculation.
For loans with a principal amount greater than $150,000, the applicant must also submit documentation adequate to establish that the applicant experienced a revenue reduction of 25% or greater in 2020 relative to 2019. Such documentation may include relevant tax forms, including annual tax forms, or, if relevant tax forms are not available, quarterly financial statements or bank statements. For loans with a principal amount of $150,000 or less, such documentation is not required at the time the borrower submits its application for a loan, but must be submitted on or before the date the borrower applies for loan forgiveness.
5. Loan Forgiveness
Second Draw PPP Loans are eligible for loan forgiveness on the same terms and conditions as First Draw PPP Loans, except that Second Draw PPP Loan borrowers with a principal amount of $150,000 or less are required to provide documentation of revenue reduction if such documentation was not provided at the time of the loan application.
Seyfarth is actively monitoring all aspects of federal COVID-19 business stimulus funding legislation. Additional updates will be provided guidance becomes available is published. Visit our Beyond COVID-19 Resource Center for more information.
 Subsection(B)(4)(g) of the Consolidated First Draw PPP IFR provides: “What qualifies as “payroll costs? Payroll costs consist of compensation to employees (whose principal place of residence is the United States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care or group life, disability, vision, or dental insurance, including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an independent contractor or sole proprietor, wages, commissions, income, or net earnings from self-employment, or similar compensation.” Subsection(B)(4)(h) of the Consolidated First Draw PPP IFR provides:
“h. Is there anything that is expressly excluded from the definition of payroll costs? Yes. The Act expressly excludes the following: i. Any compensation of an employee whose principal place of residence is outside of the United States; ii. The compensation of an individual employee in excess of $100,000 on an annualized basis, as prorated for the period during which the payments are made or the obligation to make the payments is incurred; iii. Federal employment taxes imposed or withheld during the applicable period, including the employee’s and employer’s share of FICA (Federal Insurance Contributions Act) and Railroad Retirement Act taxes, and income taxes required to be withheld from employees; and iv. Qualified sick and family leave wages for which a credit is allowed under sections 7001 and 7003 of the Families First Coronavirus Response Act (Public Law 116-127).”
Aselle Kurmanova, William B. Eck, Stanley S. Jutkowitz, Suzanne L. Saxman and Edward J. Karlin
§ 1.16 EEOC’s New ADA Regulations Could Complicate Employer Plans’ Efforts to Offer Incentives for Getting the COVID Vaccine as Part of a Wellness Program
As COVID-19 vaccines become more readily available in coming months, employers are exploring ways to maximize vaccination rates within their workforce. Some employers are considering making vaccination mandatory. Be sure to read our alert for more relating to legal considerations involved with a mandatory vaccination program. Other employers are considering simply encouraging employees to get vaccinated, offering a voluntary vaccination program, or even offering an incentive to employees who receive the vaccine as part of a workplace wellness program. Employers should be aware of the existing (and recently proposed) Americans with Disabilities Act (ADA) guidelines that may impact the design of any such program.
Background – ADA Restrictions on Wellness Programs
As described in greater detail here, the ADA applies to employer-sponsored wellness programs that include a medical exam or disability-related inquiry. The ADA generally permits employers to make medical examinations or inquiries in connection with a wellness program, but only if such program is “voluntary.” Under EEOC guidelines, that means:
- The program is reasonably designed to promote health or prevent disease, is not overly burdensome, and is not a subterfuge for discrimination.
- The program is not a “gateway plan,” requiring employees to submit to a medical exam or inquiry in order to access an enhanced benefits package.
- The program offers a reasonable accommodation to persons for whom it is medically inadvisable to participate
- Participants are provided with a notice informing them of why their information is being requested, how it will be used, and how it will be protected.
- Incentives are limited.
The final requirement, relating to the level of permitted incentives, is in a state of flux. Until 2016, there were no guidelines on how much of an incentive could be offered to encourage participation in a wellness program. In 2016, however, the EEOC finalized regulations that would permit an incentive of up to 30% of the cost of self-only coverage under the employer’s health plan. Those regulations were challenged by the AARP, however, and were ultimately struck down by the District Court who ordered the EEOC to reissue guidelines that engage in a more thorough process detailing how it determined that the incentive level met the ADA’s voluntary standard.
Last week, the EEOC issued a Notice of Proposed Rulemaking that would limit any incentives offered in a connection with a participation-only wellness program (i.e., one where participants are simply required to submit to a medical exam or inquiry but not required to achieve any particular outcome) to a “de minimis” threshold. Examples of permissible incentives in the proposed regulations included a water bottle or a gift card of modest value.
Analysis of ADA’s Applicability to a Vaccination Program
The EEOC updated its Technical Assistance document on December 16, 2020, to provide that the administration of a vaccine, in and of itself, does not constitute a medical examination. That said, vaccine administration is almost always accompanied by medical questions to ascertain whether the person is susceptible to an allergic reaction, etc. That type of inquiry could constitute a disability-related inquiry and therefore would be subject to restrictions under the ADA if the information is solicited by the employer or by an entity administering the vaccine to employees pursuant to a contract with the employer.
However, the ADA can be avoided altogether if the employee gets vaccinated by a third party provider who is not under a contract with the employer to administer the vaccine because the medical pre-screening questions are not attributed to the employer under this scenario. Thus, an employer could structure its wellness program to provide a financial incentive to participants to receive a vaccine from a third-party vendor, not under contract with the employer (e.g., a local pharmacy chain), without running afoul of the ADA. While the employer could require proof that the individual received a vaccination, that should not trigger ADA restrictions because, as noted above, vaccination status is not, in and of itself, a medical examination or inquiry under the ADA.
Duty to Accommodate
Current EEOC regulations on wellness programs require accommodation for disabilities absent undue hardship. Although the proposed regulations on wellness programs do not address accommodations on the basis of religion, presumably the EEOC’s position on accommodation would be the same and the language from the current regulations regarding accommodation remains unchanged. While current EEOC regulations do not specify what type of accommodation must be offered in a vaccination scenario, presumably the employer would have to come up with an accommodation that is an alternative requirement to getting the vaccine, such as wearing a mask, getting weekly COVID tests and social distancing, so the person with the disability-related or religious objection can earn the incentive.
Of course, the duty to accommodate would generally only be implicated in situations where an individual is actually unable to get the vaccine due to a disability (or potentially a bona fide religious objection) and reasonable accommodation need only be made absent undue hardship. The viability of any such claim may be impacted by what the FDA says about any vaccine it approves in terms of any medical contraindication.
Level of Permitted Incentive
At present, it is unclear what level of incentive would be considered voluntary under ADA guidelines. Prior regulations permitting incentives up to 30% of the cost of health coverage were invalidated by the courts. The newly proposed regulations only permitting de minimis incentives are in proposed form, and the EEOC has stated that they are “simply proposals and they do not change the law or regulations.” Further, there’s a possibility these regulations could be frozen by the incoming Biden Administration and/or revised before taking final form. In any event, it’s unlikely the regulations would be finalized before more broad-based vaccine rollouts take place.
Even so, there is some risk that a plaintiff could seize upon this proposed regulations to argue that any incentive that exceeds a de minimis threshold is involuntary. To be clear, the current regulations are only in proposed form and, as noted, the EEOC has made clear it is not “law.” Further, courts can defer to, but often do not follow EEOC regulations. But, employers should keep this proposal in mind as they implement an incentive-based COVID vaccination program.
Karla Grossenbacher, Jennifer A. Kraft and Benjamin J. Conley
§ 1.17 EEOC Wellness Rules Proposed, Water Bottle Enthusiasts Rejoice
Synopsis: For years, employers have struggled to understand what level of incentives in wellness programs might be considered “voluntary” under the Americans with Disabilities Act (ADA). After earlier guidelines were challenged and ultimately thrown out by a federal court, the EEOC has finally issued its long-awaited, revised guidelines under the ADA and the Genetic Information Nondiscrimination Act (GINA). As described in this alert, the newly proposed rules would generally limit incentives to “de minimis” levels for so-called “participation-only” wellness programs, while deferring to HIPAA’s guidelines for “health-contingent” wellness programs.
Brief Background on Federal Laws Governing Wellness Programs
Employers generally offer wellness programs to promote health and disease prevention within their workforce. Despite these noble intentions, a variety of federal laws govern such programs with the intent of balancing workforce health against the risks of employment discrimination on the basis of adverse health conditions or genetic information. While not an exclusive list, employer wellness programs are generally governed by some or all of the following federal laws (depending on the design of the program):
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA generally breaks wellness plans/programs into two categories:
- Participation-Only Wellness Programs. These include wellness programs that do not require participants to achieve a specific health outcome, but instead simply require them to take a certain action (e.g., obtain a flu shot, submit to a biometric screening, take a health risk assessment). HIPAA does not impose any requirements upon these types of programs, other than require that they be made available to similarly situated participants. These types of programs are regulated by, and the target of, new guidelines under the ADA, as described below.
- Health Contingent Wellness Programs. Health contingent wellness programs are those that require participants to attain a certain outcome or meet a health standard (e.g., run a 5k, maintain a certain cholesterol level, cease smoking, maintain a certain Body Mass Index (BMI)). These types of programs are required to comply with five standards under HIPAA:
- The program must be reasonably designed to promote health or prevent disease.
- Any reward offered cannot exceed 30% of the cost of coverage elected by the participant (increase to 50% for programs involving a tobacco cessation component).
- The full reward must be available to all similarly situated individuals unless the program offers a reasonable alternative for obtaining the reward. (Note that different requirements apply for activity-only and outcome-based programs.)
- Participants must be notified of the availability of the reasonable alternative.
- Participants must be given the opportunity no less frequently than annually to attain the reward.
Americans with Disability Act
The ADA applies to employer-sponsored wellness programs that include a medical exam or disability-related inquiry. Examples of the types of programs that might be subject to the ADA include health risk assessments that involve medical questions or biometric screenings. Smoking cessation programs are not necessarily subject to the ADA unless smoking status is determined based on a biometric screening (medical exam) instead of a self-certification.
The ADA generally permits employers to make medical examinations or inquiries in connection with a wellness program, but only if such program is “voluntary.” For years, employers have struggled in determining what constitutes a “voluntary” program for these purposes. In 2016, the EEOC finally issued regulations establishing certain parameters to assist employers in determining whether a program would be considered voluntary. Generally, those standards included the following:
- The program is reasonably designed to promote health or prevent disease, is not overly burdensome, and is not a subterfuge for discrimination.
- The program is not a “gateway plan,” requiring employees to submit to a medical exam or inquiry in order to access an enhanced benefits package.
- Incentives to participate do not exceed 30% of the cost of self-only
- The program offers a reasonable accommodation for persons for whom it is medically inadvisable to participate.
- Participants are provided with a notice informing them of why their information is being requested, how it will be used, and how it will be protected.
Shortly after the rules were issued, the AARP challenged the EEOC’s interpretation of the voluntariness standard, arguing that they exceeded their regulatory authority in permitting incentives of up to 30% of the cost of coverage. The District Court agreed, and it struck down that portion of the rule effective as of January 1, 2019 (the rest of the rule remained in force).
The newly proposed rule (described below) is intended to address the Court’s directive that the EEOC reissue guidelines that engage in a more thorough process detailing how it determined that the incentive level met the ADA’s voluntary standard.
Genetic Information Nondiscrimination Act
GINA is generally intended to prevent employers from discriminating against employees on the basis of genetic information. The law broadly restricts employers from incentivizing employees to provide genetic information or to provide medical information about family members.
In 2016, the EEOC issued guidelines that established parameters for how employers may collect genetic information or information about family members without running afoul of GINA guidelines. Under those rules:
- Individuals must provide a knowing, voluntary, written authorization prior to disclosing such information.
- Employers may not offer an incentive that exceeds 30% of the cost of self-only coverage in soliciting genetic information from the spouse of an employee.
- Employers could not offer any inducement for genetic information about an employee’s child.
In the same legal challenge described above, the District Court struck down the EEOC’s 30% threshold as applied to GINA (the rest of the rule remained in force). The rule described below attempts to issue new guidelines in accordance with the Court’s directive.
Highlights of the New ADA Rule
The EEOC’s proposed rule takes a similar approach to the earlier HIPAA rule, splitting wellness programs into two categories and applying different rules to each:
3. Participation-Only Wellness Programs. The proposed rule targets participation-only wellness programs, limiting incentives offered in connection with such a program to a “de minimis” standard. Any incentive offered that exceeds that threshold would be considered involuntary, in violation of the ADA. The rule offers the following examples:
- Permissible Incentives: water bottles or gift cards of modest value
- Impermissible Incentives: a paid annual gym membership or free airline tickets
The EEOC’s proposed rule requests comments on whether additional examples would be helpful.
4. Health Contingent Wellness Programs. The EEOC’s proposed rule would offer a “safe harbor” for any health contingent wellness program offered as part of a group health plan. Under the safe harbor, the program would be deemed to be in compliance with the ADA if it complies with the HIPAA rules described above.
Notably, the rules also appear to eliminate the previously-required ADA notice described above. The EEOC explained that because incentives will no longer be able to exceed a de minimis threshold, no such notice would be required to ensure voluntariness.
Highlights of the New GINA Rule
Under the proposed rule, employers can offer incentives to encourage employees or their spouses to provide genetic information, but those incentives must be no more than de minimis. In a departure from the earlier rule, employers may offer incentives to encourage provision of genetic information of dependent children as well (as long as those incentives are no more than de minimis).
Timing/Effective Date of EEOC Rules
The new EEOC guidelines are in proposed form, and the EEOC is soliciting comments for 60 days following the date the rules are published in the Federal Register. The EEOC will review any comments received before issuing a final rule. Until the rules are final, the EEOC has stated that they are “simply proposals and they do not change the law or regulations.” It would be important to caveat these comments though as follows:
- Regulatory Freeze. As is common in new administrations, the Biden Administration has announced it intends to implement a broad-based regulatory freeze on all pending rules upon entering office. Presumably this rule will be included, although it is unclear whether the rule will ultimately be adopted by the new administration.
- Interim Interpretation of ADA’s Voluntariness Standard. Even in the absence of this rule, the ADA remains an active law, including its undefined requirement that wellness programs must be voluntary. Participants in a wellness program could challenge any form of incentive on the basis that it renders the program involuntary (and there are pending lawsuits in which plaintiffs allege a seemingly reasonable incentive renders the program involuntary). There is some risk that a plaintiff could seize upon this proposed rule to argue that any incentive that exceeds a de minimis threshold is involuntary. To be clear, the current rule is only in proposed form and, as noted, the EEOC has made clear it is not “law.” But, employers should keep this proposal in mind as they implement new or review current wellness plans.
Considerations for Employers in Designing Wellness Programs
If finalized, this rule could lead to some employers to either scale back their participation-only wellness programs or to gravitate toward health-contingent wellness programs. Under these rules (and the HIPAA guidelines), employers would have far greater flexibility to incentivize behavior under health-contingent programs.
Similarly, the regulatory agencies have indicated in prior, non-binding guidance that a participation-only wellness program might be considered a health contingent wellness program if it only targets participants based on health status (e.g., if only diabetics have to take a biometric screening). Employers might consider offering more targeted programs based on health status in the hopes of avoiding the more restrictive ADA “de minimis” standard. Under this approach, the wellness program would need to comply with the other HIPAA requirements as discussed above.
Finally, we understand that many employers are considering whether and to what extent to incorporate a mandatory or incentivized COVID vaccination program into their current wellness design. These rules have the potential to impact any such design. Click here for more on vaccine-related wellness considerations.
Benjamin J. Conley, Jennifer Kraft, Diane Dygert and Joy Sellstrom
§ 1.18 PBGC Simplifies Calculation Of Liability For Withdrawal From Multiemployer Pension Plans
Seyfarth Synopsis: The Pension Benefit Guaranty Corporation (PBGC) recently issued a final rule intended to simplify the calculation of withdrawal liability for multiemployer plans that have adopted benefit reductions, benefit suspensions, surcharges, and contribution increases.
Under ERISA, multiemployer pension plans assess withdrawal liability on employers that withdraw from the plans. Withdrawal liability represents a withdrawing employer’s proportionate share of a plan’s unfunded vested benefits. The calculations of withdrawal liability can be highly complex.
Congress approved changes under the Pension Protection Act in 2006 and the Multiemployer Pension Reform Act in 2014 that permitted financially troubled plans to reduce certain benefits, impose benefit suspensions, assess surcharges, and impose contribution increases as part of a “funding improvement plan” or “rehabilitation plan.” Under the law, these changes are generally disregarded for purposes of calculating withdrawal liability. The PBGC’s final rule provides simplified methods that plans may use in excluding those changes from the withdrawal liability determination.
The final rule will apply to employer withdrawals from multiemployer pension plans that take place in plan years beginning on or after February 8, 2021. The PBGC expects the final rule will benefit multiemployer pension plans that adopt the simplified methodology by reducing the cost associated with the withdrawal liability calculation. Notably, however, it does not appear that the final rule will result in any significant changes to the amounts of withdrawal liability assessed on employers that withdraw from multiemployer pension plans. The rule only simplifies the way that those amounts are calculated.
Even though the PBGC issued this rule to “simplify” the calculation of withdrawal liability for certain plans, this area of law itself remains very complex. Employers that are considering withdrawal from a multiemployer pension plan, are engaging in reorganizations or transactions that might trigger a withdrawal, or that have been assessed withdrawal liability, should be sure to consult with counsel.
Additionally, the PBGC’s rule may be just the beginning of a busy year of legal developments affecting multiemployer pension plans. With the number of severely underfunded plans continuing to increase and a new administration about to begin, Congress is likely to soon consider new legislation to address the risk of insolvencies in multiemployer pension plans. Stay tuned for further developments.
James M. Hlawek
§ 1.19 Recent Supreme Court Trump Decisions and ERISA Jurisprudence
Seyfarth Synopsis: The Supreme Court has shown a recent reluctance, as a general matter, to expand the scope of its review. That reluctance should apply as well to cases that seek to extend the scope and enforcement of ERISA.
Is there a connection between — the Supreme Court’s December 2020 decisions dismissing Presidential election lawsuits and the Presidential policy of excluding from census apportionment immigrants not considered to be in lawful status, on the one hand, and ERISA jurisprudence, on the other hand?
These recent Supreme Court decisions reveal a strong majority of Justices who believe federal court jurisdiction is limited, and dramatically so. Texas v. Pennsylvania, challenged, among other things, the lack of compliance with state legislative election law. Seven of the nine justices ruled that “Texas has not demonstrated a judicially cognizable interest in the manner in which another State conducts its elections.” In the immigration census decision, Trump v. New York, six justices ruled the case non-justiciable. They relied on two related doctrines — standing and ripeness. On standing, the majority said that a case must demonstrate “an injury that is concrete, particularized, and imminent rather than conjectural or hypothetical.” On ripeness, they said that any case must not be dependent on “contingent future events that may not occur as anticipated, or indeed may not occur at all.” To be sure, these cases may yet wind their way back to the Court for a review on the merits, but the route will be a bumpy one.
This judicial reluctance to rock the boat applies to ERISA jurisprudence as well. In Rutledge v. Pharmaceutical Care Management Association (No. 18-540), the Supreme Court refused to strike down an Arkansas PBM law on ERISA preemption grounds. The decision was unanimous. See SCOTUS Upholds Arkansas PBM Law Against ERISA Preemption Arguments | Beneficially Yours.
Commentators have noted that Justice Roberts, in particular, employs a strong philosophy of judicial deference or restraint. His view is that the people should take their complaints to the ballot box, not the courthouse. Enough of his fellow conservatives on the Court are often persuaded to agree, notwithstanding calls for a more aggressive Court.
So, as a general matter, private lawsuits that are commenced to “make new law” may increasingly be commenced in state court. ERISA lawsuits are not so easily accommodated via state litigation, however. All ERISA claims, other than claims for benefits, must be commenced in federal court. 29 U.S.C. 1132(e)(1). As we have noted previously, when commenting on the Spokeo and Thole standing decisions, a number of technical ERISA violations, including some fiduciary breach claims, may be beyond the reach of private plaintiffs. See Spokeo and the Future of ERISA Litigation | Beneficially Yours; The Supreme Court Further Narrows Federal Court Jurisdiction Over an ERISA Complaint, Relying on Article III of the Constitution | Beneficially Yours. And ERISA limits remedies, see Mass. Mut. Life Ins. Co. v. Russell, 473 U.S. 134 (1985), and that can make it tough to allege concrete injuries for technical violations.
It remains to be seen, of course, how aggressive the Department of Labor will be in enforcing ERISA violations under President Biden. But private ERISA plaintiffs trying to extend the scope and enforcement of ERISA will have a tougher time making their case to the Supreme Court.
Mark Casciari and Rebecca Bryant
§ 1.20 Hold Up! Maybe You Can Invest Your Retirement Plan to Save the Planet!
Seyfarth Synopsis: DOL final regulation on fiduciary implications of investing in ESG under review by the Biden administration.
You may recall our prior blog posts and Legal Update discussing the back-and-forth over the years surrounding the wisdom, or even ability, for plan fiduciaries to invest plan assets in funds with a strategy focused on factors such as environmental, social or corporate governance, sustainability or religion — the so-called ESG factors. See our blog posts here and here, and our Update here.
When we left you last, in November 2020, the DOL had finalized its regulation that basically came down on the side that ESG factors are non-pecuniary and it would be inappropriate for fiduciaries to make investment decisions based on non-pecuniary factors. This was in the face of voluminous criticism received from the investing community.
Well, this regulation is listed here among those that the Biden administration wants reviewed in accordance with the Executive Order “Protecting Public Health and the Environment and Restoring Science to Tackle the Climate Crisis.” In addition, the White House issued a memo to all agency heads to “consider” postponing for 60-days rules that have published rules but have not yet taken effect.
So, stay tuned!
§ 1.21 IRS Announces 2021 Limits for Certain Health and Fringe Benefit Options
Seyfarth Synopsis: The IRS has announced the adjustments to key limits for certain health and welfare benefit programs, including HDHP deductibles, HSA and FSA contributions, and other fringe benefit options for 2021.
The IRS issued new limits on health and fringe benefit options under Rev. Proc. 2020-32, Rev. Proc. 2020-45, and Notice 2020-84, which announce the 2021 limits for certain benefit programs, including dollar limits for contributions to health savings plans (“HSAs”) under high deductible health plans (“HDHPs”), flexible spending accounts (“FSAs”) under Section 125 cafeteria plans, qualified transport fringe benefit programs, Qualified Small Employer Health Reimbursement Accounts (“QSEHRAs”), and the new PCORI fee.
While some of the limits have not changed, there are a few notable increases. A summary of the key limits for employers to note for 2021 are included in the table below:
Benefit Programs and Limits:
Health Savings Accounts (HSAs)
– Maximum HSA contribution:
Self-only: 2020 Limit: $3,550; 2021 Limit: $3,600
Family: 2020 Limit: $7,100; 2021 Limit: $7,200
– HDHP annual deductible minimum:
Self-only: 2020 Limit: $1,400; 2021 Limit: $1,400
Family: 2020 Limit: $2,800; 2021 Limit: $2,800
– Maximum Out-of-pocket:
Self-only: 2020 Limit: $6,900; 2021 Limit: $7,000
Family: 2020 Limit: $13,800; 2021 Limit: $14,000
– Health FSA Maximum Contribution
2020 Limit: $2,750; 2021 Limit: $2,750
– Maximum Carryover of unused amounts
2020 Limit: $550; 2021 Limit: $550
– Qualified Transportation Fringe
Parking (monthly): 2020 Limit: $270; 2021 Limit: $270
Transit passes and Vanpools (monthly): 2020 Limit: $270; 2021 Limit: $270
Employer Provided Maximum: 2020 Limit: $14,300; 2021 Limit: $14,400
Individual Maximum: 2020 Limit: $14,300; 2021 Limit: $14,400
– Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
Self-Only Maximum: 2020 Limit: $5,250; 2021 Limit: $5,300
Family Maximum: 2020 Limit: $10,600; 2021 Limit: $10,700
– PCORI Fee*
2020 Limit: $2.54; 2021 Limit: $2.66
* For plan years ending on or after October 1, 2020 and before October 1, 2021.
Rev. Proc. 2020-45 provides other limits that may impact benefit offerings, including the 2021 premium tax credits and small business health care tax credit. The revised limits provided in Rev. Proc. 2020-32 and Rev. Proc. 2020-45 took effect as of January 1, 2021.
Also, look to and sign up for our blog Beneficially Yours for further discussion of employee benefits topics and updates at https://www.beneficiallyyours.com/
§ 1.22 How to SECURE Your Safe Harbor Plan
Seyfarth Synopsis: The IRS issued Notice 2020-86, which provides guidance on the rules that apply to safe harbor plans that were changed by the Setting Every Community Up for Retirement Enhancement Act of 2019 (the “SECURE Act”). The guidance covers the increase in automatic contributions permitted under a qualified automatic contribution arrangement (or “QACA”) safe harbor plan, safe harbor notice requirement changes, and issues related to the retroactive adoption of safe harbor status.
The SECURE Act included a number of changes to the rules that apply to safe harbor plans. As described in our prior Legal Update available here, the SECURE Act (1) increased the 10% cap on automatic contributions under a QACA to 15%, (2) eliminated the requirement that a non-elective safe harbor plan notify participants of the plan’s safe harbor status before the beginning of the plan year, and (3) established new rules that permit the adoption of a non-elective safe harbor plan design at any time during a plan year (or even the following plan year) if certain requirements are met.
Notice 2020-86 answers a number of open questions relating to these changes to the safe harbor rules.
- Increase in 10% Cap to 15% for Automatic Contributions. While plan sponsors are not required to increase the cap on automatic deferrals under a QACA from 10% to 15%, some plans incorporate the maximum cap on automatic deferrals by reference to the Code. For those plans, if the plan sponsor does not want the 15% increased cap to apply, the plan must be amended (generally by December 31, 2022). The Notice makes clear that a failure to timely amend in that situation may result in a plan operational error.
- Safe Harbor Notice Requirements. The guidance clarifies that a notice may still be required for certain plans, even if the plan is designed to provide non-elective contributions to satisfy the safe harbor requirements.
- The safe harbor notice requirement continues to apply to traditional safe harbor plans that provide safe harbor non-elective contributions if the plan also provides non-safe harbor matching contributions that are designed so that they are not required to satisfy the ACP test.
- The safe harbor notice requirements continues to apply to plans that have an eligible contribution arrangement (or “EACA”) (i.e., those plans that provide for the permissive withdrawal of automatic contributions within 90 days) with a non-elective contribution that satisfies either the traditional or QACA safe harbor requirements.
The Notice also addresses how a plan sponsor would provide notice to preserve the right to reduce or suspend safe harbor non-elective contributions mid-year if a safe harbor notice is no longer required. Generally, under IRS rules, a plan sponsor may reduce or suspend safe harbor contributions mid-year if it includes a statement in the safe harbor notice that the contributions could be suspended midyear. (If this statement is not included in the safe harbor notice, then the plan sponsor must be able to show that it is operating at an economic loss to suspend the contributions.) The guidance states that including this suspension statement in any type of notice is acceptable, and that for the 2021 plan year, a notice with the suspension statement may be provided as late as January 31, 2021 for a calendar year plan.
- Retroactive Safe Harbor Status. The Notice also includes several helpful questions and answers addressing the retroactive adoption of safe harbor non-elective contributions:
- Plan sponsors may re-adopt a non-elective safe harbor formula for the entirety of the plan year after reducing or suspending non-elective safe harbor contributions mid-year. In this case, the plan is not required to satisfy the ADP or ACP test for the plan year.
- Safe harbor non-elective contributions must be made by the extended tax return due date in order to be deductible for the prior year. So, even though plan sponsors may now amend a plan after the end of the plan year to provide for 4% non-elective safe harbor contributions, these contributions will not be deductible for such prior plan year if made after the plan sponsor’s tax return due date. (Instead, they would be deductible for the taxable year in which they were contributed to the plan.)
The Notice indicates that the IRS does not intend this guidance to be the final word and that the IRS hopes to issue regulations related to the safe harbor changes found in the SECURE Act. We will be ready if and when those regulations are issued.
Christina Cerasale and Sarah Touzalin
§ 1.23 Fate of EEOC Wellness Regulations Remains Unknown
Seyfarth Synopsis: Unpublished U.S. Equal Employment Opportunity Commission (EEOC) proposed regulations regarding incentives offered under wellness programs are set to be withdrawn and reviewed after the Biden White House issues a regulatory freeze.
On January 7, 2021, the EEOC forwarded to the Office of Federal Register its proposed rules under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) related to wellness programs for publication. The proposed regulations had already been cleared for publication by the Office of Management and Budget (“OMB”). The EEOC also published an unofficial version of the regulations on its website at that time. Seyfarth’s Legal Updates on aspects of the proposed rules, including COVID vaccine implications, can be found here and here.
Before the proposed rules actually were published, however, the Biden White House issued a regulatory freeze. Under the regulatory freeze, it appears that these proposed regulations will be withdrawn from the Office of the Federal Register and set aside for review. The review and approval must be completed by a department or agency head appointed or designated by President Biden (or an approved delegate), unless the OMB director allows publication of the proposed regulations due to some sort of emergency exception.
Whether publication of the EEOC proposed rules will continue to be delayed or whether the rules in their current form will be published at all remains unclear. We look forward to further clarity once the Biden administration informs the public of its intentions for wellness programs generally, and of the fate of the proposed regulations. As explained in our Legal Update, the incentive provisions were removed from the regulations, effective January 1, 2019. Until regulations addressing incentives are published in the Federal Register, employers have little guidance as to the extent to which the new EEOC will allow wellness incentives under the ADA.
Christina Cerasale and Joy Sellstrom
§ 1.24 To Vote or Not to Vote? That Is (Still) the Question
Seyfarth Synopsis: In mid-December 2020, after a truncated comment period and without public hearings, the US Department of Labor (DOL) finalized its proposed regulations on a fiduciary’s responsibilities when exercising shareholder rights like proxy voting (summarized here). They were published in the Federal Register on December 16, 2020 (click here) and were designated as effective on January 15, 2021. However, given the new Administration, the future of that final rule is unclear.
As part of the DOL’s one-two punch to plan fiduciaries’ obligations regarding investment selection and management, the agency quickly finalized its proposed regulation on exercising shareholder rights. (See our other blogs here and here regarding the DOL regulations on ESG investing.) The DOL recognizes that the “fiduciary act of managing plan assets includes the management of voting rights (as well as other shareholder rights) appurtenant to shares of stock.” As we noted in our prior post, the DOL’s view on fiduciaries conducting proxy voting ties the obligation to their concern that voting proxies may relate to non-pecuniary interests. In that case, the DOL’s position in the proposed rule was that plan fiduciaries should actually refrain from voting the proxy.
After receiving a great deal of reaction (including written comments and submissions) from a variety of stakeholders, the DOL made significant changes to the proposed rule. Instead of requiring or prohibiting the voting of certain proxies, the DOL has adopted a principles-based approach under which fiduciaries must adopt a process for exercising shareholder rights that emphasizes their existing ERISA duties of prudence, acting solely in the interest of the plan participants and beneficiaries, and acting exclusively for the purpose of providing benefits to such plan participants and beneficiaries and defraying administrative costs.
The DOL also adjusted some of the other language in the proposed rule that was more prescriptive. This includes modifying the requirement to “investigate” facts surrounding an investment decision to one that requires an “evaluation” of the facts. Also, the obligation that fiduciaries require specific documentation of the rationale for proxy voting decisions from an investment manager who was delegated the proxy voting function has been removed in favor of a more general monitoring approach.
The fate of this final rule is unclear under the new Administration. This is in contrast to the final rule addressing investment selection and management, which was specifically identified in President Biden’s Executive Order “Protecting Public Health and the Environment and Restoring Science to Tackle the Climate Crisis.” (See our blog here discussing that Executive Order and those DOL regulations.)
So, yet another reason to stay tuned!
Diane Dygert and Linda Haynes
§ 1.25 The Biden Administration Removes Limits on Agency “Guidance” – And Creates A New Agenda Enforcement Tool
Synopsis: On January 20, 2021, the Biden Administration revoked the Trump Administration Executive Order (EO) which had restricted agency Guidance. On January 27, 2021, the Department of Labor (DOL) rescinded the “PRO Good Guidance” rule that it had issued pursuant to the Trump EO – a rule that limited the force of informal guidance in DOL enforcement actions. This rescission may undercut the persuasive effect of an employer interpretation of federal statutes at the agency level, because more Guidance limits the ability for employer interpretations and increases agency enforcement power.
In September of 2020, we published a blog post describing how the Trump Administration reigned in the role of informal federal Department of Labor opinions, generally called “Guidance,” in the agency’s enforcement actions against employers. See our blog post here. The upshot was that there would be less Guidance, and thus more employer freedom to interpret federal statutes.
Now, the Biden Administration has weighed in by rescinding the Trump Administration’s Guidance rule. In a final rule, effective on January 27, 2021, the Department of Labor posits that Trump’s internal rule on guidance “deprives the Department and subordinate agencies of necessary flexibility” and “unduly restricts the Department’s ability to provide timely guidance on which the public can confidently rely.” The Biden Executive Order that led to this agency action, in turn, states that the Administration intends “to use available tools to confront urgent challenges,” including the pandemic, economic recovery, racial justice and climate change. The Order added that the Administration is relying on “robust agency action” to achieve its goals.
You can compare the Trump rule at Fed. Reg. vol. 85, no. 168 (8/28/20) with the Biden rule at Fed. Reg. vol. 86, no. 16 (1/21/21) to drill down on the different treatment of agency Guidance.
We draw these conclusions from the latest Department action on Guidance:
- Employers should expect more Guidance.
- Employers should expect the Department of Labor (and likely other federal agencies) to insist on compliance with each and every issuance of Guidance, thus shrinking the universe of employer statutory interpretations that don’t conflict with Guidance.
- More Guidance may mean more clarity in agency enforcement standards, depending on the drafting quality of the Guidance.
- Whether any particular Guidance is legally binding will still depend on court rulings, as it may be inconsistent with governing statutes or the Constitution .
Please reach out to your Seyfarth attorney if you would like to discuss the impact the Biden Administration rescission may have on your employee benefit plans.
Mark Casciari and Joy Sellstrom
§ 1.26 Missing Participant Guidance Trifecta
On January 12, 2021, the Department of Labor (DOL) issued a 3-part set of missing participant guidance for employer-sponsored retirement plans, addressing a variety of issues:
- Best practices for reducing missing participant populations;
- Explanation of the DOL’s goals and process in missing participant audits under the Terminated Vested Participant Project; and
- Authority for fiduciaries of terminating defined contribution plans to use the PBGC Missing Participant Program.
Uniting participants with their retirement benefits has been a priority for the DOL for a number of years, as well as for plan sponsors and fiduciaries who want to see their employees benefit from their hard earned retirement dollars. In that regard, while additional guidance is always welcome, as discussed below, several of the DOL’s best practices could be viewed as impractical at best, or at worst, unworkable by plan fiduciaries.
Best Practices for Reducing Missing Retirement Plan Participants
Under ERISA, a plan fiduciary has a legal duty to act prudently and to administer an ERISA-governed retirement plan in accordance with its terms. The DOL (mostly via plan audits) has long been on a mission to alert and remind plan fiduciaries of their obligations under ERISA to locate and distribute retirement benefits to “missing” participants and beneficiaries.
Missing participants and beneficiaries are commonly identified in connection with:
- becoming entitled to a distribution as the result of a plan termination;
- becoming eligible for a mandatory distribution upon termination of employment under the plan’s small benefit cash out rules;
- reaching their required beginning date for minimum distributions (or earlier required distributions, if applicable);
- becoming entitled to a plan benefit upon someone’s death;
- becoming entitled to a benefit under the terms of a qualified domestic relations order; and
- by not cashing a plan check (or by having undeliverable mail).
Prior to this most recent guidance, the most extensive, albeit informal, guidance issued by the DOL in this area focused on missing participants and beneficiaries under a terminated defined contribution plan. See DOL Field Assistance Bulletin (FAB) 2014-1. Not surprisingly, plan fiduciaries (as well as DOL investigators) have applied the principals espoused in FAB 2014-1, by analogy, to active plans.
The DOL’s most recent foray into the issues of missing participants and beneficiaries was published on January 12, 2021, as an informal “best practices” memo (the “Memo”). In its own words, the Memo “outlines best practices that the fiduciaries of defined benefit and defined contribution plans, such as 401(k) plans, can follow to ensure that plan participants and beneficiaries receive promised benefits when they reach retirement age.”
The Memo begins by listing a number of “red flags” fiduciaries should be aware of that may indicate a systemic issue is either around the corner or exists currently, and in either case, should be addressed promptly. These red flags include (among others) missing, inaccurate, or incomplete contact information in the plan’s system, and the absence of procedures for handling uncashed checks.
The memo then describes the DOL’s vision of best practices in the form of the following four categories of action items, along with the DOL’s relatively extensive bullet point “recommendations” for satisfying a fiduciary’s duty under each category:
- Maintaining accurate census information for the plan’s participant population.
- Implementing effective communication strategies.
- Conducting missing participant searches.
- Documenting procedures and actions.
While many of the suggestions are seemingly prudent and sensible, others may not be feasible for some plans or may be cost prohibitive. Additionally, each plan’s circumstances may differ based on a number of factors such as plan size and type (e.g., defined benefit or defined contribution). Correctly, the DOL agrees with this sentiment, stating “[n]ot every practice …is necessarily appropriate for every plan.” We suggest, nonetheless, that all plan fiduciaries review their policies and procedures for locating missing participants, at least to be prepared for questions that may arise if their plan is examined by the DOL. This latest guidance can be found here: Missing Participants – Best Practices for Pension Plans (dol.gov)
DOL’s Goals and Process in Missing Participant Audits
The second part of the DOL’s January 12, 2021 guidance on missing participants, Compliance Assistance Release 2021-01 (Release), describes the DOL’s approach on auditing defined benefit plans under its Terminated Vested Participants Project (TVPP). The DOL’s purpose is to unite participants and beneficiaries with their benefits and help them avoid significant and unnecessary RMD-related excise taxes. The goals of the TVPP are to ensure plans:
- maintain adequate records to identify their participants, the amount they are due under the plan, and when their benefits can start,
- inform participants of their rights and responsibilities (e.g., steps required to avoid required minimum distribution excise taxes), and
- implement appropriate search procedures where participant and beneficiary information is incorrect or incomplete.
To that end, the Release explains how the DOL identifies plans that have difficulty tracking terminated vested participants and timely distributing benefits, red flags that can suggest a problem, and its approach to closing out cases. In particular, the DOL identified (i) plans that report a large number of terminated vested participants entitled to future benefits, (ii) bankruptcy, and (iii) corporate merger and acquisition activities, as instances where plans could face problems with loss of participant data.
The DOL generally sends two letters when opening an investigation: one opening the case and one requesting more targeted information and documentation. During the investigation, the DOL generally looks for evidence of:
- systemic errors in plan recordkeeping and administration associated with failure of a participant or beneficiary to enter pay status before death or RMD beginning dates,
- inadequate procedures for identifying and locating missing participants and beneficiaries,
- inadequate communications (see Further on Communications, below) with terminated vested participants nearing normal retirement age (and beneficiaries of terminated vested participants) informing them of their right to commence benefits, and
- inadequate procedures for addressing uncashed distribution checks.
Red flags suggesting possible problems include: census data with missing or incomplete participant data, more than a “small” number of terminated vested participants who are eligible to claim benefits but have not done so, continuing to mail to bad addresses without taking steps to find the correct address, failing to use resources like the USPS Address Correction Service and/or the National Change of Address database to find replacement addresses, and not taking advantage of recordkeeper services for finding missing participants. The DOL also said fiduciaries should monitor the performance of retained third party search firms and ensure they are complying with any contractual commitments regarding missing persons.
Further on Communications
The DOL commented on conditions that can reduce a notice’s effectiveness. For example, benefit notices that do not clearly explain the participant’s right to pension benefits, e.g., his/her vested status, right to benefits, and/or the consequence of excise taxes, can contribute to a terminated vested participant problem. Failure to write in “plain English” and sending to populations not fluent in English without providing language assistance, or communicating the availability of assistance, also can make communications less effective than intended. Participants may have benefits under prior plans or worked for a company under a different name due to mergers or acquisitions, and the DOL is concerned that participants might not recognize the connection to their benefits if a successor plan’s correspondence does not include the name of the prior employer or plan.
Working with the Fiduciary and Closing the Case
The DOL seemed to express a collaborative approach, reiterating its goal of helping the plan find missing participants. It noted it will give reasonable time to respond to information requests, engage in meaningful discussions with plan fiduciaries, and grant time extensions where appropriate. Further, the DOL indicated that if the plan provides appropriate remedies for affected individuals and corrects flaws in its recordkeeping, communication, search and other relevant policies, the DOL will generally list those corrective steps without citing the individual plan fiduciaries for specific violations of ERISA when closing out a case.
Temporary Enforcement Policy for Use of PBGC Missing Participant Program by Terminating Defined Contribution Plans
In conjunction with the above guidance, the DOL also issued Field Assistance Bulletin (FAB) 2021-01, which announces a temporary enforcement policy on terminating defined contribution plans’ use of the Pension Benefit Guaranty Corporation’s (PBGC) Missing Participants Program (Program). The policy applies to both plan fiduciaries of terminating defined contribution plans and qualified termination administrators (QTA) of abandoned individual account plans.
As background, the DOL currently provides a fiduciary safe harbor under DOL Reg. § 2550.404a-3 for use in making distributions from terminated defined contribution plans and abandoned plans to missing and nonresponsive participants and beneficiaries. The safe harbor generally requires that distributions be rolled over to an IRA, although in limited circumstances fiduciaries may make distributions to certain bank accounts or to a state unclaimed property fund. If the conditions of the safe harbor are met, the plan fiduciary or QTA will be deemed to have satisfied ERISA’s requirements with respect to the distribution of benefits.
In December 2017, the PBGC issued final regulations expanding the Program to defined contribution plans that are terminated on or after January 1, 2018. Under the expanded Program, terminating defined contribution plans may either (i) transfer missing or nonresponsive participant benefits to the PBGC, in which case the PBGC will make payments to missing participants once they are located; or (ii) submit missing or nonresponsive participant information to the PBGC (but not transfer the account), in which case the PBGC will communicate such information to the participants once they are located. The Program requires fiduciaries to conduct a diligent search to locate missing participants before reporting them as missing.
Under FAB 2021-01, the DOL announced that, pending further guidance, it will not pursue fiduciary breach claims against plan fiduciaries of terminating defined contribution plans or QTAs of abandoned plans in connection with the transfer of a missing or non-responsive participant’s or beneficiary’s account balance to the Program rather than using one of the available options under the DOL’s fiduciary safe harbor regulation described above (i.e., an IRA). To qualify for this relief, the plan fiduciary or QTA must comply with the guidance in FAB 2021-01 and have acted in accordance with a good faith, reasonable interpretation of ERISA. The DOL also indicated the fee charged by the PBGC for certain accounts transferred to the Program could be paid for from the transferred account, as long as the plan’s terms do not prohibit such payment.
The DOL noted, however, that the temporary enforcement policy does not preclude the DOL from pursuing ERISA violations for a failure to diligently search for participants and beneficiaries prior to transferring their accounts to the PBGC or for a failure to maintain plan and employer records. Additionally, the temporary enforcement policy does not legally protect plan fiduciaries or QTAs from civil claims made by plan participants or their beneficiaries. Nonetheless, the DOL’s announcement is welcome news for fiduciaries and QTAs who opt to take advantage of the Program. A copy of FAB 2021-01 is available here.
The recent DOL guidance provides a lot of information for plan sponsors and fiduciaries to consider. Please contact your Seyfarth Employee Benefits Attorney with any questions you may have about this guidance and its application to your plan.
Kelly Joan Pointer, Benjamin F. Spater and Kaley M. Ventura
§ 1.27 How to Sign Your Life Away… Electronically
Seyfarth Synopsis: Electronic signatures may be the wave of the future for the IRS, and are more necessary now as a result of the remote work environment. The IRS issued some recent guidance, allowing two authorization forms (Forms 2848 and 8821) to be signed electronically. While this guidance is a welcome step in the direction of electronic signature acceptance, the guidance is very limited, and its use may not be as practical as we would have hoped. Many IRS filings related to benefit plans, e.g., determination letter filings and Voluntary Compliance Program filings, require signatures on forms not covered by the guidance. Thus, benefit plan sponsor and administrators will need more comprehensive relief from the IRS before being able to use electronic signatures broadly for common IRS filings for benefit plans.
In the remote working environment of the COVID-19 pandemic, coordinating “wet” ink signatures on IRS forms has presented challenges for clients and their tax professionals alike. In the benefit plan space, the Form 2848, Power of Attorney and Declaration of Representative, is required to authorize the IRS to discuss matters such as a determination letter application or Voluntary Compliance Program submission with the plan sponsor’s representative, including their outside legal counsel. The Form 2848 must be signed by both the plan sponsor and its outside representative – a feat that has become harder to coordinate as many of us continue to work remotely from home, and some have questioned whether the IRS would accept an electronic signature on this Form.
New guidance provides clarity on the circumstances in which the IRS will accept electronic signatures on a Form 2848. In News Release IR-2021-20, the IRS announced an online tool for submitting the authorization forms without a handwritten signature. The IRS guidance notes that using the online tool with a Secure Access account is the only method to submit electronic signatures on the Form 2848; a Form 2848 that is mailed or faxed to the IRS still requires “wet” signatures.
That said, plan sponsors, plan administrators, and their representatives will still need to coordinate handwritten signatures on other documents for matters before the IRS. For example, the Form 5300, Application for Determination for Employee Benefit Plan, in the case of a determination letter application, and the penalty of perjury statement, in the case of a VCP, are not covered by the new guidance and still appear to require handwritten signatures.
Additionally, use of the online tool presents its own challenges for plan sponsors and their attorneys alike. To take advantage of the tool, the plan sponsor’s attorney must first create a Secure Access account and provide the IRS with certain personal information (such as the attorney’s individual tax filing status and a financial account number linked to their name). Similarly, the attorney may be required by the IRS to verify personal identification (for example, by requesting a driver’s license) of the individual signing for the plan sponsor before submitting the Form 2848.
Observation: The Secure Access account can be used by individual taxpayers for their own personal income tax purposes, which would explain the requirements to provide a tax filing status and financial account information. These requirements make less sense when the Secure Access account is being used by an attorney to upload forms for a client.
Irine Sorser and Christina Cerasale
§ 1.28 Extended Loan Rollover Timeline: More Flexibility for Participants and More Complexity for Plan Administrators
Seyfarth Synopsis: The IRS released final regulations, under T.D. 9937, that generally adopt the proposed rules relating to qualified plan loan offsets issued last year, with one modification relating to the applicability date. Plan administrators should be prepared to evaluate whether their systems can properly track qualified plan loan offsets, which must now be specifically identified in any Form 1099-R that is distributed to an employee.
Many defined contribution plans require an outstanding loan balance to be immediately repaid by a participant in certain events, such as termination of the plan, a request for a distribution, or a participant’s termination of employment. A failure to timely repay the balance results in a loan default. Once in default following one of these events, a participant’s account balance is offset (or reduced) by the amount of his or her outstanding loan balance in satisfaction of that remaining loan balance. This offset amount is treated as an actual distribution from the plan — rather than a “deemed distribution” — and is subject to traditional distribution taxation rules.
Participants can avoid these taxation rules by rolling over the offset amount to an eligible retirement plan, which includes another employer-sponsored defined contribution plan or an IRA, when permissible. Historically, the standard 60-day rollover period applied to a plan loan offset. However, effective January 1, 2018, the tax code was amended by the Tax Cuts and Jobs Act of 2017 to provide an extended rollover period for a type of plan loan offset called a “qualified plan loan offset” or “QPLO.” A QPLO is a plan loan offset that occurs under a defined contribution plan solely due to either:
- Termination of a qualified defined contribution plan, or
- Termination of employment, coupled with an offset that occurs within 12 months after the employee’s termination date.
Under the extended rollover period, a participant may rollover all or a portion of the QPLO any time up until the participant’s federal income tax filing due date, including extensions, for the year that the QPLO was distributed. A plan loan offset amount that is not a QPLO, but is an otherwise eligible rollover distribution, may still be rolled over by a participant or surviving spouse; however, the standard 60-day rollover period applies.
For example, assume a participant terminates employment with an outstanding loan balance of $10,000, and a 401(k) account balance of $50,000. If the participant elects to take a distribution of her account balance immediately following her termination date, she would receive a cash payment of her net account balance, or $40,000, which is her account balance, reduced by the outstanding loan balance. Although the plan issued a check for only $40,000, the plan will report an actual distribution of $50,000 on the participant’s Form 1099-R. In order to avoid having to pay taxes and potential early withdrawal penalties, the participant may roll over the $40,000 amount within 60 days of its distribution under the general rollover rules. Additionally, in order to avoid taxation of and potential penalties on the $10,000 qualified plan loan offset, the participant would be responsible for funding and rolling over that additional $10,000 amount before her tax filing due date, with extensions, for the year of the distribution.
The IRS issued proposed regulations in August 2020 that addressed the extended rollover period associated with QPLOs and solicited comments.
The Final Regulations
The final regulations mostly mirror the proposed, with a key modification related to their applicability date. Specifically, the final regulations apply to distributions made on or after January 1, 2021. The IRS indicated that this revision gives plan sponsors time to review plan administration and update their systems to track plan loan offsets, termination dates, and the participant’s one-year anniversary date of termination. This is especially important because QPLO distributions must be separately identified on the Form 1099-R beginning with the 2021 tax year (i.e., Forms 1099-R filed in January 2022).
For reporting purposes, Forms 1099-R are required to distinguish between the QPLOs and other plan loan offsets. A plan loan offset other than a QPLO is reported on Box 7 of Form 1099-R as an actual distribution, rather than a deemed distribution. If the plan loan offset is a QPLO, however, then Box 7 is marked with Code “M.”
Considerations for Plan Administrators
- Communicate the appropriate rollover deadline to participants depending on the type of offset (i.e., a standard plan loan offset subject to the 60-day rollover requirement versus a QPLO subject to the extended rollover deadline).
- Confirm whether current administration can identify a standard plan loan offset versus a QPLO to ensure that Box 7 of the Form 1099-R is appropriately coded.
- Update plan loan procedures and other materials, summary plan descriptions, and relevant plan documentation as may be necessary.
You can read the full regulations here, which were published in the Federal Register on January 6, 2021.
Jon Karelitz and Lauren Salas
§ 1.29 Waistbands Aren’t the Only Thing Requiring Flexibility During the Pandemic
The Consolidated Appropriations Act of 2021 (“CAA”) offers significant relief for employers sponsoring flexible spending accounts. After much clamoring from the employer community, the IRS finally issued clarifying guidance in the form of Notice 2021-15 (the “Notice”). Check out our full Legal Update for details.
Benjamin J. Conley, Jennifer Kraft, Joy Sellstrom and Diane Dygert
§ 1.30 One-Year Expiration of Outbreak Period: Pandemic Rages On, But It’s (Probably) Time to Pay Your COBRA Premiums
Seyfarth Synopsis: As you’ll recall, last Spring, the DOL and IRS issued guidelines providing relief from certain deadlines for employee benefit plans, retroactive to March 1, 2020 (i.e., the beginning of the COVID-19 national emergency declared by the President). The relief was issued pursuant to authority granted to the agencies under ERISA Section 518 and Code Section 7508(A) and extended through the end of the “Outbreak Period.” Click here, here and here to review our prior articles on the Outbreak Period. We wanted to provide a quick update on what we’re hearing out of Washington D.C. relating to the timing and process for the expiration of the “Outbreak Period.”
In general, the extended deadline relief applied to the following deadlines applicable to participants and plan administrators:
- The COBRA election deadline;
- The COBRA premium payment deadline;
- The HIPAA special enrollment deadline;
- The deadline for filing a claim or appeal for benefits or a request for an external review of an adverse benefits determination; and
- The deadline for plan administrators to provide the COBRA election notice.
Under the guidance, any such deadline occurring on or after March 1, 2020, would be tolled for the entirety of the national emergency, plus 60 days (the “Outbreak Period”). That said, when the guidance was published it was widely believed that the national emergency period would be lifted at some point in 2020. In fact, the authority granted to the DOL and IRS under ERISA Section 518 and Code Section 7508(A) only allows such relief to extend for a one-year period.
Given this framework, our understanding is that the relief afforded under these rules will expire effective February 28, 2021 – and this expiration would be a “hard stop,” meaning there will not be a 60 day “wind down” period as anticipated in the original guidance. (But keep in mind that the deadlines were simply tolled during this period, so any remaining time a participant or plan administrator had to complete the action when the suspension took effect on March 1, 2020, will still be available after February 28, 2021.)
We reached out to various Washington D.C. policy groups to get insight into whether the agencies agree with this interpretation, and whether and to what extent they believe they have the authority to further extend the Outbreak Period, absent Congressional action granting them such authority. Here are a few key takeaways from that discussion:
- Both agencies are aware of the issue and are considering whether to issue clarifying guidance.
- The DOL seems more open to seeking avenues to further extend the Outbreak Period. The ideas they are contemplating include treating this as an “evergreen period,” with a new one year period commencing after the conclusion of the prior one year period, or perhaps even applying the one-year window on an individual-by-individual basis (which would be an administrative mess).
- The IRS is less keen on issuing any sort of extension. They are sensitive to the fact that the IRS more broadly relies on the authority under Code Section 7508(A) to extend a number of other non-benefits-related deadlines. So, they are concerned about the precedent this might set if they extend further in this context.
- Regardless of the above, both agencies seemed to tacitly confirm that, absent any further action, February 28, 2021 will be the end date for the deadline relief.
Looming in the background of all of this is the proposed COVID relief bill which would include a prospective COBRA subsidy of 85% of the cost of coverage, including the right for persons to elect COBRA prospectively to run for the remainder of their COBRA window, even if the election period has expired. So, seemingly the urgent need for an extension of the Outbreak Period is lessened (assuming the COBRA subsidy makes it into the final bill).
Given the balance of likelihoods, employers should consider communicating this upcoming expiration of the Outbreak Period (e.g., through a Summary of Material Modification or other participant communication), at the very least to COBRA participants but potentially to the broader population given the implications for HIPAA special enrollments and claim filing deadlines. (That is, unless the employer had previously communicated a February 28, 2021 end date.) It will also be important to coordinate with COBRA and claims administration vendors to ensure there is alignment/uniformity in approach.
In any case, we’re monitoring and will keep you posted on developments.
Benjamin J. Conley and Kaley Ventura
§ 1.31 Waistbands Aren’t the Only Thing Requiring Flexibility During the Pandemic: IRS Clarifies Guidance on Latest FSA Provisions and Offers Additional Relief
Seyfarth Synopsis: The Consolidated Appropriations Act of 2021 (“CAA”) offers significant relief for employers sponsoring flexible spending accounts (for a more detailed description of those changes, check out our alert). After much clamoring from the employer community, the IRS finally issued clarifying guidance in the form of Notice 2021-15 (the “Notice”). Notably, the guidance included new, additional relief that extends certain flexibility from earlier notices (Notices 2020-29 and 2020-33) into the 2021 calendar year.
Full Carryover/Grace Period Permitted for HCFSA or DCFSA for 2020 and 2021 Plan Years
Typically, carryovers of unused balances were not permitted for dependent care FSAs (DCFSAs) at all, and health care FSA (HCFSA) carryovers were limited to $550 (as adjusted for inflation in accordance with IRS Notice 2020-33). Employers sponsoring an HCFSA or DCFSA could implement a grace period, not to exceed 2.5 months after the close of the plan year, during which participants could continue to incur expenses to spend down their remaining FSA balances.
The CAA permits a full carryover of any unused balance under either an HCFSA or DCFSA for plan years ending in 2020 and 2021. In the alternative, it allows employers to offer a grace period of up to 12 months following the close of the 2020 and/or 2021 plan years.
The Notice includes the following clarifications to these provisions:
- The carryover or grace period can apply to an HCFSA, a DCFSA or a limited purpose HCFSA (i.e., an HSA-compatible FSA that can be used for dental or vision expenses and/or post-deductible medical expenses).
- The provision does not permit cross-pollination of HCFSA and DCFSA balances. Remaining health care dollars can only be use for the next year’s HCFSA and remaining dependent care dollars can only be used for the next year’s DCFSA.
- The carryover option is available for plans that already had a carryover, plans that previously had a grace period, and plans that had neither a grace period nor a carryover. The same flexibility applies for implementing a grace period.
- If a plan had an extended grace period for the 2019 plan year (pursuant to the relief provided in IRS Notice 2020-29), then any amounts remaining as of the end of that grace period as of December 31, 2020 (or, such earlier date within the 2020 calendar year, as elected) would be eligible for carryover into 2021. On the other hand, 2019 balances remaining solely because of the DOL’s pandemic relief extending claims deadlines during the “Outbreak Period” would not be eligible for carryover.
- As is normally the case for carryovers, an employer may require that employees make a minimum deferral election to access prior year funds available for carryover. To the extent the employer requires such a minimum, if an employee initially declined to enroll but later elects to enroll (either due to a mid-year election change event or because the employer has offered election change flexibility), the employer may permit the employee to access such carryover amounts and use those amounts for expenses incurred between January 1, 2021 and the date of the employee’s mid-year election to participate.
- Employers can limit the carryover or grace period to an amount less than the full balance, and may limit the carryover or grace period to a window less than the full plan year.
- For participants who may be switching from a non-HDHP with a general purpose HCFSA to an HDHP, the carryover or grace period would generally impact HSA eligibility. To mitigate this impact, employers may either:
- allow participants to opt-out of the carryover or grace period;
- allow participants to elect to convert the carryover or grace period balance to a limited purpose HCFSA; or
- automatically convert the carryover or grace period balance to a limited purpose HCFSA.
This is notable in that existing IRS guidance did not seem to allow for such a participant-by-participant grace period opt-out/conversion feature (it was only expressly allowed for carryovers).
- Amounts available during the extended grace period or carryover are disregarded for nondiscrimination testing.
- Employers can adopt a carryover for the HCFSA and a grace period for the DCFSA (or vice versa).
- Any amounts carried over under the CAA (pursuant to a carryover or grace period) are disregarded for purposes of DCFSA W-2 reporting.
- While balances available at the end of a grace period are typically forfeited, the Notice clarifies that the forfeiture requirement does not apply here because the full-year grace period would extend through the next plan year rather than ending at the end of the plan year. As such, if a plan adopts a grace period (rather than a carryover), 2020 balances can be available through the 2021 and 2022 plan years.
- This means the main practical difference between adopting a grace period or a carryover under the CAA relief is the availability of a spend down beyond the year of termination for a terminated employee. As described in the next section, this continued participation is only available under a plan with a grace period, not a carryover. Given this subtle difference, the IRS would require that an employer specify whether it has adopted a grace period or a carryover in its plan amendment.
Continuation of Participation in HCFSA by Terminated Participants
Typically, employers could permit former DCFSA participants to continue to spend down balances on post-termination qualifying expenses for the remainder of the year, but HCFSA participants could only continue participation post-termination if they were eligible for and elected COBRA.
The CAA permits employers to allow former HCFSA participants who terminate during 2020 or 2021 to continue participating post-termination, through the end of the plan year in which they terminated (plus any grace period).
The Notice includes the following clarifications to this provision:
- Employers may limit the length of the post-termination participation period, if desired.
- Employers may limit the post-termination balance to the participant’s year-to-date contributions at the time of termination (rather than the full year election amount, as would typically be required under the uniform availability rules that apply to HCFSAs).
- This provision may only extend coverage beyond the end of the plan year in which the termination occurred if the plan has a grace period. It is not available for carryover balances into the plan year following termination.
- Notably, this provision does not eliminate the requirement to send a COBRA notice where applicable.
Special Relief under DCFSA For Aged-Out Dependents
Typically, DCFSAs can reimburse expenses incurred for qualifying child care for children up to age 13.
The CAA allows plans to temporarily raise the eligible age limit to 14, but only for amounts contributed during the plan year with an enrollment period ending on or before January 31, 2020 (for calendar year plans, the 2020 plan year).
The Notice includes the following clarifications to this provision:
- Employees can seek reimbursement for expenses incurred in the 2020 or in the 2021 plan year for aged out dependents (those between 13 and 14), if the employer adopts a carryover or grace period provision carrying forward unused 2020 DCFSA election amounts.
Relaxed Election Change Guidelines for FSAs
Typically, FSA elections are irrevocable during the plan year, unless the employee experiences a mid-year status change event and timely notifies the plan administrator of the event.
The CAA permits employers to allow mid-year election changes for FSAs without regard to whether such employee incurred a qualifying life event, for plan years ending in 2021.
The Notice includes the following clarifications to this provision:
- The CAA permits employers to allow an employee who previously declined to enroll in the HCFSA or DCFSA to make a new election to enroll. (Some had speculated this provision only allowed election changes for persons who had an existing election in place.)
- Employers may limit the time period for making such an election (e.g., an employer could establish a two week window in March to permit election changes).
- If an employee revokes an election mid-year, the employer can decide whether to continue to allow the employee to spend down accumulated amounts on future expenses or to limit the employee to reimbursement of expenses incurred prior to the revocation.
- While FSA election changes may only be prospective, the IRS would permit employers to allow employees to use such prospectively elected FSA deferrals for expenses incurred after January 1, 2021, but before the date of such election change.
- If an employer elects to limit reimbursements from a general purpose HCFSA following revocation to expenses incurred prior to revocation, then the employee will not be treated as being enrolled in disqualifying coverage for HSA purposes starting with the month following such revocation.
Extension of Relaxed Election Change Rules to non-FSA Elections
While the CAA only relaxes election change guidelines for FSAs, the Notice extends such relief to all Section 125 elections, subject to similar parameters as outlined in IRS Notice 2020-29 (more on those limits, here).
The Notice provides employers with flexibility in choosing to implement (and/or limiting implementation of) this CAA provision and lists various types of “guardrails” an employer might put in place, including limiting elections to increases/enrollment, limiting the timeframe for elections, and limiting the number of election changes an employee could make during the plan year.
Amendment Relief for Pre-tax OTC/Menstrual Product Reimbursements
As described in greater detail here, the CARES Act permits plans to expand reimbursement under certain pre-tax vehicles (HCFSAs, HSA, MSAs, HRAs) to include over-the-counter drugs and menstrual products. The provision was effective retroactive to January 1, 2020, but unlike with other laws impacting Section 125 plans, the CARES Act included no relief from the general rule that amendments may only be made prospectively.
The Notice solves this dilemma by permitting employers to amend their Section 125 plan to expand permitted reimbursements at any time, with a retroactive effect to January 1, 2020.
We will continue to monitor and alert you of any new or additional regulatory developments clarifying provisions of the CAA. In the interim, please contact the authors of this Alert or the benefits lawyer you work with for additional information.
Benjamin J. Conley, Jennifer Kraft, Joy Sellstrom, and Diane Dygert
§ 1.32 DOL Issues Clarification of Outbreak Period — Sort of
At the 11th hour, on February 26, 2021, the Department of Labor (DOL) issued EBSA Disaster Relief Notice 2021-01 (the “Notice”) to provide guidance on the duration of the COVID-related relief previously provided by the DOL in Notice 2020-01 and by the DOL and IRS in a separate joint notice (the 2020 Notices). Under the 2020 Notices, various timeframes under ERISA and the Internal Revenue Code were to be disregarded, including for purposes of filing claims for benefits, electing and paying for COBRA continuation coverage, and requesting special enrollments. See our previous alert here.
The relief provided in the 2020 Notices began March 1, 2020 and continued until 60 days after the announced end of the COVID National Emergency or such other date announced by the relevant agencies (the “Outbreak Period”). However, by statute, the disregarded period for individual actions was limited to one year from the date the individual action would otherwise have been required or permitted. One year from March 1, 2020 is February 28, 2021. Employers, vendors and other stakeholders have been unclear as to how to apply the limit as the February 28th date approached, as we commented on in our recent blog post here.
End of Suspension Period
Notice 2021-01 states that the timeframes that are subject to the relief under the 2020 Notices will have the applicable periods disregarded until the earlier of:
- One year from the date the individual or plan was first eligible for relief; or
- 60 days after the announced end of the COVID National Emergency.*
In other words, the relief will be applied on an individual-by-individual basis, which is likely to present a host of administrative difficulties for employers. An example in the 2020 Notices provides that if a qualified beneficiary would have been required to make a COBRA election by March 1, 2021, the election requirement is delayed until the earlier of one year from that date (i.e., March 1, 2022) or the end of the Outbreak Period.
Individual Accommodation and Notice
In addition to providing that the relief is to be applied on an individual-by-individual basis, the Notice implies that after the relief is no longer available due to the statutory one-year limit, plan administrators should individually notify participants of the end of a relief period and ensure that participants who are losing coverage under an employer-provided plan are aware of other coverage options such as the Health Insurance Marketplace. The Notice states that the guiding principle for administering employee benefit plans is to act reasonably, prudently, and in the interest of the workers and families who rely on their health, retirement and other employee benefit plans for their physical and economic well-being. Accordingly, plan fiduciaries should make reasonable accommodations to prevent the loss or undue delay in payment of benefits in such cases and should take steps to minimize the possibility of individuals losing benefits because of a failure to comply with pre-established time frames.
“For example, where a plan administrator or plan fiduciary knows, or should reasonably know, that the end of the relief period for an individual action is exposing a participant or beneficiary to a risk of losing protections, benefits, or rights under the plan, the administrator or fiduciary should consider affirmatively sending a notice regarding the end of the relief period. Moreover, plan disclosures issued prior to or during the pandemic may need to be re-issued or amended if such disclosures failed to provide accurate information regarding the time in which participants of beneficiaries were required to take action….”
Given the DOL’s statements, plan administrators should consider communicating the relief provided by this Notice to participants and beneficiaries. In addition, employers should ensure that their vendors will apply the time frames on an individual-by-individual basis.
Please contact the attorney at Seyfarth Shaw LLP with whom you usually work if you would like assistance in applying the relief or preparing a Summary of Material Modification (SMM) or other communication.
*President Biden announced in a letter to Congress on February 24, 2021 that the national emergency declared in Proclamation 9994 will continue in effect beyond March 1, 2021.
Joy Sellstrom, Danita N. Merlau, Kaley M. Ventura and Diane V. Dygert
§ 1.33 Parliamentarian to Decide Fate of Multiemployer Pension Reform in the COVID Relief Act
Seyfarth Synopsis: If the Senate Parliamentarian blesses it, the $1.9 trillion American Rescue Plan (a.k.a. the latest COVID-19 relief bill) may include multiemployer pension relief that would provide underfunded multiemployer pension plans with sufficient monies from the Treasury Department to pay for all accrued benefits owed to retirees, without reduction, through the plan year ending in 2051. Notably, any multiemployer pensions plans eligible for this relief would not have to repay those monies.
Embedded in the $1.9 trillion “American Rescue Plan” is yet another attempt at multiemployer pension plan reform, entitled the “Butch Lewis Emergency Pension Plan Relief Act of 2021” (“Butch Lewis”). The Senate Parliamentarian is to decide whether Butch Lewis has the necessary budget impact to remain part of what is to be a budget reconciliation bill that will need only majority approval in the Senate. That decision should come very soon.
Butch Lewis is a continuation of various prior legislative efforts aimed at addressing the multiemployer pension plan crisis, including earlier versions of the Butch Lewis Act of 2019, the Emergency Pension Plan Relief Act of 2020, and other pending pension reform legislation. Gone are attempts to share any economic pain among the stakeholders, or to provide any mechanism for the repayment of financial assistance given to underfunded multiemployer pension plans. Instead, if it remains in the American Rescue Plan, Butch Lewis as drafted will make any underfunded multiemployer plan eligible for “special financial assistance” that is not subject to any financial repayment obligations, provided it meets one of the following criteria:
- The multiemployer pension plan is in critical and declining status in any plan year beginning in 2020 through 2022;
- The multiemployer pension plan suspended benefits in accordance with the process set forth in the Multiemployer Pension Reform Act of 2014 (“MPRA”);
- The multiemployer pension plan is certified by the plan actuary to be in critical status in any plan year beginning in 2020 through 2022, has a “modified funded percentage” (defined as the percentage equal to a fraction, the numerator of which is current value of plan assets and the denominator of which is current liabilities) of less than 40%, and has a ratio of active to inactive participants which is less than 2 to 3; or
- The multiemployer pension plan became “insolvent” after December 16, 2014, as defined under Internal Revenue Code Section 418E, and has remained so insolvent and has not been terminated as of the date of enactment of Butch Lewis.
Multiemployer pension plans seeking special financial assistance must apply no later than December 31, 2025, with revised applications submitted no later than December 31, 2026. Butch Lewis allows the PBGC to limit applications during the first 2 years following enactment to certain plans, such as those that are insolvent or are likely to be insolvent within 5 years.
The amount of financial assistance provided to eligible multiemployer pension plans is equal to the amount required to pay all accrued benefits, without reduction, due from the date of payment of the special financial assistance through the last day of the plan year ending in 2051. In short, eligible multiemployer pension plans should have sufficient funds to pay benefits for the next 30 years, provided investment performance over that period is line with projected investment returns and other actuarial assumptions.
Butch Lewis does have provisions to attempt to limit plans from mismanaging the monies they receive. The special financial assistance and any earnings on such assistance must be segregated from other plan assets, and can only be invested in investment-grade bonds or other investments as permitted by the PBGC. The PBGC also is authorized to impose by regulation conditions on plans receiving special financial assistance relating to increases in future accrual rates and any retroactive benefit improvements; allocation of plan assets; reductions in employer contribution rates; diversion of contributions to, and allocation of expenses to, other benefit plans; and withdrawal liability.
Any multiemployer pension plan that receives special financial assistance shall be deemed to be in critical status until the last plan year ending in 2051, and it also must reinstate any previously suspended benefits under the MPRA, and provide payments equal to the amount of benefits previously suspended (either as a lump sum or in equal monthly installments). Multiemployer pension plan accepting special financial assistance under Butch Lewis will not be eligible to apply for a new suspension of benefits under the MPRA.
The funds used to pay for the special financial assistance would come directly from the Treasury Department. The payment to the multiemployer pension plan would be a single, lump-sum payment. There is currently no provision for a tax on participating employers, or any reduction in participating employee benefits. The proposed law does provide, however, for an increase in premium rates for multiemployer plans from the currently indexed annual per participant rate (which is $31 per participant for plan years beginning in 2021) to $52 per participant for plan years beginning after December 31, 2030, with indexing for inflation tied to the Social Security Act’s national wage index.
Any participating employer that withdraws within 15 calendar years from the effective date of when a plan receives special financial assistance will not see any reduction in its withdrawal liability assessment due to the special financial assistance. Withdrawal liability will be calculated without taking into account special financial assistance received until the plan year beginning 15 calendar years after the effective date of the special financial assistance. As currently drafted, Butch Lewis would not otherwise change how withdrawal liability is calculated, including application of the withdrawal liability payment schedule, the 20-year cap on payments, or the mass withdrawal liability rules.
In short, Butch Lewis as currently drafted basically would result in the federal government picking up the tab for certain seriously underfunded multiemployer pension plans for the next 30 years, without imposing any costs directly on such plans or their participating employers, unions, participants or retirees. As such, it could be a huge relief for such underfunded plans and their participating employers and participants if Butch Lewis is passed. Stay tuned.
Ronald Kramer, Seong Kim, and James Hlawek
§ 1.34 Pension and Executive Compensation Provisions in the American Rescue Plan Act
Seyfarth Synopsis: On March 11, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (“ARPA”), the $1.9 trillion COVID-19 relief bill. ARPA includes various forms of multiemployer and single employer pension plan relief, as well as certain executive compensation changes under Section 162(m) of the Internal Revenue Code (“Code”), which are discussed further below. Please see our companion Client Alert on the other employee benefit items of interest in ARPA here.
Multiemployer Pension Plan Relief
ARPA retains the key provisions of the Butch Lewis Emergency Pension Relief Act of 2021 (the “Butch Lewis Act of 2021”), providing relief to financially troubled multiemployer pension plans. The Butch Lewis Act of 2021 was a continuation of multiple prior legislative efforts aimed at addressing the multiemployer pension plan crisis, including its earlier iterations (the Butch Lewis Act of 2017, the Butch Lewis Act of 2019), the Emergency Pension Plan Relief Act of 2020, the Chris Allen Multiemployer Pension Recapitalization and Reform Act, and other legislative proposals. Most notably, ARPA includes the provision of the Butch Lewis Act of 2021 for direct financial assistance without a repayment obligation. ARPA also gives multiemployer plans the opportunity to extend zone status, extend funding improvement and rehabilitation plans, and provides amortization relief .
- Special Financial Assistance
ARPA creates a “special financial assistance fund” under the Treasury Department from which the Pension Benefit Guaranty Corporation (“PBGC”) will be able to make grants to financially troubled multiemployer pension plans. As noted above, any multiemployer pension plan receiving relief would not have to repay those funds. To be eligible for financial relief, a multiemployer pension plan would need to satisfy one of the following criteria:
- The multiemployer pension plan is in critical and declining status in any plan year beginning in 2020 through 2022;
- The multiemployer pension plan suspended benefits in accordance with the process set forth in the Multiemployer Pension Reform Act of 2014 (“MPRA”);
- The multiemployer pension plan is certified by the plan actuary to be in critical status in any plan year beginning in 2020 through 2022, has a “modified funded percentage” (defined as the percentage equal to a fraction, the numerator of which is current value of plan assets and the denominator of which is current liabilities) of less than 40%, and has a ratio of active to inactive participants which is less than 2 to 3; or
- The multiemployer pension plan became “insolvent” after December 16, 2014, as defined under Code Section 418E, and has remained so insolvent and has not been terminated as of the date of enactment of ARPA.
Under this program, multiemployer pension plans seeking special financial assistance must apply no later than December 31, 2025, with revised applications submitted no later than December 31, 2026. ARPA also allows the PBGC to limit applications during the first two years following enactment to certain plans, such as those that are insolvent or are likely to be insolvent within five years.
The amount of financial assistance provided to eligible multiemployer pension plans is equal to the amount required to pay all benefits, without reduction, due from the date of payment of the special financial assistance through the last day of the plan year ending in 2051. The payment to the multiemployer pension plan would be a single, lump-sum payment. Interestingly, there is no noted cap on the amount of financial assistance available per plan or the order which the PBGC will prioritize applications for financial assistance. The PBGC is expected to issue further guidance shortly.
ARPA places certain restrictions on plans receiving special financial assistance. The money received (and earnings on such amounts) must be segregated from other plan assets, and may only be invested in investment-grade bonds or other investments as permitted by the PBGC. The PBGC is authorized to impose additional conditions on plans receiving special financial assistance. These restrictions relate to (1) increases in future accrual rates and any retroactive benefit improvements; (2) allocation of plan assets; (3) reductions in employer contribution rates; (4) diversion of contributions to, and allocation of expenses to, other benefit plans; and (5) withdrawal liability.
Any multiemployer pension plan that receives special financial assistance will be deemed to be in critical status until the last plan year ending in 2051, and must also reinstate any previously suspended benefits under the MPRA (either as a lump sum or in equal monthly installments paid over five years). Multiemployer pension plans accepting special financial assistance will not be eligible to apply for a new suspension of benefits under the MPRA.
ARPA also provides for an increase in PBGC premium rates for multiemployer plans from the currently indexed annual per participant rate (which is $31 per participant for plan years beginning in 2021) to $52 per participant for plan years beginning after December 31, 2030, with indexing for inflation tied to the Social Security Act’s national wage index.
Earlier versions of the Butch Lewis Act of 2021 included provisions stating that any participating employer that withdraws within 15 calendar years from the effective date of when a plan receives special financial assistance would not see any reduction in its withdrawal liability assessment due to the special financial assistance. The relief bill as passed, however, no longer appears to include this carve out for withdrawal liability. As passed, ARPA would not otherwise change how withdrawal liability is calculated, including application of the withdrawal liability payment schedule, the 20-year cap on payments, or the mass withdrawal liability rules. As noted above, however, ARPA gives the PBGC authority to impose additional conditions with respect to withdrawal liability.
- Temporary Funding Status Relief.
Under ARPA, eligible multiemployer pension plans may elect to retain for plan year 2020 or 2021 (known as the “designated plan year”) the zone status that applied for the previous year. In addition, any multiemployer plans that were in endangered or critical status in the year prior to their designated plan year would not be required to update their funding improvement plan, rehabilitation plan, or corresponding schedules, until the year following the designated year.
If a multiemployer plan is not considered to be in endangered or critical status as a result of an election, no further notification is required regarding its endangered or critical status, but such plan must provide notice to its participants, beneficiaries, the PBGC, and the DOL of its election under ARPA.
- Funding Improvement Plan and Rehabilitation Plan Relief.
ARPA allows multiemployer pension plans that are already in endangered or critical status to extend any applicable funding improvement plan or rehabilitation plan for five years. This relief applies to plan years beginning on or after December 31, 2019.
- Amortization Relief.
Similar to relief provided in 2008 and 2009, ARPA allows multiemployer pension plans to amortize investment losses for plan years ending on or after February 29, 2020 over a 30-year period (instead of 15 or less). In addition to investment losses, the extended amortization period also applies to “other losses” related to COVID-19, including experience losses related to reductions in contributions, reductions in employment, and deviations from anticipated retirement rates.
Single Employer Pension Plan Relief
ARPA has two sections that grant some funding relief to single-employer defined benefit pension plans. First, ARPA extends the amortization period for certain funding shortfalls under the minimum funding requirements and resets certain prior shortfall amounts to zero. Single-employer pension plans are subject to minimum funding requirements under the Code and ERISA. One of the items included in the required minimum funding calculation is a shortfall amortization charge, which allows plans to spread the charge for funding shortfalls over a certain number of years. Before ARPA’s adoption, the amortization period used to determine this charge was generally 7 years. ARPA has extended this period to 15 years. ARPA also sets all prior shortfall amounts to zero for plan years beginning after December 31, 2021 (or an earlier year as elected by the plan sponsor), so any shortfall amount will be recalculated and spread over a longer time period.
Additionally, ARPA extends the funding stabilization changes that were enacted by Congress over the past 10 years, beginning with the MAP-21 changes in 2012, that were scheduled to start phasing out in 2021. Under these funding stabilization rules, the interest rates used for determining the present value of plan liabilities are subject to maximum and minimum percentages and the difference between the maximum and minimum percentages gradually increases (i.e., phases out) over time. ARPA shrinks the difference between the two percentages and extends the period before the range begins to phase out, which further stabilizes the funding calculations. ARPA also creates a 5% floor for the 25-year average of the interest rate that is subject to the minimum and maximum percentages. If an increase to the otherwise effective interest rate occurs due to the floor, this would decrease the present value of plan liabilities. These changes are effective for plan years beginning after December 31, 2019, but a plan sponsor may elect to wait to apply the changes for all purposes, or just for purposes of determining the application of the benefit restrictions under Code Section 436 until the 2021 or 2022 plan year.
The earlier version of the bill that passed the House contained a section freezing the cost of living adjustments for Code Section 415 and 401(a)(17) (i.e., the limits on “Annual Additions” and annual “Compensation” that may be considered under a qualified retirement plan) for calendar years beginning after 2030. However, this section was removed from the bill in the Senate and replaced with an expansion of the $1 million deduction limitation on compensation under Code Section 162(m), described further below.
Code Section 162(m) prohibits publicly held corporations from deducting wages or other compensation in excess of $1 million paid annually to certain covered employees. Currently, the limitation applies to anyone who has served as CEO, CFO or one of the next three highest compensated officers during any tax year beginning after December 31, 2016. ARPA expands the application of the $1 million deductibility cap to include the next five highest compensated employees, in addition to the CEO, CFO and the three other highest compensated officers. Unlike other covered employees, ARPA does not require that these additional five employees be permanently treated as covered employees; rather, this group of five additional covered employees would be re-determined based on compensation levels each year. This change will take effect for tax years beginning after December 31, 2026.
Seong Kim, Christina M. Cerasale, Kaley M. Ventura and Alan B. Cabral
§ 1.35 Freedom Ain’t Free. COBRA, On the Other Hand…
American Rescue Plan Act Provides 100% COBRA Subsidy
Seyfarth Synopsis: The latest COVID relief bill, the American Rescue Plan Act (ARPA), provides for a 100% COBRA premium subsidy from April 1, 2021 through September 30, 2021. ARPA, which was signed into law by President Biden on March 11, 2021, also significantly expands a tax break for dependent care expenses. This Alert provides an overview of these key welfare benefit provisions and how they may impact plan sponsors. Please see our companion Client Alert on the other employee benefit items of interest in ARPA here.
Most notably, ARPA offers a 100% subsidy to COBRA qualifying beneficiaries for the period commencing April 1, 2021 continuing through September 30, 2021 (the “Subsidy Period”). The subsidy is available to those who become COBRA eligible during the Subsidy Period as well as those currently enrolled and those who are within their COBRA continuation window but who failed to elect or previously dropped coverage.
The COBRA subsidy in many ways mirrors the subsidy offered during the American Recovery and Reinvestment Act of 2009 (ARRA), so while ARPA is light on details, we can look to IRS/DOL guidance under ARRA for clues as to how the agencies may implement these provisions. Key highlights from the bill include the following:
- Who is Eligible? The COBRA subsidy is available to any person who experienced a qualifying event due to termination of employment or reduction in hours (other than a voluntary separation), who is still within their COBRA continuation window (generally 18 months following loss of coverage), even if that person did not timely elect COBRA. In certain circumstances eligibility can end before the conclusion of the Subsidy Period, as noted below.
- Calculating the Subsidy. During the Subsidy Period, qualifying individuals are treated as having paid the full amount of COBRA premiums owed (typically, 102% of the cost of coverage.
- Extended Election Period. ARPA gives a qualified beneficiary who (a) is eligible for COBRA but did not elect COBRA as of April 1, 2021, or (b) elected and discontinued COBRA coverage before April 1, 2021 another chance to elect COBRA during the period beginning April l, 2021 and ending 60 days after notice of the extended election period is received.
- Employer Notice Obligations.
- General Notice. With respect to any person who becomes entitled to elect COBRA during the Subsidy Period, employers must include information in the COBRA election notice regarding the availability of the premium subsidy and (if applicable) the option to enroll in different coverage.
- Notice of Extended Election Period. With respect to the individuals described above who are entitled to an extended election period, by May 31, 2021, employers must notify those persons of the new 60-day opportunity to elect COBRA prospectively for the Subsidy Period. ARPA directs the DOL to put out model notices within 30 days of enactment, but it notes that the obligation can be satisfied by modifying existing notices or adding an insert.
- Notice of Expiration of Subsidy Period. ARPA also requires notice when premium assistance is expiring, with the notice to be sent no more than 45 days from expiration, and no less than 15 days from expiration. ARPA directs the DOL to issue a model notice within 45 days of passage of the Act.
- New Open-ish Enrollment Window. ARPA allows plans to offer a 90 day “open enrollment” window in which a COBRA-covered (or eligible) individual could (a) enroll in coverage, or (b) switch to another employer benefit plan option other than the one in which the person is currently enrolled (or was enrolled in at the time of the qualifying event). This opportunity would be at the plan administrator’s discretion and must be limited to coverage that is the same cost or less expensive than the option in which the person was enrolled in as of the qualifying event date (and is not an excepted benefit, a qualified small employer health reimbursement arrangement (QSEHRA) or a health flexible spending account).
- Early Loss of Eligibility. Any person who has become eligible for other group health coverage or Medicare will no longer be eligible. ARPA places an obligation on the participant to notify the plan administrator of such loss of eligibility and imposes penalties on the participant for failure to do so. (Under ARRA, if a person had an election window for other group coverage before the commencement of the subsidy period but that election window had lapsed, the individual would be considered subsidy eligible until the next enrollment window for the other coverage. We would expect the agencies to adopt similar guidelines here.)
- Tax Credit for Employer/Carrier. Employers (for self-funded plans and fully-insured plans subject to federal COBRA), who cover subsidy-eligible persons are reimbursed for the foregone COBRA premium via an advanced tax credit equal to the value of the subsidy. While the tax credit is capped at the total payroll taxes owed by the employer (or insurer), it is a refundable tax credit with respect to any excess. Additional guidance is expected on how the credit is claimed in other scenarios (e.g., multiemployer plans).
- No Tax on Participant. The COBRA subsidy is not treated as income for purposes of the plan participant.
- Interaction with Outbreak Period. As described in our Alert, the DOL and IRS previously provided relief by suspending the time period for an individual to elect COBRA until 60 days after the end of the National Emergency, or if earlier, one year after the individual became eligible for the relief (the Outbreak Period). It is unclear how this relief will be coordinated with the new enrollment and notice rules in ARPA, and whether a single notice could be used to satisfy notice all COBRA-related notice obligations.
Expanded Dependent Care Exclusion for 2021
Current tax rules permit an exclusion from income for up to $5,000 (married filing jointly) or $2,500 (single or married filing separately) for employer-provided dependent care benefits or pre-tax salary deferrals through a Section 125/129 plan.
ARPA more than doubles this limit for the 2021 tax year, allowing an exclusion of up to $10,500 (married filing jointly) or $5,250 (single or married filing separately).
Employers may amend their Section 125/129 plan at any point before the end of the 2021 plan year to adopt this provision. Employers who choose to expand such tax deferral limits should be cognizant of the potential impact on nondiscrimination testing, which is notoriously challenging for certain employers to pass even at existing levels.
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We will continue to track the regulatory agencies’ implementation of these provisions and keep you apprised of any further developments.
Benjamin J. Conley and Joy Sellstrom
§ 1.36 Baby Steps: Departments Issue Third Set of COVID FAQs
Seyfarth Synopsis: On February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) jointly issued FAQS ABOUT FAMILIES FIRST CORONAVIRUS RESPONSE ACT AND CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT IMPLEMENTATION PART 44 regarding implementation of the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), and other health coverage issues related to COVID-19. These FAQs continue building the knowledge bank from prior FAQs, such as the ones issued in June 2020 (here).
Are things beginning to settle after the storm? As plans get accustomed to our “new normal,” including covering COVID testing and vaccinations, the Departments further refine and clarify guidance on what precisely does (and does not) need to be covered, which helps employers in establishing a roadmap to make vaccines widely available to their employees inside the bounds of group health plan requirements.
Under the FFCRA and CARES Act, group health plans are required to cover diagnostic testing and related items and services without cost-sharing requirements and providers of diagnostic tests for COVID-19 must publish the cash price of a COVID-19 diagnostic test on the provider’s public internet website. The FAQs address more specific fact patterns related to testing. For example, the FAQs explain that:
- The Departments previously said a plan cannot limit the number of tests that it will cover for an individual. (See Q/A-6 of FAQ 43). This is true, per these latest FAQs, even if the individual is asymptomatic and has no recent exposure. No criteria or screening can be imposed on the coverage of tests. And as long as the test is issued by a licensed health care provider, the location of the test does not matter (e.g., drive-through tests are covered). (See Q/A-3). In addition, point-of-care (i.e., rapid) tests must be covered on the same basis as other tests. (See Q/A-4).
- The Departments previously distinguished testing for diagnostic purposes from testing for surveillance or employment purposes, stating that testing for diagnostic purposes (sought by the individual) has to be covered, but testing for general public surveillance or employment purposes (such as pursuant to a “return to work” program) does not. One way to distinguish is that a public surveillance or employment purpose is not primarily for individualized diagnosis and treatment. These latest FAQs clarify that plans and issuers can make that distinction, and encourage them to communicate the difference in circumstances where testing is (or is not) covered. (See Q/A-2.)
Most group health plans are required to cover preventive services without cost-sharing requirements. This now includes any “qualifying coronavirus preventive service”, which is an item, service, or immunization that is intended to prevent or mitigate COVID-19 and that is, with respect to the individual involved—
- An evidence-based item or service that has in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF); or
- A vaccine that has in effect a recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).
Plans must provide coverage without cost-sharing for the cost and administration of all COVID-19 vaccines that receive a recommendation – starting no later than 15 business days after the date the USPSTF or ACIP makes the recommendation regarding a qualifying coronavirus preventive service. (See Q/A-7 & Q/A-8). As of the date of the FAQs, February 26, 2021, the ACIP had approved Pfizer BioNTech and Moderna COVID-19 vaccines. Subsequently, on February 28, 2021 the ACIP recommended the Johnson and Johnson COVID-19 vaccine. Even if a participant is not in a category of individuals prioritized for vaccination at the time he/she receives it, the plan must cover it. (See Q/A-10).
SBC Notice Requirements
Normally, if a plan makes a material modification in any of the terms of the plan or coverage that would affect the content of the Summary of Benefits and Coverage (SBC), the plan must provide notice of the modification to enrollees not later than 60 days prior to the date on which the modification becomes effective. Although the Departments will not take enforcement action against a plan that does not provide at least 60 days’ advance notice of a material modification regarding the addition of qualifying coronavirus preventive services, plans should notify participants about coverage of qualifying coronavirus preventive services as soon as reasonably practicable. (See Q/A-11).
Ways for Employers to Issue COVID Vaccines
Many employers have asked how they can sponsor programs to facilitate vaccination of their employees who are not enrolled in the employer’s major medical plan. The answer as of now appears to be offering the vaccine through an Employer Assistance Program (EAP) or through an onsite clinic.
Our December 2020 alert discussed employer sponsored vaccine programs (here) and the technical concern that such programs create a group health plan which then, in turn, is subject to the Affordable Care Act, COBRA, and other laws applicable to group health plans. Certain “excepted benefits,” however, are exempt from many such requirements. The Departments previously said that COVID testing under an EAP or onsite clinic would ameliorate the concern about operating a group health plan out of compliance with the ACA. As anticipated in our alert, the Departments confirm in these FAQs that an EAP can offer COVID vaccines (and their administration) and still remain an excepted benefit. The same goes for on-site medical clinics. (See Q/A-12 and 13).
Also see our alert about offering incentives for vaccinations, here.
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We hope you find this helpful, and welcome you to contact your Seyfarth Employee Benefits lawyer with any questions about these FAQs or any other related guidance.
 See Issue 42 of the joint FAQs, here, and our blog post here.
 State and local public health authorities can limit eligibility for tests if necessary to manage testing supplies, for example, but once the test is issued (at least for individual, diagnostic purposes), it has to be covered. (See Q/A-1).
 The EAP would need to still comply with other applicable requirements, however.
Kelly Joan Pointer and Joy Sellstrom
§ 1.37 Yes, Your Health FSA Can Cover Your Surgical Mask Purchase!
Seyfarth Synopsis: Avid readers of Beneficially Yours may recall that just over a year ago we asked the pressing question of whether surgical mask purchases could be covered under a health care FSA, among other “novel” coronavirus questions — see what we did there? [Click here for our previous post.] The IRS has confirmed our ground-breaking declaration that masks purchased to prevent contracting the coronavirus could be reimbursable under your health care FSA.
The IRS has finally weighed in — Announcement 2021-7 — allowing personal protective equipment (PPE) to be treated as qualifying medical expenses under Internal Revenue Code Section 213. PPE includes such items as masks, hand sanitizers and sanitizing wipes for the primary purpose of preventing the spread of the virus that causes COVID-19. So, if these items are not otherwise covered by insurance or deducted on an individual’s tax return, they can be reimbursed under the individual’s health care flexible spending account (FSA), health care reimbursement account (HRA), health care savings account (HSA), or Archer medical savings account (MSA).
To the extent these health care arrangements have been permitting these reimbursements already, this announcement provides welcome confirmation. Other plan sponsors may want to use this opportunity to review the rules for their FSAs and HRAs to determine if they should be expanded to specifically allow for reimbursements for these PPE purposes. The IRS states that FSAs and HRAs may be amended for any period beginning on or after January 1, 2020, as long as the plan has been operated consistently and the amendment is in place before the end of the calendar year following the end of the year for which the change is effective. For example, by December 31, 2021 for a change effective January 1, 2020. No retroactive amendment may be adopted later than December 31, 2022.
§ 1.38 A Ninth Circuit Panel Finds No ERISA Preemption Of Seattle Health Care Ordinance
Seyfarth Synopsis: A recent panel decision from the Ninth Circuit rejects an ERISA preemption argument that a Seattle ordinance regulating private sector health care should be nullified in order to safeguard the ERISA administrative scheme.
On March 17, 2021, a three judge panel of the Court of Appeals for the Ninth Circuit found that ERISA did not preempt a provision in the Seattle Municipal Code that mandates hotel employers and ancillary hotel businesses to provide money directly to designated employees, or to include those employees in the employer’s health benefits plan. If the employer provides self-insured health benefits, that plan ordinarily would be protected from state laws intruding on its administration, under the broad ERISA preemption clause that nullifies state and local laws that “relate to” ERISA plans.
This case is captioned — The ERISA Industry Committee v. City of Seattle, No. 20-35472.
The three panel judges reasoned that the Seattle ordinance was not preempted by relying on the Ninth Circuit decision in Golden Gate Rest. Ass’n v. City & Cnty. of San Francisco, 546 F.3d 639 (2008). The panel said that the Seattle ordinance does not “relate to” any ERISA plan, in accord with Golden Gate, because the employer may fully discharge its expenditure obligations by making the required level of employee health care expenditures to a third party, here the employees directly. The decision was unsigned (per curiam).
There are a number of interesting aspects to the Seattle decision.
First, the panel labeled the decision as an unpublished Memorandum. Circuit Rule 36-3(a) states that unpublished Memoranda are not precedent. The panel thus limited the impact of its decision, which is unfortunate given a conflict in the circuits (noted below).
Second, the Ninth Circuit panel made no mention of the conflict between Golden Gate and Retail Indus. v. Fielder, 475 F.3d 180 (4th Cir. 2007). In Fielder, the Court of Appeals for the Fourth Circuit ruled that a Maryland law that required large employers to spend at least 8% of their total payrolls on employee health insurance costs or pay the shortfall to the state was preempted by ERISA. The court reasoned that the Maryland law was preempted because it “effectively” required employers in Maryland to restructure their ERISA plans, and thus conflicted with ERISA’s goal of permitting uniform nationwide administration of those plans.
Third, the Ninth Circuit panel applied a presumption “against” ERISA preemption. By contrast, a recent (unanimous) ERISA preemption decision of the Supreme Court, Rutledge v. Pharmaceutical Care Management Assn., discussed in a previous blog post blog post, makes no reference to any such presumption.
Fourth, the Ninth Circuit panel seems to apply field preemption concepts set forth in Justice Thomas’s concurring opinion in Rutledge. That test can be explained by asking whether a provision in ERISA governs the same matter as the state law, and thus could replace it. ERISA, of course, does not regulate direct payments to employees. This construct of preemption appears to narrow the ERISA preemption standard now applied by a solid majority of the Supreme Court.
We live in an age of state experimentation with matters arguably regulated by ERISA. Expect to see more such experimentation and more litigation to defend the federal scheme in ERISA.
Mark Casciari and Kathleen Cahill Slaught
§ 1.39 ARPA COBRA Subsidy: DOL Releases Model Notices, Punts (to IRS?) on Most Open Issues
Seyfarth Synopsis: As discussed in our March 11, 2021 Alert, Congress has made another avenue of health coverage more accessible by fully subsidizing the cost of COBRA coverage from April 1 – September 30, 2021 for individuals who lost their health coverage due to an involuntarily termination or a reduction in hours under the American Rescue Plan Act of 2021 (ARPA). On April 7, 2021, the Department of Labor (DOL) published FAQs to further explain this COBRA subsidy and provided models of the required related notices.
Notable Points from the FAQs
- Eligibility Based on Reduction in Hours. The FAQs take an expansive view on when a reduction in hours constitutes a qualifying event (clarifying that “involuntary” does not modify the reduction in hours trigger), stating that the following situations are covered: “reduced hours due to change in a business’s hours of operations, a change from full-time to part-time status, taking of a temporary leave of absence, or an individual’s participation in a lawful labor strike, as long as the individual remains an employee at the time that hours are reduced.” Terminations of employment only render an employee eligible for the subsidy though if involuntary. (The guidance did not define what constitutes an involuntary termination, but clarified that exclusions for gross misconduct will still apply.)
- Interaction with DOL Outbreak Period. The election extension provided under the DOL’s Outbreak Period guidance (generally tolling the COBRA election period window for up to a year) does not apply to the newly created, 60-day election window under the ARPA. In other words, subsidy-eligible individuals who fail to elect COBRA within 60 days of the date they receive the notice will not be eligible for a subsidy. (They may still qualify for COBRA under the DOL’s Outbreak Period rules, but it will be at their own cost.)
Similarly, the DOL relief extending notice deadlines does not apply to the ARPA-required notices (the general election notice or the notice of pending subsidy expiration, discussed below).
- Impact of Employer COBRA Subsidy. The FAQs do not address one of the key questions many employers have been asking: If the employer subsidizes COBRA via a severance arrangement, will that reduce the amount of tax credit the employer may claim? The guidance merely states the following: “An employer or plan to whom COBRA premiums are payable is entitled to a tax credit for the amount of the premium assistance.”
- Deadline for Distributing New Election Notice. The FAQs specify that the deadline for plans to distribute the new ARPA general election notice is May 31, 2021. Any coverage elected pursuant to that general notice would be effective retroactive to the first period of coverage beginning on or after April 1, 2021. Or, the employee can elect to enroll only prospectively following receipt of the notice (but that delayed enrollment does not extend the subsidy window). An individual may want to delay enrollment if he or she was enrolled in Marketplace coverage and receiving a tax credit (as the subsidized COBRA could render that person ineligible for the tax credit).
- Timing of Participant Coverage Election. If an individual believes he or she qualifies for the COBRA subsidy, that person can reach out to the COBRA administrator or plan administrator in advance of receiving the election notice and request the right to enroll. If the person is correct that he or she qualifies, the plan cannot require the person to pay a premium (even if it intends to reimburse them later after the election notice goes out). Presumably the person would ultimately need to later return the election notice however (which certifies to the employer the individual’s eligibility for the subsidy).
- Plan Cannot Require Payment of Admin Fee. The FAQs make clear that the assistance-eligible individual cannot be charged anything for COBRA (the plan cannot charge the admin fee to the participant).
- Marketplace Special Enrollment at Subsidy Expiration. The FAQs indicate a subsidy expiration “may” constitute a Marketplace special enrollment event. It is unclear whether this suggests that offering such a special enrollment is at the discretion of the Marketplace/carrier, or if it is required.
New Model Notices
ARPA requires employers to notify qualified beneficiaries regarding the availability of this COBRA subsidy and their related rights. The DOL provided the following model notices as described more fully below:
- Notice: General Notice.
Deadline: 60 days after the qualifying event (normal COBRA procedure).
Description: This notice is for plans subject to Federal COBRA to send to individuals experiencing any qualifying event between April 1, 2021-September 30, 2021 (including voluntary terminations). It is essentially the DOL’s standard COBRA general notice with ARPA information woven throughout. So, while this notice may be provided separately or with the standard COBRA general notice, it makes sense to use the ARPA general notice during the relevant period rather than providing participants two sets of notices.
- Notice: Alternative Notice
Deadline: Normal state mandated deadlines.
Description: This notice is an option for plans subject to state mini-COBRA laws (not Federal COBRA). They may send to individuals experiencing any qualifying event between April 1, 2021-September 30, 2021 (including voluntary terminations).
- Notice: Notice of Extended Election Period.
Deadline: May 31, 2021.
Description: This is the notice directed at people who had COBRA qualifying events in the past. It is for individuals who lost Federal COBRA coverage due to involuntary termination of employment or reduction in hours occurring generally between October 1, 2019 and March 31, 2021.* So by May 31, 2021, employers must notify such individuals that they have a special 60-day opportunity to elect COBRA prospectively between April 1, 2021 through September 30, 2021. The COBRA coverage period cannot exceed the coverage period they otherwise would have been entitled to in connection with the original qualifying event.
Deadline: Same as deadline for the notice listed above.
Description: This should be attached to the three notices listed above. It is the form for individuals to complete to request premium assistance.
Deadline: 15-45 days before subsidy ends.
Description: ARPA also requires notice when premium assistance is expiring, with the notice to be sent no more than 45 days from expiration, and no less than 15 days from expiration. It must be sent to anyone whose subsidized Federal or State mini-COBRA ends between April 1, 2021 and September 30, 2021, and is still entitled to more COBRA coverage after the subsidy ends.
The FAQs provide that employers may be subject to an excise tax of $100 per qualified beneficiary per day, not to exceed $200 per family per day, for failure to timely provided the above notices.
Please contact your Seyfarth Benefits Attorney with any questions.
*This is general guidance only. The specific dates may vary from plan to plan.
Kelly Joan Pointer, Danita N. Merlau and Benjamin J. Conley
§ 1.40 Positive Employer Risk Management: Ninth Circuit Approves ERISA Plan Forum Selection Clause
Seyfarth Synopsis: In a decision with major significance for ERISA plans, the Court of Appeals for the Ninth Circuit has upheld the validity of forum selection clauses in those plans.
ERISA is replete with details. Among them is the proper forum for litigation under the statute. ERISA lists multiple potential venues. The question then becomes whether an ERISA plan can mandate that litigation must be commenced in one of those venues. Pondering this question is not merely an academic exercise as ERISA jurisprudence is not uniform, raising the risk of inconsistent interpretations by different courts. Additionally, certain courts see more ERISA litigation than others, allowing greater familiarity with the statute.
In the case of In re Becker, No. 20-72805, – F.3d – (9th Cir. April 1, 2021), the Ninth Circuit considered whether the district court properly transferred a 401(k) plan lawsuit from the Northern District of California to the District of Minnesota (where the plan sponsor resides and the plan is administered) pursuant to the plan’s forum-selection clause.
ERISA provides that lawsuits “‘may be brought’ where: (1) the plan is administered; (2) the breach took place; or (3) a defendant resides or may be found.” The Court held that the statute’s use of “may” indicates that any of these options is acceptable. (Indeed, the Court said, even an arbitration forum is permitted). Accordingly, it held that a plan clause mandating where a lawsuit may be commenced is permitted by the statute if the selected forum is one of those listed in the statute.
The Court noted that a forum selection clause can support the important ERISA goal of uniform plan administration by having the same court interpreting the plan. Plan sponsors can readily appreciate this point as they prefer to select individuals to serve as plan fiduciaries who can be expected to review many claims in a consistent fashion.
The Ninth Circuit decision comports with all other Courts of Appeal decisions that have considered the ERISA plan forum selection issue and should make ERISA litigation more predictable, while frustrating any potential forum shopping by plaintiffs.
Jules Levenson and Mark Casciari
§ 1.41 Do You Have Employees in Washington State? Take Note: New Long-Term Care Payroll Tax Goes Into Effect January 1, 2022
Seyfarth Synopsis: In an effort to plan for the projected long-term care needs of its residents, State of Washington passed the Long-Term Services and Supports Trust Act (SHB 1323) requiring each worker in Washington to contribute $0.58 per $100 (0.58%) of wages to a trust set aside to pay long-term care benefits for its residents. The law was enacted in 2019 and becomes effective in 2022. Benefits under the Act are first payable in 2025. Washingtonians may opt out, but must have qualifying long-term care coverage in place by November 1, 2021.
- Starting January 1, 2022, employers must remit on a quarterly basis a payroll tax of 0.58% (adjusted based on Washington’s CPI) of Washington employees’ wages to the trust. There is no cap on wages for this purpose.
- There is a one-time opt-out window from October 1, 2021 to December 31, 2022 for individuals who have qualifying long-term care coverage from any source (e.g., their employer, spouse’s employer, an individual policy) by November 1, 2021. There are special effective dates for union employees.
- To be considered qualifying long-term coverage, the coverage must meet the requirements listed here: RCW 48.83.020: Definitions. (wa.gov).
- The right to opt-out belongs to the individual (not the employer). To opt out, the individual will apply to the State. If approved, the State will send an opt-out approval letter to the individual. The individual will then provide a copy of the letter to current and future employers. Other specifics on the opt-out procedure are still in the works.
- Long-term care benefits are only available to Washington residents who have paid premiums for either: (i) a total of 10 years with no more than a five-year interruption; or (ii) three of the six years before the date of application for benefits. Additionally, the resident must have worked at least 500 hours during each of the 10 or three year measurement period, as applicable.
- The maximum benefit payable is $100/day up to a maximum lifetime benefit of $36,500.
Options for Employers:
- Do not offer long-term care insurance to Washington-based employees and simply collect and remit the payroll tax (other than for those employees with an opt-out approval letter),
- Review long-term care coverage already in effect to determine if it is considered qualifying coverage under the Act, or
- Quickly procure new long-term care coverage that meets the Act’s definition of qualifying coverage.
Regardless of the option selected, employers may wish to inform their Washington employees of the upcoming payroll tax and their ability to opt out.
Please contact your Seyfarth attorney with any questions.
Liz Deckman and Kelly Pointer
§ 1.42 Protecting Your Nest Egg From Cyber-Criminals
Seyfarth Synopsis: Retirement plans hold millions (sometimes, hundreds of millions) of dollars in assets, and participants’ personal information is increasingly maintained and accessible online. With such large amounts of money accessible electronically, retirement plans can be a prime target for cyber-criminals. In response to this growing issue, on April 14, 2021, the Department of Labor (“DOL”) issued a three-part set of informal guidance with best practices and suggestions from different perspectives for addressing cybersecurity in the retirement plan world. Acknowledging that businesses largely rely on third parties, namely, the plan’s recordkeeper, to secure and protect participant data, the guidance describes what cybersecurity protection to look for when selecting service providers. The guidance also provides tips for recordkeepers and other service providers responsible for maintaining plan data, and ideas for plan participants on safeguarding their data and plan accounts online.
The three guidance documents are titled: Tips for Hiring a Service Provider with Strong Security Practices, Cybersecurity Program Best Practices and Online Security Tips.
“Tips When Hiring a Service Provider With Strong Security Practices” (for Plan Fiduciaries)
Plan administrators have a fiduciary duty under ERISA to act prudently when selecting and monitoring plan service providers. This DOL two-page guidance document provides tips for fiduciaries when hiring a service provider, and provisions to include in the contract with the service provider.
The tips to consider when evaluating a service provider include:
- Consider the service provider’s cybersecurity standards, practices, policies and results, and compare these to standards adopted by other service providers in the industry.
- Look for a service provider that follows a “recognized standard” for information security and that uses a third-party auditor to review and validate its cybersecurity practices.
- Ask the service provider how it validates its cybersecurity practices and levels of security standards it has met and implemented.
- Evaluate the service provider’s track record. How has it handled past security breaches?
- Consider whether the service provider carries any insurance policies that would cover losses caused by cybersecurity and identity theft breaches (for both internal and external threats).
Observation. These tips could be helpful, and highlight what many plan administrators already consider when evaluating and hiring service providers. However, as we have seen, adhering to these tips and suggestions may reduce the likelihood or severity of data breaches, but they are not a guarantee against cybersecurity issues.
“Cybersecurity Program Best Practices” (for Service Providers)
The DOL also issued a number of best practices for use by plan recordkeepers and other service providers that are responsible for plan data. The best practices include having a formal, well documented cybersecurity program, conducting annual risk assessments and third party audits of security controls, conducting periodic cybersecurity awareness training and appropriately responding to any past cybersecurity incidents. The DOL has indicated that these items should be reviewed and considered by the plan fiduciaries when evaluating whether to hire a service provider.
Observation. When reviewing a service provider’s cybersecurity program and internal controls, plan administrators may want to consider involving individuals from the IT department or an outside security consultant to ensure that explanations provided by the vendor align with these best practices.
“Online Security Tips” (for Participants)
The DOL guidance illustrates that it is not solely up to plan fiduciaries and plan service providers to take the necessary steps to secure plan data. Plan participants also play a vital role in reducing the risk of fraud and retirement plan account losses resulting from cyber-attacks. The third part of the DOL guidance provides online security tips for participants, including the use of unique passwords, two-factor authorization, regularly monitoring plan accounts, being cautious of phishing attacks and making sure that antivirus software is current. The guidance does not currently suggest that plan fiduciaries or service providers should periodically provide online security tips to participants.
Observation. Plan administrators and recordkeepers may want to consider reviewing and updating summary plan descriptions, enrollment materials and other annual participant-facing notices to incorporate some of these security tips so that participants are on notice of the steps that they can take to reduce the risk of fraud and retirement account losses resulting from a the unauthorized access of their retirement account.
This informal guidance illustrates that protecting against data breaches is complicated and not an all-or-nothing proposition. A plan administrator could follow every tip outlined by the DOL when selecting a service provider, but if the participant compromises his or her own account password, the administrator’s efforts are moot. Thus, service providers, plan fiduciaries and participants should all take steps to protect against cybersecurity breaches.
Please contact your Seyfarth Employee Benefits Attorney with any questions you may have about this guidance and its application to your plan.
Christine M. Cerasale, Sara J. Touzalin and Kelly Joan Pointer
§ 1.43 Federal Court Allows Discovery in ERISA Case Based on “Information and Belief” Allegations That Plaintiff Merely Believed to Be True
Seyfarth Synopsis: A federal district court denied a motion to dismiss an ERISA complaint that was based in large part on secondhand “information and belief” allegations about the defendants’ business operations. The decision serves as a warning to defendants that they may be forced into costly discovery based on allegations that a plaintiff merely believes to be true.
We have commented on a Supreme Court decision making it more difficult for ERISA plaintiffs to withstand motions to dismiss in federal court and to proceed with expensive discovery. See The Supreme Court Further Narrows Federal Court Jurisdiction Over an ERISA Complaint, Relying on Article III of the Constitution | Beneficially Yours. A recent district court decision on a routine motion to dismiss, however, underscores that defendants continue to face challenges in obtaining dismissals of ERISA claims in federal court and avoiding discovery.
In Teamsters Local Union No. 727 Health and Welfare Fund v. De La Torre Funeral Home & Cremation Services, Inc., No. 19-cv-6082, 2021 U.S. Dist. Lexis 42046 (N.D. Ill. Mar. 5, 2021), the court refused to dismiss an ERISA and LMRA complaint seeking to hold defendants, who did not sign a collective bargaining agreement, liable for a settlement agreement related to delinquent contributions to various health, welfare, and pension funds. The plaintiff brought the allegations under alter ego, joint employer, and successor liability theories. The complaint was based in large part on “information and belief” allegations about the defendants’ business operations. The court noted that the allegations relied on secondhand information that plaintiff merely believed to be true, and that the allegations regarded matters particularly within the knowledge of the defendants. The court denied the defendants’ motion to dismiss, finding that such allegations were sufficient to allow the plaintiff’s claim to proceed.
This decision is important because of the substantial consequence of losing a motion to dismiss. Losing a motion to dismiss is a ticket to the often distasteful world of discovery. As the Supreme Court noted in Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007), discovery, at least in the class action context, is so expensive that it often leads to settlement regardless of the merits of the case. This is all the more true today given the enormous increase in electronic data a party maintains, especially after a pandemic that has created much more video and other electronic data that may be subject to discovery.
So, while the Supreme Court has made it more difficult under some circumstances for ERISA plaintiffs to withstand motions to dismiss, district courts may still favor discovery over dismissal. Individual district courts may decide to encourage settlement and preclude appellate review by allowing claims to continue, even when the allegations are based on information that a plaintiff merely believes to be true.
Motion to dismiss litigation in ERISA cases will continue to command the attention of federal courts. At issue is whether the plaintiff can allege enough to access substantial discovery rights.
Mark Casciari and James Hlawek
§ 1.44 Don’t Look Now, But Is That a New SECURE Act on the Horizon?
Seyfarth Synopsis: The SECURE Act, passed at the end of 2019, significantly altered the retirement landscape. Now, proposed legislation, “SECURE Act 2.0,” sets out to make even more changes. As before, several of the proposed provisions will require employers to closely consider the new rules. For newly established plans, there will be requirements that did not exist before. For a reminder on how the SECURE Act 1.0 changed the retirement landscape in 2020 click here and here.
Last week, on May 5, the House Ways and Means Committee sent the Securing a Strong Retirement Act of 2021, “SECURE Act 2.0,” to the House for consideration. Here are some of the more significant changes that the bill as currently drafted would bring to the retirement landscape:
- Raises the minimum distribution age. After being based on attainment of age 70½ for decades, the Act would raise the required minimum distribution (“RMD”) age once again over several years. The SECURE Act 1.0 raised the RMD to age 72. If passed, SECURE Act 2.0 would continue the raise in the RMD age to 73 in 2022, 74 in 2029, and 75 in 2032.
- Increases and “Roth-ifies” catch-up contributions. The limit on 401(k) catch-up contributions for 2021 is $6,500, indexed annually for inflation. The proposed provisions would keep the catch-up age at 50 but increase the limit by an additional $10,000 per year for employees at ages 62, 63, and 64. The Act also provides that effective in 2022, catch-up contributions to 401(k) plans must be made on an after-tax, Roth basis.
- Also allows Roth-ification of matching contributions. Plan sponsors may, but are not required, to permit employees to elect that some or all of their matching contributions to be treated as Roth contributions for 401(k) plans.
- Student loan matching. The Act would allow, but not require, employers to contribute to an employee’s 401(k) or 403(b) plan account by matching a portion of their student loan payments.
- Expanding automatic enrollment for new plans. Defined contribution plans established after 2021 will be required to enroll new employees at a pretax contribution level of 3% of pay. This level will increase annually by 1% up to at least 10% (but no more than 15%). There are exceptions for small businesses with 10 or fewer employees, new businesses, church plans and governmental plans.
- Expedited part-time workers. One of the more significant changes under SECURE Act 1.0 was the expansion of eligibility for “long-term, part-time workers” to contribute to their employers’ 401(k) plan. SECURE Act 2.0 would expedite plan participation by these workers by shortening their eligibility waiting period from 3 years to 2 years, meaning employees could contribute if they have worked at least 500 hours per year with the employer for at least 2 consecutive years and are at least age 21 by the end of that 2 year period. If passed, the first group of affected workers would become eligible on January 1, 2023, not 2024 as is the case under current law.
As noted, this bill has not been signed into law. Although there is bipartisan support, it is likely that the provisions will be modified as the bill makes its way through Congress. Presently, this proposal is expected to be taken up by the Senate after its August recess. To stay up to date, be on the lookout for additional Beneficially Yours blog posts and Seyfarth Legal Updates.
Liz Deckman & Sarah Magill
§ 1.45 The Big Apple Joins a Small Crowd, With Possible Headaches for Local Employers
Seyfarth Synopsis: New York City has joined the growing list of jurisdictions to establish a mandatory auto-IRA retirement savings program for private sector employers who do not offer employees access to a retirement plan. By doing so, it becomes part of the trend to provide the opportunity for employees who do not have access to an employer-sponsored plan to save for their retirement during their working years through a payroll-deduction process.
Three states — California, Oregon and Illinois — have established, and operate, such programs at the state level, whereby covered employers are required to auto-enroll employees in IRA retirement savings accounts. The California program, CalSavers, recently prevailed in the U.S. Court of Appeals for the Ninth Circuit against a challenge that the program was pre-empted by ERISA. The primary bases for this decision are that the program is not run by a private employer and that employers maintaining ERISA retirement plans are exempted from coverage by the program (hence no interference with an ERISA plan).
Several other states have begun to implement similar programs, in some cases mandatory and in others (like New York State) voluntary. All the programs appear to have in common that they create an administrative board to operate the program, and then leave such board to work out the details of implementation.
The New York City legislation follows the same pattern — one piece of legislation establishes the program and another establishes a “retirement savings board” to implement and oversee the program. The program applies to private sector employers located in the City employing at least five employees and that do not currently offer a retirement plan such as a 401(k) plan or a pension plan. The default employee contribution rate, which will apply to employees who are age 21 or older and working at least 20 hours a week, is set at 5%, although an employee can choose a higher rate (up to the IRA annual maximum) or a lower rate (including none).
Although the City’s legislation takes effect 90 days after enactment (i.e., in August 2021), the program will not go into effect until implemented by the retirement savings board, which is contemplated to take as long as two years. Further, the program will not go into effect if the City’s corporation counsel determines that there is a substantial likelihood that the program will conflict with, or be preempted by, ERISA. Such determination should take the Ninth Circuit decision into consideration, given the strong resemblance between the City’s program and the CalSavers program.
Like several other states, New York State has authorized an auto-IRA program (the New York State Secure Choice Savings Program), but the New York State program differs from most other such programs by using Roth (after-tax) IRAs, which have a limit on the contributor’s income, although such limit is unlikely to be exceeded by the employees targeted by the program. Further, the New York State program is voluntary — no employer is required to make it available to employees.
No conflict should arise between the City’s program and the New York State Secure Choice Savings Program, because the current state program is voluntary. However, there are current proposals to make the New York State program mandatory, in which case a conflict could arise. Even under the current New York State program, it is unclear whether the City would accept Roth IRA contributions as meeting the City’s mandate, leaving aside questions regarding the contribution rate and which employers and employees are covered.
A more formidable operational difficulty for City employers is that Connecticut and New Jersey have authorized, but not yet implemented, mandatory auto-IRA programs for employers located in those states, although Connecticut is reported to be launching a pilot program in July, 2021. Although all these programs exempt employers that maintain an ERISA retirement plan, there may be employers located within the metropolitan New York City area whose employees will be subject to differing mandates depending on whether employed in New Jersey, Connecticut or the City itself, all of which will require compliance by that employer but with possibly differing rules.
At the moment there is nothing a New York City employer needs to do. We are monitoring developments related to this new program, including the corporate counsel’s determination as to whether or not there is a substantial likelihood that the New York City program will be preempted by ERISA, and will report back.
If you have any questions, please contact your Seyfarth attorney for additional information.
§ 1.46 IRS Releases Extensive Guidance on ARPA COBRA Subsidy
Seyfarth Synopsis: On March 11, 2021, President Biden signed into law the American Rescue Plan Act (“ARPA”), which requires plan sponsors to provide free COBRA coverage from April 1, 2021 through September 30, 2021, to individuals who lose coverage due to an involuntary termination of employment or reduction of hours. This is also referred to as the “100% COBRA Subsidy” or “COBRA premium assistance.” On April 7, 2021, the Department of Labor (“DOL”) published additional guidance on the COBRA Subsidy requirements in the form of Frequently Asked Questions (“FAQs”) and model notices. The updated DOL guidance, while helpful, still left many questions unanswered. On May 18, 2021, the Internal Revenue Service (“IRS”) issued additional guidance in IRS Notice 2021-31 (the “Notice”) to provide further clarification for employers, plan administrators, and health insurers regarding the COBRA Subsidy.
We have summarized the key points from IRS Notice 2021-31 below.
Who is an Assistance Eligible Individual (“AEI”)?
The ARPA provides for a temporary 100% reduction in COBRA premiums for individuals who: (1) lose healthcare coverage due to an involuntary termination or a reduction in hours; (2) are eligible for COBRA continuation coverage for some or all of the period from April 1, 2021, through September 30, 2021 (the “Subsidy Window”); and (3) elect COBRA continuation coverage. These individuals are referred to Assistance Eligible Individuals (“AEIs”). AEIs also include qualified beneficiaries who are the spouse or dependent child of the employee. A qualified beneficiary is considered an AEI if he or she was covered under the group health plan on the day before the reduction in hours or involuntary termination that caused the loss of coverage.
- Ineligibility. Eligibility for other group health coverage renders an individual ineligible for the 100% Cobra Subsidy, even if that other coverage does not provide “minimum value” or “affordable” coverage as defined under the Affordable Care Act.
- An individual may become an AEI more than once. If an individual elects free COBRA and then later becomes eligible for (and enrolled in) another group health plan during the Subsidy Window, he or she will no longer qualify as an AEI. If the individual then loses coverage under the other group health plan (within the Subsidy Window), he or she can regain their status as an AEI.
- Self-certification or attestation. An employer may, but is not required to, have individuals self-certify or attest to the fact that they are eligible for free COBRA and/or that they are not eligible for other group health plan coverage or Medicare. While this is not a legal requirement, employers that plan to claim the available tax credit to offset the costs of the COBRA Subsidy will need to retain records substantiating individuals’ eligibility. In addition, an employer may have knowledge of an individual’s initial eligibility for COBRA, but they may not necessarily have knowledge of their ongoing eligibility. For these reasons, obtaining an attestation and/or self-certification of eligibility may be desirable. An employer may also rely on other evidence to substantiate eligibility, such as employment records concerning a reduction in hours or involuntary termination of employment.
- Eligibility for other coverage. Eligibility for other coverage will only disqualify an individual from the COBRA Subsidy if they have an active, open enrollment period during the Subsidy Window. So, for example, if an individual had an opportunity to enroll in their spouse’s plan during a 30-day window in January 2021, but did not enroll, that person can still qualify for the COBRA Subsidy. But, the IRS guidance notes that, due to the DOL’s Covid-19 “Outbreak Period” relief, most plans are required to extend HIPAA special enrollment windows for up to a year. To the extent an individual’s extended special enrollment window runs into the Subsidy Window, that will disqualify them from receiving COBRA premium assistance.
- Enrollment in another plan. If an individual enrolls in coverage under another group health plan, they may still qualify for the COBRA Subsidy, provided the individual is no longer covered by the other group health plan coverage as of April 1, 2021.
- Enrollment in Medicare. The Notice clarifies that if an individual is enrolled in Medicare before becoming eligible for COBRA due to a reduction in hours or involuntary termination of employment, they may remain on Medicare but they would not qualify for the COBRA Subsidy. This is because they were enrolled in Medicare first (before COBRA).
- Other qualifying events. Qualifying events other than a reduction in hours or an involuntary termination of employment, are not qualifying events for COBRA premium assistance purposes. Further, if the qualifying event was something other than an involuntary termination of employment or a reduction in hours (such as divorce or a dependent aging out), the individual would not qualify for the COBRA Subsidy even if the person later experiences a reduction in hours or an involuntary termination of employment.
- Second qualifying event. If the original qualifying event was an involuntary termination of employment or a reduction in hours, and the employee remains covered beyond 18 months due to a disability extension or a second qualifying event (e.g., divorce or a dependent aging out), the employee could qualify for the COBRA Subsidy during the extended (i.e., post-18 month) period, if that extended period overlaps with the Subsidy Window. Contrary to earlier DOL guidance which indicated employers may only need to look back to qualifying events occurring on or after October 2019 to determine who may be an AEI, this guidance could require employers to look back much earlier (potentially as far back as April of 2018).
- Retiree health coverage. Retiree health coverage only impacts an individual’s eligibility for the COBRA Subsidy if it is provided under a different plan than the plan in which the individual was enrolled when he or she experienced a qualifying event. So, for instance, if a plan permitted persons who terminated at age 55 to elect COBRA or to remain covered under the active plan for a period of time, a person who chose to remain on active coverage could still elect COBRA and qualify for the COBRA Subsidy.
- New dependents. COBRA premium assistance is limited to AEIs that were enrolled as of the coverage termination date, as well as, a child who is born or adopted by the covered employee during the COBRA continuation coverage period.
- Unpaid premiums. An individual’s eligibility for COBRA premium assistance is not affected by late or unpaid premiums for retroactive COBRA continuation coverage (pre-April 1, 2021).
Reduction in hours
The Notice confirms that a reduction in hours constitutes a qualifying event for purposes of the subsidy, regardless of whether the reduction in hours was involuntary or voluntary. This includes furloughs and work stoppages resulting from a lawful strike initiated by employees (or their representatives) or a lockout initiated by the employer.
What is an “involuntary” termination?
The Notice confirms that the determination of whether a termination is “involuntary” is based on facts and circumstances surrounding the event. The following are examples of events that may qualify as involuntary terminations:
- Voluntary termination for good reason. Where the termination is due to employer action that results in a material negative change in the employment relationship analogous to a constructive discharge. This includes terminations designated as voluntary or as a resignation if the employee is willing and able to continue working.
- Termination while absent due to illness or disability. Only if there was an expectation that the employee would return to work following the illness or disability.
- Retirement. Only if the employee would have been terminated, absent the retirement, and the employee had knowledge of the impending involuntary termination.
- Resignation. If due to a material change in geographic location of employment.
- Voluntary separation programs. The Notice provides that involuntary terminations include employee participation in a voluntary severance program that constitutes a window arrangement, where the employee was facing an impending termination. This leaves open the question of whether participation in a VSP would qualify where there is no stated (or unstated) risk of impending termination. Similarly, it does not address whether a VSP qualifies if not structured as a “window program.” Notably, in 2009 the IRS indicated that any form of “buy-out” program could qualify if there was a suggestion that some employees may be terminated after the program concluded. Other FAQs within the notice make clear that circumstantial evidence can always lead to the conclusion that a termination labeled “voluntary” could still be considered involuntary, but employers would have certainly welcomed more direct guidance addressing these types of programs.
- Resignation for safety. If due to concerns about workplace safety, but only if the employee can demonstrate the employer’s actions or inactions resulted in a material negative change in the employment relationship analogous to a constructive discharge.
- Involuntary reduction in hours. An employee-initiated termination of employment in response to an involuntary material reduction in hours is treated as a termination for good reason.
- Non-renewal of employment contract. If the employee was willing and able to continue the employment relationship and execute another contract. This does not qualify, however, if the parties never intended a renewal to be executed.
The following examples do not constitute involuntary terminations:
- Termination due to gross misconduct. Presumably, this event is carved out because COBRA is not required for terminations resulting from gross misconduct. Many employers still extend COBRA when there is not overwhelming support for concluding the behavior was gross misconduct. Employers could likely apply the same rationale in treating such individuals as AEIs, if COBRA was extended. Family members employees terminated for gross misconduct are also ineligible for the COBRA subsidy.
- Terminations for personal reasons. Examples include health conditions of employee or family member, childcare issues, or other similar issues.
- Death of the employee. If the individual died following a reduction in hours or involuntary termination, the dependents would remain eligible for COBRA continuation coverage.
What coverage is eligible for COBRA premium assistance?
Dental, vision, and HRAs qualify for premium assistance. Retiree coverage also qualifies, but only if it is offered under the same group health plan as the coverage made available to active employees. The notice does not explicitly discuss other COBRA-eligible benefits such as EAPs or onsite clinics, but we presume that to the extent an employer has determined those benefits are subject to COBRA, they should also qualify for the subsidy.
If an AEI enrolls in other, more expensive coverage than the coverage in which the individual was enrolled as of the qualifying event date, the individual loses eligibility for the subsidy entirely, unless the coverage in which the individual was enrolled in is no longer available. If the plan in which the individual was enrolled is no longer available, the individual must be offered the most similar plan available. In that case, the individual will be eligible for the subsidy even if the plan of benefits is more expensive.
For example, an AEI was enrolled in a plan with an $800 per month COBRA premium. The employer also offers coverages that are $700, $750, or $1,000 per month. The individual can enroll in the $700 or $750 per month options with premium assistance. The AEI will not be eligible for premium assistance if he or she enrolls in the $1,000 per month option.
When does the COBRA Subsidy period begin and end?
The COBRA Subsidy period begins with the first period of coverage a premium is charged beginning on or after April 1, 2021. AEIs must be allowed to elect coverage prospectively or retroactively to April 1, 2021, provided the qualifying event date was on or before that date.
The subsidy period ends at the earliest of: (1) the first day the AEI becomes eligible for other group health plan coverage or Medicare; (2) the day the individual ceases to be eligible for COBRA continuation coverage; or (3) the end of the last period of coverage beginning on or before September 30, 2021.
ARPA extended election period
A qualified beneficiary who does not have COBRA continuation coverage in effect on April 1, 2021, but who would have been an AEI if the election were in effect, may elect COBRA continuation coverage under the ARPA extended election period. This includes an individual who has an open COBRA election period as of April 1, 2021. So, for example, if an employee elected COBRA as of the qualifying event date but the spouse did not, the spouse would be entitled to an extended election right to take advantage of the ARPA subsidy.
Additionally, an individual who, as of his or her original qualifying event date, only elected certain of the coverages in which that person was enrolled (i.e., dental-only or vision-only) can still elect the remaining coverages under the extended election period.
How does this interact with the Outbreak Period Guidance?
Within 60 days from receiving the election notice, an AEI may elect subsidized COBRA. If the AEI elects subsidized COBRA, within the same 60 day period, the AEI must also elect or decline COBRA continuation coverage retroactive to the loss of coverage. If the qualified beneficiary elects retroactive COBRA continuation coverage, the qualified beneficiary may be required to pay COBRA premiums for periods of coverage beginning before April 1, 2021.
If an election is not made during the 60 day period, a qualified beneficiary will lose the right to elect retroactive coverage. They will also forgo the 100% COBRA subsidy. It is unclear from the Notice whether the qualified beneficiary would still be permitted to elect coverage prospective at a later date (during the Outbreak Period).
The DOL’s Outbreak Period relief extends the period of time that individuals have to make COBRA elections and premium payments for up to a full year (or, if sooner, through the end of the Public Health Emergency plus 60 days).
Calculating the premium tax credit and employer subsidies
Employers can only claim the tax credit in the amount equal to the amount the employee would have been required to pay in the absence of the ARPA subsidy. So, if the employer typically charges less than 102% of the premium, or has offered the employee a premium subsidy pursuant to a severance agreement, the amount the employer could claim would be reduced accordingly. But, if an employer increases the employee’s premium obligation from the previous, reduced amount, the employer can claim the increased tax credit. Separately, if an employer does not subsidize COBRA directly, but provides the employee a taxable lump sum payment intended for COBRA, the employer can still claim the full amount of the tax credit.
If additional non-AEIs are covered (e.g., because a non-AEI spouse is added during open enrollment) causing the total COBRA premium to increase, the incremental cost is not considered to be COBRA premium assistance for purposes of the tax credit. If there is no additional cost for adding non-AEIs, then the employer can claim the full cost as a tax credit.
Claiming the premium tax credit
Employers are entitled to the tax credit as of the date on which the employer receives the AEI’s election of COBRA continuation coverage. Employers are permitted to reduce payroll tax deposits and claim a refund of amounts, up to the amount of the anticipated credit. If applicable, an employer can file IRS Form 7200 to request an advance of the anticipated premium assistance credit that exceeds the federal employment tax deposits available for reduction on a quarterly basis.
To claim the premium assistance credit, the employer reports the credit and the number of individuals receiving COBRA premium assistance on IRS Form 941 for the applicable quarter. If an employee fails to notify the employer that he or she became eligible for other coverage, the employer can still claim the tax credit, unless the employer knew the individual was ineligible for the subsidy. The credit is included in the employer’s gross income, but the employer cannot “double dip” and also claim the credit as qualified wages under the CARES Act, or as qualified health plan expenses under the FFCRA. Employers are entitled to the credit regardless of whether it uses a third-party payer to report and pay employment taxes.
If an employer originally collected, but then reimburses an AEI for premiums that should have been covered under the ARPA, the employer is entitled to the credit on the date in which they reimburse the AEI. ARPA requires the employer to reimburse the employee within 60 days of the date the premium was paid (or presumably later if the employer didn’t receive the individual’s attestation until a later date).
The Notice states that the Treasury Department and the IRS are aware of additional issues related to the COBRA premium assistance provisions, which are still under consideration. There is a possibility of additional guidance in the future.
We will continue to track the regulatory agencies’ implementation of these provisions and keep you apprised of any further developments.
Benjamin J. Conley, Seong Kim, Sarah N. Magill and Joy Sellstrom
§ 1.47 Ninth Circuit Rules – State Pension Mandate Not Preempted Even Though An Employer Chooses Not To Establish ERISA Plan
Seyfarth Synopsis: The Court of Appeals for the Ninth Circuit has once again upheld against an ERISA preemption challenge, a State private sector benefits mandate, notwithstanding that ERISA provides that the decision to establish an ERISA plan rests solely with the employer.
The Supreme Court has often stated that ERISA is not a pension mandate statute; rather it simply encourages private sector employers to establish ERISA pension plans. See Gobeille v. Liberty Mutual Ins. Co., 136 S.Ct. 936 (2016) (“ERISA does not guarantee substantive benefits.”)
(The federal no-mandate rule is different in the health plan context, primarily due to the Affordable Care Act.)
ERISA accomplishes its purpose to encourage, and not to mandate, plans through streamlined rules of administration, limited court remedies and a broad preemption clause. That clause preempts all state and local laws that merely relate to an ERISA plan as a “don’t worry about state law” reward for choosing to establish an ERISA plan. The statutory scheme is that the final word on whether to establish an ERISA pension plan remains within the complete discretion of the employer.
We have reported previously on the Supreme Court’s latest preemption decision finding no preemption — SCOTUS Upholds Arkansas PBM Law Against ERISA Preemption Arguments | Beneficially Yours. We also have reported on a recent Ninth Circuit decision with the same holding — A Ninth Circuit Panel Finds No ERISA Preemption Of Seattle Health Care Ordinance | Beneficially Yours.
Now, in Howard Jarvis Taxpayers Assoc. v. CalSavers Program, the Ninth Circuit has again found no preemption. The issue was whether a California law, like those of six other States (and Seattle and New York City), see generally The Big Apple Joins a Small Crowd, With Possible Headaches for Local Employers | Beneficially Yours, mandates private sector employers, which choose not to establish an ERISA plan, to contribute employee wages to the state to provide pension benefits. The court found no preemption because the contributed money becomes a state, not an ERISA, plan benefit. It is of no moment, the court said, that the employer’s contribution becomes a pension benefit, because the state’s contributory scheme imposes minimal administrative duties on the employer. The court added that the proliferation of state benefits mandates presents serious policy issues that Congress may want to address down the road. It is unclear whether the CalSavers preemption decision will be litigated further.
It also is unclear whether the CalSavers decision will encourage private sector employers now without ERISA plans to establish (or refrain from establishing) plans.
One current example of this preemption dilemma arises in Washington State, which recently passed the Long-Term Services and Supports Trust Act. The Act imposes a payroll tax on each employee in Washington of .58% of wages. These amounts are collected by the employer and sent to a trust established by the State to pay long-term care (LTC) benefits for its residents. Employees who have qualifying private LTC insurance (including coverage from an ERISA long term care plan) can be exempt from the payroll tax. Employees still must satisfy certain eligibility requirements. Employers with unhappy workers who must pay the tax, but never become eligible for benefits, may now feel State pressure to establish an ERISA plan, when they otherwise would not. Or they may feel pressure not to establish an ERISA plan, relying on the State to provide benefits instead. And, of course, the Act may be challenged on preemption grounds.
Expect more State benefit mandates and perhaps more litigation throughout the country on whether these laws are preempted by ERISA.
Liz Deckman and Mark Casciari
§ 1.48 Did You Get Your Vaccine Yet… Your Employer May Offer You an Incentive
Seyfarth Synopsis: The EEOC has released anticipated guidance (found here) related to the COVID-19 pandemic and what employers can and cannot do (“Updated Guidance”). The Updated Guidance provides guidance on 4 main topics: (1) employer mandated vaccination policies; (2) reasonable accommodations; (3) employee vaccination and confidentiality; and (4) vaccine incentives. This legal update focuses on permissible incentives provided by employers which encourage employees to be vaccinated. For a discussion of the other topics, see our Employment Law Lookout found here.
We previously noted that the EEOC’s existing guidance under the Americans with Disabilities Act (ADA) makes it unclear whether and what level of an incentive an employer may offer to encourage employees to get the COVID-19 vaccine. Offering an incentive in exchange for a vaccination could create a wellness program that contains disability-related inquiries. Although the Updated Guidance does not answer what level of incentive would be permissible, it provides helpful guidance for employers who want to establish an incentive program.
Incentives Permitted Under the ADA
Although the ADA prohibits employers from making disability-related inquiries to employees, there is an exception for inquiries made in connection with a voluntary employee health program (such as a wellness program offering vaccines). It is currently unclear what level of incentive would cause a program to be involuntary. (Regulations proposed in January 2021 permitting only de minimis incentives — such as water bottles — have been withdrawn by the current administration).
Where a vaccine is administered by a third party (e.g. pharmacy, personal health care provider or clinic), the Updated Guidance clarifies that requesting documentation or confirmation that an employee received a COVID vaccination is not a disability-related inquiry covered by the ADA. Therefore, an employer may offer any size incentive to an employee to provide confirmation of vaccination administered outside of the work environment.
If the vaccine is administered by the employer or its agent (e.g. a provider hired by the employer), however, employees would have to answer disability-related screening questions from the employer or the agent prior to receiving the vaccine. Therefore, the ADA would apply and restrict the incentives that could be offered. A “very large incentive” could make employees feel pressured to disclose protected medical information and the program may not be voluntary.
Incentives Permitted Under GINA
The Genetic Information Nondiscrimination Act (GINA) restricts employers from requesting genetic information from employees, including information about the manifestation of disease or disorder in a family member (i.e. family medical history). The Updated Guidance explains when employer provided incentives for COVID vaccinations could violate GINA.
The Updated Guidance provides that GINA is not violated when an employer offers an incentive to employees to provide proof of vaccination from a third party, because the fact that the employee received a vaccination is not genetic information. GINA is also not violated when an employer offers an incentive to employees if the vaccine is administered by the employer or its agent, because the vaccines currently available (Pfizer, Moderna and Johnson and Johnson) do not require pre-vaccination screening questions that inquire about genetic information. (See above for a discussion regarding the ADA.)
The Updated Guidance provides that GINA would allow an employer to offer an incentive to employees to provide documentation or other confirmation from a third party that their family members have been vaccinated.
GINA would be violated, however, if an employer offers an incentive to employees in return for a family member getting vaccinated by the employer or its agent, because this would require asking the family member medical questions. Asking these medical questions would lead to the employer’s receipt of genetic information in the form of family medical history of the employee.
Notably, an employer can offer vaccinations to an employee’s family members without offering an incentive, as long as the employer takes steps to comply with GINA. This means that the employer must; (1) ensure that all medical information obtained during the screening process is used only for providing the vaccination; (2) the information is kept confidential; and (3) the information is not provided to any managers, supervisors, or others who make employment decisions for the employees. In addition, employers need to obtain prior, knowing, voluntary, and written authorization from the family member before the family member is asked any questions about his or her medical conditions.
To stay up to date with future guidance, be on the lookout for additional Beneficially Yours blog posts and Seyfarth Legal Updates.
Diane V. Dygert, Joy Sellstrom, and Sarah N. Magill
§ 1.49 Rule 10b5-1: Fix the Cracks But Save the Baby
On June 7, 2021, U.S. Securities and Exchange Commission Chair Gary Gensler announced at the CFO Network Summit that he has asked his staff to make recommendations for the Commission’s consideration on how it might “freshen up” Rule 10b5-1, which provides officers and directors with a way to limit risks associated with the purchase or sale of their company’s securities. Chair Gensler critiqued what he identified as “real cracks” in the present insider trading regime, including the absence of : (1) mandatory cooling off period requirements before an insider can make their first trade; (2) limitations on insiders’ ability to cancel plans when they do have material nonpublic information; (3) disclosure requirements regarding trading plans; and (4) limitations on the number of trading plans a company can issue. Chair Gensler appears to be advocating for tightening of the rules in these respects, rather than abolishment of important Rule 10b5-1 trading plans.
Overview of Rule 10b5-1
While Exchange Act Section 10(b) and Rule 10b-5 generally prohibit the purchase or sale of securities “on the basis of” material nonpublic information, Rule 10b5-1, adopted in 2002, establishes an affirmative defense for insider trading allowing insiders to purchase or sell securities pursuant to pre-formulated trading plans. A purchase or sale is not considered to be made “on the basis of” material nonpublic information if the person making the purchase or sale demonstrates that before becoming aware of the information, the person had:
- Entered into a binding contract to purchase or sell the security,
- Instructed another person to purchase or sell the security for the instructing person’s account, or
- Adopted a written plan for trading securities;
and the contract, instruction or plan meets certain elements set forth in the rule. See 17 CFR § 240.10b5-1.
10b5-1 Plans as Applied
By executing pre‐planned transactions under a Rule 10b5‐1 plan entered in good faith, an individual is insulated from liability, even if actual trades made pursuant to the plan are executed at a time when the individual may be aware of material, non‐public information that would otherwise subject that person to liability under Section 10(b) or Rule 10b5‐1. When properly created and implemented, Rule 10b5-1 trading plans permit company insiders to sell their shares without litigation risk or exposure. Specifically, through the Rule, insiders can effectively refute any inference of scienter by demonstrating that the trades were pre-scheduled and therefore not likely to indicate misuse of material inside information.
In addition to insulating officers and directors from liability for insider-trading claims, such plans also can protect against unfounded allegations of scienter premised on insider sales (i.e., securities fraud and breach of fiduciary duty claims). Insider sales can sometimes be used by plaintiffs as part of their attempt to show a strong inference of knowledge of fraudulent activity. For example, plaintiffs typically allege that the sale of company stock by insiders shortly prior to public knowledge of alleged fraud is indicative of scienter. However, where such sales are effectuated pursuant to trading plans that were implemented prior to the alleged fraud, the inference of knowledge of fraud from those sales is in many cases mitigated.
Notably, however, Rule 10b5-1, may not protect officers and directors where there is evidence that the trading officer or director had knowledge of material, nonpublic information at the time the plan was enacted.
Observations and Considerations
Officers and directors are expected by many companies to invest in the company at some level. In most cases such ownership has the beneficial effect of aligning the interest of directors and officers with those of shareholders whose only connection to the company is ownership of the shares. While current trends in many public companies are questioning of the maximization of shareholder value being the sole proper goal of officers and directors, (see, e.g., Directors Roundtable publications) it is certainly one of the goals that directors and officers must consider. 10(b)-5-1 is well designed to help officers and directors avoid the risks of being sued criminally or in widespread and sometimes baseless civil actions when impact purchases and sales are for financial planning purposes rather than to take advantage of material inside information. By allowing directors and officers to adopt a financial plan which is developed based on their own financial needs, 10(b)5-1 allows for directors and officers to avoid in some cases potential liability when they are simply following a financial plan unrelated to material inside information.
Based on the comments from Chair Gensler, it is likely that we will see some additional restrictions on Rule 10b5-1 plans in the future, including mandatory cooling off periods between the adoption of a plan and when it goes into effect, limitations on cancellation, modifications and overall number of plans, as well as mandatory disclosure. However, Rule 10b5-1 trading plans remain an important risk mitigation tool for officers and directors and we hope and expect that Chair Gensler is very thoughtful in proposing restrictions on their use.
Assuming Mr. Gensler’s proposed changes when described in more detail are limited to eliminating misuse of such plans they are to be applauded. What remains to be done is to see that the changes do not accidently throw out valuable aspects of these plans. In other words, the baby with the bath water. 10(b)-5-1, properly used, is very beneficial in several respects, including in encouraging able directors to serve in that capacity.
Gregory A. Markel, Daphne Morduchowitz and Renée B. Appel
§ 1.50 Audio Recordings Are Up for the Taking!
Seyfarth Synopsis: The DOL has waded into a long-simmering debate about whether audio recordings of phone calls between a plan participant and the plan’s administrator or insurer should be provided to the participant when challenging a benefit determination under the plan, and they have come down squarely on the side of the participant.
A recent DOL information letter lays out the Department’s view that audio recordings are considered relevant documents that plan administrators, insurers, and third party administrators must provide to a claimant upon request, regardless of how the recording is used in the course of plan administration or a benefit determination.
The DOL’s position was expressed in response to a claimant’s request for an advisory opinion after a claims administrator denied the claimant’s request for audio recordings of a phone call associated with an adverse benefits determination. The DOL felt that this issue was best addressed through an information letter (as opposed to an advisory opinion) as it invoked established principles under ERISA, which would apply more broadly than to the discreet facts of the claimant’s situation.
In the claimant’s situation, the administrator made a transcript of the call available as an alternative to the audio recording. It asserted that it was not obligated to provide the actual recordings because they were “not created, maintained, or relied upon for claim administration purposes” and were instead made “for quality assurance purposes.”
In addressing the matter, the DOL turned to its long-standing claims regulations under ERISA Section 503. These regulations require that a claimant be provided with copies of all documents, records and other information “relevant” to the claim for benefits. The DOL was not persuaded by the claims administrator’s arguments that the phone recordings were not relevant, and it cited to two parts of 29 CFR 2560.503-1(m)(8) in its assertion that audio recordings are indeed relevant records that should be provided to claimants.
- First, in response to the plan administrator’s argument that the recordings were “not relied upon for claim administration purposes,” the DOL cites 29 CFR 2560.503-1(m)(8)(ii). This section notes that a record is considered relevant if it “was submitted, considered, or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination.” (emphasis added). With this, the DOL is not concerned with whether the recording was used in the course of the benefit determination. Rather, if a recording was generated in the course of a benefit determination, then it is considered relevant and should be produced by the applicable plan administrator, insurer, or third party administrator.
- Second, in response to the plan administrator’s argument that the recordings were made for quality assurance purposes, the DOL cites 29 CFR 2560.503-1(m)(8)(iii). This section notes that a record is considered relevant if it “demonstrates compliance with the administrative processes and safeguards required pursuant to” the plan’s claims procedures. Relevance is further established if the record can be used as an administrative safeguard that verifies consistent decision making under a plan. The plan administrator’s quality assurance argument ironically works against the administrator because an audio recording made for the purposes of quality assurance and plan consistency falls squarely into the definition of section (m)(8)(iii) and, therefore, renders the recording relevant. As such, an administrator’s attempt to argue withholding on the basis of quality assurance will be futile and the recording should be produced to the claimant.
Further, the DOL shot down any argument that relevant records include only paper or other written materials, saying that the preamble to their recent amendments to the regulations makes it clear that audio recordings can be part of the administrative record.
Overall, the information letter shines a spotlight on the common practice of insurers and third party administrators to deny access to audio recordings, often even to representatives of the plan administrator. Looking forward, plan administrators should work with their vendors and review the terms of their service agreements to ensure that any requests for relevant documents, records, or information are reviewed under this broad definition and appropriately provided to the claimant upon request. Not doing so risks non-compliance with the DOL regulations and potentially the imposition of substantial penalties if challenged in court.
Diane Dygert and Lauren Salas
§ 1.51 SCOTUS Doesn’t Want to Tell Us How They Really Feel About The ACA – Dismissal of ACA Lawsuit Based Only on Standing Grounds
Seyfarth Synopsis: In Texas v. California, the Supreme Court rejected another challenge to the Affordable Care Act (“Obamacare” or “ACA”). The Court never reached the merits of the challenge, relying instead on its now robust Article III standing doctrine. The plaintiffs failed to allege injury traceable to the allegedly unlawful conduct and likely to be redressed by their requested relief.
On June 17, in Texas v. California, the Supreme Court dismissed the declaratory judgment challenge to the ACA’s constitutionality brought by Texas and 17 other states (and two individuals), finding that the plaintiffs lacked Article III standing. Our earlier blog post on this case after oral argument explained that the plaintiffs alleged that the ACA’s “individual mandate” was unconstitutional in the wake of Congress reducing the penalty for failure to maintain health insurance coverage to $0.
The Court side-stepped all issues on the merits, and ruled 7-2 that the plaintiffs did not have standing because they failed to show “a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional.” The majority said that the plaintiffs suffered no indirect injury, as alleged, because they failed to demonstrate that a lack of penalty would cause more people to enroll in the state-run Marketplaces, driving up the cost of running the programs. Similarly, the majority found no direct injury resulting from the administrative reporting requirements of the mandate. The majority found that those administrative requirements arise from other provisions of the ACA, and not from the mandate itself.
Justices Alito and Gorsuch dissented, opining that the states not only have standing, but that the individual mandate is now unconstitutional and must fall (as well as any provision inextricably linked to the individual mandate).
This is the third significant challenge to the ACA over the last decade.
Moreover, the latest ACA decision has implications beyond just that statute. A solid majority of the Court has emboldened its already tough standing requirements that precondition any merits consideration in federal court. Our prior blogs here and here, have explained that the Court is intent on narrowing the door to the courthouse for many cases, including ERISA cases. This is significant because ERISA fiduciary breach cases, in particular, can be brought only in federal court. As such, we expect to see more ERISA defense arguments based on Article III standing deficiencies. And it certainly will not be enough for plaintiffs to mount a challenge under the Declaratory Judgment Act as a way to avoid the very stringent Article III injury in fact requirement.
Benjamin J. Conley and Mark Casciari
§ 1.52 Lights, Camera, Action! Another Extension to the Relief For Remote Plan Elections: Is Permanent Relief On Its Way?
Seyfarth Synopsis: The IRS has extended its relief from the physical presence requirement related to certain plan elections through June 30, 2022.
Certain elections for distributions from plans require spousal consent provided in the presence of a notary or plan representative. Although states were relaxing their notarization requirements due to the COVID-19 pandemic, many plan administrators were reluctant to accept remote notarizations for plan elections because a “physical presence” requirement remained in the IRS guidance.
In June 2020, the IRS gave temporary relief from the physical presence requirement in the Treasury Regulations related to plan elections. The relief allowed for elections to be witnessed by a notary public of a state that permits remote electronic notarization using live audio-video technology. It also allowed remote witnessing by plan representatives using live audio-video technology if certain requirements were met. See our prior blog post on this relief here.
In January 2021, the IRS further extended this temporary relief through June 30, 2021. The IRS has now extended the relief for another 12 months through June 30, 2022. The guidance also requests specific comments on whether the relief should be permanent. Among other items, the IRS asked for comment about any costs or burdens associated with the physical presence requirement and whether the removal of the physical presence requirement could cause increased fraud, spousal coercion or abuse.
This guidance will provide plan sponsors and plans continued flexibility as plan participants continue to work remotely to some degree, and particularly with respect to former employees, and we expect that plan administrators would welcome the opportunity to continue to use remote authorizations. In fact, given the widespread acceptance of remote work technologies, including video meetings apps, it makes sense that the IRS is considering making the relief permanent. Seyfarth will continue to monitor how the physical presence requirements for plan elections are evolving.
§ 1.53 Agencies Add Lengthy “No Surprises Act” Regulations to your Summer Reading List: Overview of Impact on Employer-Sponsored Plans
Seyfarth Synopsis: The No Surprises Act (the “Act”) was part of the Consolidated Appropriations Act of 2021 signed into law last December 2020. The Act was aimed at protecting insured individuals from getting a bill from a health care provider for the balance of amounts not covered by their health plan. The first set of interim final regulations (IFRs) under this new Act were released last week by the Departments of Treasury, Labor, and Health and Human Services. This alert provides an overview of the impact on employer-sponsored plans. For our broader overview of the regulations, see our July 9 Legal Update.
While most people do expect to pay some portion of the cost of their medical services after their plan pays, the “surprise” comes when these non-covered balances are exceedingly large. This is often the case when the health care provider is not “in-network” under the health care plan and is therefore free to charge whatever rate it wants for the service provided. Even when individuals make efforts to ensure their health care is provided by an in-network doctor or hospital, out-of-network services can sneak into the overall care and treatment program without their knowledge or consent. Surprise!
Prior to the No Surprises Act, the Affordable Care Act provided some level of financial protection for participants who incurred emergency services by setting a minimum level of reimbursement for health plans. These new IFRs, however, will effectively replace those rules, as of January 1, 2022. Notably, the ACA’s rules only apply with respect to so-called “non-grandfathered plans” (i.e., those that had been modified from a cost-sharing perspective since 2010 when the ACA passed into law). These new rules apply to all group health plans, without regard to grandfathered status.
The IFR tries to implement the protections for covered individuals for balance billing surprises by putting various requirements on both health care providers as well as health plans, including insurers and self-funded employer-sponsored plans.
Briefly, the rule accomplishes this goal through the following steps:
- Identifies three settings in which the law has determined participants should not be held accountable for balance billing. These settings include: non-network emergency services, services performed by a non-network provider in a network facility, and non-network air ambulance services.
- Requires plans to pay for services in those settings at certain minimum rates and to allow participants to pay at cost-sharing levels akin to what would be paid in-network.
- Requires providers to object and/or negotiate an agreed-upon payment amount with the plan within 30 days.
- If no agreement is reached, the rule requires plans and providers to submit to a binding independent dispute resolution where a third-party determines the appropriate payment rate.
This alert provides additional details on each of these steps, including:
- Health plans must cover emergency services without any prior authorization and regardless of whether the facility is in-network.
Observation: Most employer-provided health plans already meet this requirement, as the ACA mandated this coverage for all non-grandfathered plans. Although, the definition of emergency services has been broadly interpreted under these rules and should be reviewed in conjunction with your claims administrator.
- Health plans must cover certain out-of-network services, performed as part of an in-network visit, even if generally excluded.
Observation: So, a plan that generally excludes all coverage for services performed by out-of-network providers, such as an HMO or EPO, may have to adjudicate related claims for out-of-network provider services where they are performed as part of a participant’s visit to an in-network facility.
- Health plans must limit required participant cost sharing for out-of-network services in these settings to no more than the level required for the same in-network services.
Observation: This may require plans to modify their network cost-share to match. For example, both in- and out-of-network cost sharing would be set at 80%-20%, as opposed to setting out-of-network at a lower level, such as 70%-30%.
- Health plans must count any participant cost share—whether incurred in- or out-of-network—toward in-network accumulators (deductibles and out-of-pocket maximums).
Observation: This may require a change to how some plans currently tally the participant-paid portion of their health services.
- Getting to the crux of the matter for employer health plans—to the extent that a plan typically reprices non-network claims, the plan must calculate the payment to out-of-network providers (and the resulting cost-share required of participants) as if the total amount that was charged was equal to the “recognized amount.” This recognized amount is lesser of the All-Payer Model Agreement of the Social Security Act (APMA), state law where the APMA does not apply, or the “qualifying payment amount” (QPA) where state law does not apply.
Observation: The QPA will generally be the applicable standard for employer group health plans, except where the plan is fully insured. In that case, the relevant state law (if any) would apply. Self-insured plans are permitted (but not required) to opt-in to governing state laws, but to the extent such a plan opts in, the plan will be required to notify participants of the law’s applicability.
- The QPA is the lesser of the provider’s billed charge or the plan’s median contracted rate for the same or similar service in the geographic region where the service is performed. The IFRs start out by looking at the contracted rates in place under a plan as of January 1, 2019.
Observation: The QPA (or state law) will replace the traditional usual, customary and reasonable standard (UCR) or Medicare rate that many plans used, as well as other external measures (e.g., Fair Health) that many providers have pushed (at least in the context of services covered by the No Surprises Act). The agencies are particularly looking for comments on how to determine the QPA.
- Any “clean claim” for a service covered by the IFR must be processed by the health plan within 30 days.
Observation: Typically, ERISA requires that a plan issue a notification of an adverse benefit determination on a post-service claim within 30 days, so this largely aligns with how these types of claims would typically be processed.
Prohibition on Balance Billing
- The IFRs limit the amount required to be paid to an out-of-network provider by the plan to the amount agreed to by the employer’s plan (where state law is not applicable) or, if there is no agreement, to an amount determined by an “IDR entity.” The IDR is directed to consider the QPA when making its determination. The IFR defers on the details of the IDR entity process for future regulatory guidance.
Observation: As this rule is slightly different from the cost-sharing rule above, the payment to the provider might result in a different amount from the recognized amount less the cost-share portion.
- The rules require providers to obtain consent from patients to waive balance billing protections, if they want to have the right to balance bill for certain post-stabilization services or non-emergency services by an out-of-network provider at a network facility.
Observation: While this requirement generally applies to health care providers and not the health plans, it is important to know that participants must receive this notice and provide their consent in order for the out-of-network provider to try to impose any obligation on the participant for the balance after the plan has paid.
- Both plans and providers must post a publicly available notice about the protections for balance billing, and plans must include relevant language on each EOB for a covered service. The agencies issued a model disclosure notice that may be used.
Observation: Employer plans should work with their administrator to ensure the required information is available on the website and added to each EOB. Further, plan administrator may want to include this information in the plan’s SPD.
The regulations are generally effective for group health plans for plan years beginning on or after January 1, 2022. That means any planning for required changes to plans should start now. Be sure to reach out to your Seyfarth Employee Benefits lawyer for information and assistance as you work through these new rules.
Benjamin J. Conley and Diane V. Dygert
§ 1.54 PBGC Issues Much Anticipated Interim Final Rule on Special Financial Assistance Under American Rescue Plan Act
Seyfarth Synopsis: On July 9, 2021, the PBGC issued its interim final rule on ARPA’s Special Financial Assistance Program for financially troubled multiemployer pension plans. The new regulations provide guidance on the application process for Special Financial Assistance and the related restrictions and requirements, including the priority in which applications will be reviewed. The guidance also sets forth special rules regarding employer withdrawals and withdrawal liability settlements for plans receiving Special Financial Assistance. Please see our companion Legal Update on the Pension and Executive Compensation Provisions in the American Rescue Plan Act here.
On July 9, 2021, the Pension Benefit Guaranty Corporation (“PBGC”) issued extensive guidance in an interim final rule interim final rule (the “Interim Final Rule,” “Rule,” or “regulation”) to implement the American Recue Plan Act’s Special Financial Assistance (“SFA”) Program for financially troubled multiemployer defined benefit pension plans. Under the SFA Program, an eligible plan will receive the funds required for the plan to pay all benefits due from the date of the SFA payment and ending on the last day of the plan year ending in 2051. An eligible plan will receive – in a single lump sum payment – the funds required to pay all benefits due (Click here for our Legal Update on the Pension and Executive Compensation Provisions in the American Rescue Plan Act).
The Interim Final Rule, set forth in new Section 4262 of the PBGC’s regulation, provides guidance to plan sponsors on the SFA application process, including what plans need to file to demonstrate eligibility for relief; calculating the amount of SFA; assumption requirements; the PBGC’s review of SFA applications; and other restrictions and conditions. The Interim Final Rule also sets forth the order of priority in which applications will be reviewed and provides much anticipated clarification on the calculation of withdrawal liability and the assumptions to be used for SFA.
There is a thirty (30) day public comment period starting from the date of publication of the rule in the Federal Register on July 12, 2021.
The following is a high level summary of the key provisions from the Interim Final Rule. Seyfarth will hold a webinar on Friday, July 30, 2021, at 1:00 central to review the regulation in more detail, as well as the considerations for plan sponsors and contributing employers. Stay tuned for more details about the webinar.
1. Eligible Multiemployer Pension Plans
A multiemployer pension plan is eligible for SFA relief if they fall into any one of the following four categories:
- The multiemployer pension plan is in critical and declining status in any plan year beginning in 2020 through 2022;
- The multiemployer pension plan suspended benefits in accordance with the Multiemployer Pension Reform Act of 2014 (“MPRA”);
- The multiemployer pension plan: (i) is certified by the plan actuary to be in critical status in any plan year beginning in 2020 through 2022; (ii) has a “modified funded percentage” (defined as the percentage equal to a fraction, the numerator of which is current value of plan assets and withdrawal liability due, and the denominator of which is current liabilities) of less than 40%; and (iii) has a ratio of active to inactive participants which is less than 2 to 3; or
- The multiemployer pension plan became “insolvent,” as defined under Code Section 418E, after December 16, 2014, and has remained so insolvent and has not been terminated as of March 11, 2021.
Elected Critical Status Plans, Plans Terminated by Mass Withdrawal Prior to January 1, 2020
The regulation clarifies that a multiemployer pension plan that has elected to be in critical status under ERISA Section 305, but has not yet been certified as being in critical status, is not eligible for SFA. Similarly, a multiemployer pension plan that is terminated by mass withdrawal that took place prior to January 1, 2020 is not eligible for SFA relief.
Clarification on Determining Eligibility for Critical Status Plans
To ensure uniformity in applications, the data reported on the Form 5500 is to be used for purposes of determining a plan’s eligibility for SFA as a critical status plan under category “3” above. For purposes of determining the number active to inactive participants, plans should use line 6a on the 2020 Form 5500 (for total number of active participants), and the sum of lines 6b, 6c, and 6e (for total number of inactive participants based on retired or separated participants receiving benefits, retired or separated participants entitled to future benefits, and decease participants whose beneficiaries are receiving or entitled to benefits).
The regulation also provides that the three conditions necessary for a critical status plan to be eligible for SFA in category 3 above do not need to be satisfied for the same plan year, in recognition that the filing deadlines for the certification of plan’s status (known as the “zone certifications”) and the Form 5500 are not the same. The deadline for filing the certification of plan status can be more than a year before the deadline to filing the Form 5500 for the same plan year in question, and the data used for both purposes maybe from different plan years.
Assumptions For Determining Eligibility
The treatment of assumptions under the Rule differs based on the date of the applicable zone certification for the plan. If a plan sponsor applies for SFA and asserts eligibility based on a certification of critical status or critical and declining status issued prior to January 1, 2021, the PBGC is required to accept the assumptions that are incorporated into the certification, unless they are clearly erroneous.
If a plan sponsor applies for SFA and asserts eligibility based on a zone certification of critical status that was not completed prior to January 1, 2021, the plan sponsor must determine whether the multiemployer pension plan is still in critical or critical and declining status using the assumptions from the plan’s most recently completed certification prior to January 1, 2021, unless those assumptions are unreasonable (excluding the plan’s interest rate). If a plan sponsor determines one or more of those assumptions are no longer reasonable, they may propose changes to them in its application for SFA. The sponsor must disclose the proposed change, explain why the assumptions are no longer reasonable, and demonstrate that the proposed changes are reasonable.
2. Amount of Special Financial Assistance
Under ARPA, the amount of SFA relief for eligible multiemployer plans is the “amount required for the plan to pay all benefits due during the period beginning on the date of payment of the special financial assistance payment…and ending on the last day of the plan year ending in 2051….” The PBGC clarifies that the plain meaning of the statutory language means the SFA is the amount by which “a plan’s resources fall short of its obligations, taking all plan resources and obligations into account.” The relevant amounts are determined as of the “SFA measurement date,” which is the last day of the calendar quarter immediately preceding the date the plan’s application was filed. The amount of SFA, however, is subject to further adjustment for interest, outstanding PBGC loans, and the date that funds are paid to the plan.
Resources and Obligations
The value of a multiemployer pension plan’s obligations is the sum of the present value of specified benefits payments and administrative expenses to be paid by the plan through the “SFA Coverage Period” (the period beginning on the plan’s SFA measurement date and ending on the last day of the last plan year ending in 2051). The amount of benefit payments is determined as of the SFA measurement date, and is calculated by including any reinstated benefits that were previously suspended under the MPRA.
A multiemployer pension plan’s resources include the total fair market value of assets as of the SFA measurement date, plus the present value of future contributions, investment returns, withdrawal liability payments, and other expected payments into the plan during the SFA Coverage Period. It does not include any financial assistance loans received from the PBGC under ERISA Section 4261 or the amount of SFA.
3. Calculating SFA
The projection of the plan’s resources and obligations must be made on a deterministic basis and using a single set of assumptions as set forth in Section 4262.4(d) of the new regulation. That means projections must be made based on participant data as of the first day of the plan year in which the plan’s initial application is filed for SFA. If the initial application date is less than 270 days after the beginning of the current plan year, and the current year’s actuarial valuation is not yet complete, the projections may be based instead on participant census data from the first day of the plan year preceding the plan year that the initial application is filed.
The amount of SFA must generally be calculated in accordance with generally accepted actuarial principals and certain prescribed assumptions as set forth below.
Interest Rate Assumption
For purposes of determining the amount of SFA, the assumed interest rate is the lesser of: (1) the long-term interest rate used for funding standard account purposes as projected in the most recent certification of plan status completed before January 1, 2021; and (2) the “third segment rate” specified in ERISA Section 303(h) plus 200 basis points, for the month the plan’s application is filed or one of the three preceding months, as selected by the plan.
For any other assumptions than the interest rate, the plan is to look to those used in its most recently completed certification of plan status before January 1, 2021, unless they are unreasonable. If a multiemployer plan determines that any such assumptions are unreasonable, it may include a proposed change in its SFA application, except with respect to the interest rate assumption. The PBGC will accept a plan’s proposed changes to these assumptions unless it determines that the assumption is “individually unreasonable,” or that the proposed changes in assumptions are “unreasonable in the aggregate.”
4. Multiple Applications
The PBGC explains that the wording of ARPA suggests plans may have multiple filing dates by providing for separate deadlines for initial applications and revised applications. The PBGC also notes there is no limit to the number of times a multiemployer pension plan may revise its application for SFA, as long as the last revised application is filed by the statutory deadline of December 31, 2026. To prevent plan sponsors from submitting multiple applications to change the interest rate, however, the PBGC dictates in the Rule that the assumed interest rate will always be the rate from the plan’s initial application.
5. Certain Events Disregarded For Calculation Of SFA
Recognizing that a plan could implement certain changes that could entitle the plan to more SFA than was intended under the ARPA, certain events that occur between July 9, 2021 and the SFA measurement date (the last day of the quarter preceding the plan’s application) are disregarded in calculating the amount of SFA for a multiemployer pension plan. The following events are disregarded:
- Transfers of assets or liabilities, including spin-offs.
- Benefit Increases. The execution of a plan amendment increasing accrued or projected benefits, other than a restoration of benefits previously reduced under the MPRA.
- Contribution Reductions. The execution of “a document reducing a plan’s contribution rate (including any reduction in benefit accruals adopted simultaneously or arising from a pre-exiting linkage between benefit accruals and contributions),” but only if the plan does not demonstrate that risk of loss for participants and beneficiaries is reduced by execution of the document (disregarding any SPA). The plan sponsor must make such demonstration in accordance with the instructions on the PBGC’s website at gov. The “document” referred to in this rule can be either a collective bargaining agreement not rejected by the plan, or a document reallocating contribution rates.
If a multiemployer pension plan experiences a merger between July 9, 2021, and the measurement date, the total amount of SFA available is limited to the sum that each individual plan would have been eligible for had the merger not occurred. The PBGC further concludes that it is reasonable and within its regulatory authority to disregard changes made to a multiemployer pension plan after July 9, 2021, if the effect was to artificially inflate the amount of SFA. In that regard, the PBGC explained it was authorized to impose reasonable conditions to ensure that the amount of SFA provided to plans is not “inflated by way of contrived events.”
6. Information To Be Filed With SFA Application
The following information is required to be submitted with a multiemployer pension plan’s SFA application in order for it to be considered complete:
- Basic plan information specified in Section 4262.7 of the new regulation, including the name of the plan, EIN and plan number, identification of the individual filing the application and his or her role, contact information for the plan sponsor and authorized representative(s), the amount of SFA requested, identification of the applicable eligibility criteria, priority group identification, plan documents, actuarial valuation reports from the 2018 plan year to the year the application is filed, most recent rehabilitation or funding improvement plan and all amendments, Form 5500 filings, actuarial certifications and financial information, and withdrawal liability policies and procedures;
- Actuarial and financial information specified in Section 4262.8, including projected benefit payments as reported on Form 5500 and Schedule MB for 2018 to the year the application is filed, identification of the 15 largest employers (for plans with more than 10,000 participants), historical financial information, information used to determine the amount of SFA including, among other things, interest rate, fair market value of plan assets, projected amount of contributions and withdrawal liability payments, projected administrative expenses, and explanations for any proposed changes to assumptions from certification prior to January 1, 2021, and information regarding certain events;
- Copy of an executed plan amendment confirming the plan was amended to add the following provision: “Beginning with the SFA measurement date selected by the plan in the plan’s application for special financial assistance, the plan shall be administered in accordance with the restrictions and conditions specified in section 4262 of ERISA and 29 CFR part 4262. This amendment is contingent upon approval by PBGC of the plan’s application for special financial assistance;”
- Copy of a proposed plan amendment to reinstate any benefits previously suspended under the MPRA;
- A complete checklist and certain other information as described on the PBGC’s website at gov.
The application for SFA must be signed and dated by an authorized trustee who is a current member of the plan’s board of trustees, or another authorized representative. The following statement must also be included in the application and signed by the authorized trustee:
“Under penalties of perjury under the laws of the United States of America, I declare that I have examined this application, including accompanying documents, and, to the best of my knowledge and belief, the application contains all the relevant facts relating to the application, and such facts are true, correct, and complete.”
All required calculations for the SFA application must be accompanied by a certification by the plan’s enrolled actuary.
Duty to Supplement and Clarify
The PBGC may require additional information from the plan sponsor to substantiate or clarify information provided in the application. Plan sponsors are required to promptly comply with such requests.
The regulation specify that plan sponsors have a duty to promptly notify the PBGC if at any time when the application is pending they become aware that any material fact or representation is no longer accurate, or that any material fact or representation was omitted from the application.
Disclosure of Information
Unless it is considered confidential under the Privacy Act, all information submitted as part of an SFA application may be made publicly available, and the PBGC offers no assurances that any information or documentation submitted with an application will remain confidential.
7. Applications For Plans With Partitions
ARPA requires the PBGC to provide an alternative application for use by multiemployer pension plans that have been approved for a partition by the PBGC before March 11, 2021. This alternative process is provided in Section 4262.9 of the new regulation. A plan sponsor of a partitioned plan must file a single application with information about the original plan and successor plan. The filing of an application for partitioned plans falls under “priority group 2.”
8. Processing, Priority Groups, And Filing Deadlines
All initial applications for SFA must be filed by December 31, 2025. Any revised application must be filed by December 31, 2026. Applications must be filed electronically.
The PBGC will limit the number of applications accepted in a manner so that each application can be processed within 120 days. The PBGC will approve or deny the application within 120 days. The PBGC may consider an application incomplete if it does not have all of the required information. A plan sponsor may withdraw their application or revise it.
Until March 11, 2023, certain plans will be given priority to file an application if they are in one of the following groups:
Priority Group 1. The plan is insolvent or projected to become insolvent by March 11, 2022. A plan in priority group 1 may file SFA applications beginning on July 9, 2021.
Priority Group 2. The plan suspended benefits under the MPRA as of March 11, 2021, or the plan is expected to be insolvent within 1 year of the date the plan’s application was filed (as indicated above, plans that have undergone partition also fall in priority group 2). A plan in priority group 2 may file SFA applications beginning on January 1, 2022, or such earlier date specified on the PBGC’s website.
Priority Group 3. The plan is in critical and declining status and had 350,000 or more participants. A plan in priority group 3 may file SFA applications beginning on April 1, 2022, or such earlier date specified on the PBGC’s website.
Priority Group 4. The plan is projected to become insolvent by March 11, 2023. A plan in priority group 4 may file SFA applications beginning on July 1, 2022, or such earlier date specified on the PBGC’s website.
Priority Group 5. The plan is projected to become insolvent by March 11, 2026. The PBGC will specify the date a plan in this group can file an application on its website at least 21 days in advance of such date, and such date will not be later than February 11, 2023.
Priority Group 6. The plan is projected by the PBGC to have a present value of financial assistance payments under ERISA Section 4261 that exceeds $1,000,000,000 if special assistance is not provided. The PBGC will specify the date a plan in this group can file an application on its website at least 21 days in advance of such date, and such date will not be later than February 11, 2023.
Additional Priority Groups. The PBGC may add additional priority groups and deadlines to apply, which will be posted on its website.
Beginning with when the PBGC starts accepting applications for priority group 2, an application for emergency filing may be accepted if: (1) the plan is insolvent or expected to become insolvent within 1 year of filing the application or suspended benefits under the MPRA as of March 11, 2021; and (2) the plan notifies the PBGC before submitting the application that it qualifies as an emergency in accordance with the instructions on the PBGC website.
9. Restrictions on SFA Use and Investment
A multiemployer pension plan that receives SFA must separately account for such amounts and it must be segregated from other assets. SFA funds, and any earnings thereon, can only be used to make benefit payments and pay administrative expenses. SFA funds must also be invested in fixed income securities and investment-grade bonds or other investments as permitted by Section 4262.14 of the PBGC regulation. Plans will be required to keep at least one year’s worth of benefit payments and administrative expenses invested in accordance with these rules, even if it runs out of SFA funds.
The PBGC acknowledged concerns that its restrictions on investing SFA could have adverse impacts on overall plan financial health, especially given historically low interest rates on fixed income securities. The PBGC considers the investment restrictions set forth in the new regulation to be a starting point, and is seeking public input on refining its rules in this area, with several specific questions posed by the PBGC for public comment.
10. Conditions for Receipt of SFA
A multiemployer pension plan that receives SFA must be administered in accordance with PBGC guidelines. Those conditions include prohibiting benefit increases during the SFA period if it is attributable to service accrued prior to the amendment (other than restoring benefits suspended under the MPRA), and only allowing prospective benefit increases where the plan’s actuary certifies that employer contribution increases are sufficient to pay for the benefit and those increases were not included in the determination of SFA.
During the SFA period, the contributions that a multiemployer pension plan receives per contribution base unit (e.g., per hour worked) cannot be less than those set forth in the collective bargaining agreement(s) or plan documents in effect on March 11, 2021, unless the plan sponsor determines the change lessens the risk of loss to participants. If the reduction affects annual contributions over $10 million and over 10% of all employer contributions, the change is subject to PBGC approval.
The regulation also prohibits a decrease in the proportion of income received or an increase in the proportion of expenses allocated to a plan that receives SFA, subject to certain exceptions. Plans receiving SFA are also prohibited from engaging in a transfer of assets or liabilities (including a spinoff) or merger except with PBGC approval.
The PBGC is soliciting public comment on whether there are other circumstances relating to the conditions for receipt of SFA where the PBGC should consider providing approval for exceptions.
11. Withdrawal Liability Conditions for Receipt of SFA
As anticipated, the PBGC did impose certain conditions on withdrawal liability for plans that receive SFA. The PBGC, however, considered and apparently rejected mandating that, during the SFA Coverage Period, SFA assets would be disregarded in the determination of unfunded vested benefits for the assessment of withdrawal liability. Instead, it adopted two other conditions: a restriction on withdrawal liability interest assumptions, and a requirement for PBGC approval of certain withdrawal liability settlements.
Withdrawal Liability Interest Assumptions
The interest assumptions used to determine unfunded vested benefits and calculate withdrawal liability must be the PBGC’s mass withdrawal interest assumptions that approximate the market price that insurance companies charge to assume a similar pension-benefit-like liability. Plans receiving SFA must use those interest assumptions for withdrawal liability calculations until the later of 10 years after the end of the plan year in which the plan receives payment of SFA or the last day of the plan year in which the plan no longer holds SFA or any earnings thereon in a segregated account. Given plan termination interest rates are generally much lower than rates most plans use to calculate withdrawal liability, this will likely increase a withdrawing employer’s liability—although whether that increase will necessarily offset the impact of SFA may depend upon the particular circumstances of the withdrawing employer and the plan.
The PBGC determined that without the interest assumption change “the receipt of SFA could substantially reduce withdrawal liability owed by a withdrawing employer,” and “could cause more withdrawals in the near future than if the plan did not receive SFA.” Payment of SFA “was not intended to reduce withdrawal liability or to make it easier for employers to withdraw.”
PBGC Approval of Certain Withdrawal Liability Settlements
Any settlement of withdrawal liability during the SFA Coverage Period is subject to PBGC approval if the present value of the liability settled is greater than $50 million. The PBGC will only approve such a settlement if it determines that: (1) it is in the best interests of the participants in the plan; and (2) it does not create an unreasonable risk of loss to PBGC. The information the PBGC will require in order to review a proposed settlement includes: the proposed settlement agreement; the facts leading to the settlement; the withdrawn employer’s most recent 3 years of audited financials and a 5-year cash flow projection; a copy of the plan’s most recent actuarial evaluation; and a statement certifying the trustees have determined that the proposed settlement is in the best interest of the plan, its participants and beneficiaries.
12. Promise of Additional PBGC Regulations as to Assumptions for All Plans
Last but not least, in its explanation of the final interim rule the PBGC noted that it plans to use its authority under Section 4213(a) of ERISA to propose a separate rule of general applicability setting forth actuarial assumptions which “may” be used to determine an employer’s withdrawal liability. Presumably, this general rule would be applicable to all plans, not simply those that receive SFA. This could have a significant impact on how withdrawal liability is calculated in the future.
It will take some time for plans and participating employers to digest the interim final rule and what it means for their particular situation. As noted there will be a thirty-day public comment period, which may lead to additional changes. The PBGC is not done with its rulemaking, both as to SFA recipients or, apparently, plans generally. Stay tuned, and mark your calendars for the webinar on July 30th.
There are a number of issues that have not been addressed in this regulation, and we will be issuing a further memorandum soon outlining some of the important open questions.
Seong Kim, Ronald Kramer and Alan Cabral
§ 1.55 Who Is Liable for Withdrawal Liability? — The Seventh Circuit Explains an Expansive Definition
Seyfarth Synopsis: In a recent decision highlighting the potential for far-reaching responsibility for withdrawal liability payments, the Court of Appeals for the Seventh Circuit affirmed a judgment against two individuals contending that their ownership interest in the contributing company’s principal place of business was a purely passive investment.
In February 2018, a trucking company ceased all operations and withdrew from the Local 705 Teamsters Multi-Employer Pension Fund. The fund sent the company, and the individuals who owned its principal place of business, a demand for payment of withdrawal liability.
The company and the individuals did not request review of the demand. The fund then commenced litigation to collect on its demand.
The Seventh Circuit affirmed a judgment in favor of the fund and against the contributing company and individuals. The decision is reported as Local 705 International Brotherhood of Teamsters Pension Fund v. Pitello, 2021 WL 2818326 (7th Cir. July 7, 2021).
The court explained that withdrawal liability extends to all “trades or businesses” under common control with the withdrawing employer, on a joint and several liability basis. The court said that joint and several liability does not extend, however, to parties with purely “passive or personal investments.”
The individuals argued that their ownership of the at-issue property should not be deemed a trade or business because they: (1) never received any rent or tax benefits as a result of the company’s use of the property, (2) purchased the property 18 years earlier and held it purely as an investment, (3) did not lease it to anyone after the company ceased operations, and (4) never employed anyone to manage the property.
The court found that another company the individuals owned did charge rent for the property after the contributing company ceased operations. The court thus reasoned that “whatever value the[y] received through their rent-free arrangement with [the company] had been lost,” and the decision to generate replacement rental income thereafter made clear that their ownership of the property was a business venture.
Moving forward, this decision should serve as a reminder that courts are willing to entertain expansive definitions of who may be jointly and severally liable for withdrawal liability. See our articles that address the complexity of judicial review on the scope of liability. No Partnership, No Common Control, No Withdrawal Liability: Private Equity Funds Not Liable for Portfolio Company’s Multiemployer Plan Withdrawal Liability | Beneficially Yours and The Ninth Circuit Hammers Out A New Successorship Liability Test Under The MPPAA | Beneficially Yours. All companies and individuals in this space also should become familiar with the PBGC’s interim final rule on the Special Financial Assistance provisions of the American Rescue Plan Act, which sets forth rules on employer withdrawals and withdrawal liability settlements. See PBGC Issues Much Anticipated Interim Final Rule on Special Financial Assistance Under American Rescue Plan Act | Beneficially Yours.
Mark Casciari, Tom Horan and James Nasiri
§ 1.56 Paycheck Protection Program: Loan Forgiveness Deadlines Approaching
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The Paycheck Protection Program (PPP) loan forgiveness deadlines are quickly approaching. In order to avoid making unnecessary PPP loan payments, borrowers must submit loan forgiveness applications to their lenders within 10 months from the end of their respective covered periods. This means that borrowers receiving PPP loans in the initial tranche in early- to mid-April 2020 will have due dates beginning in July 2021. If a loan forgiveness application is received by the due date, payments are deferred until a decision on the forgiveness application is made by the lender and the Small Business Administration (SBA).
In December 2020, the SBA began requiring borrowers of more than $2 million to submit a loan necessity questionnaire in connection with the application for loan forgiveness. Many borrowers found these questionnaires to be intimidating, burdensome, and intrusive.
Significantly, the SBA has officially eliminated the loan necessity forms and review for PPP loans of $2 million or greater in a notice sent out on July 9, 2021. In this notice, the SBA said it would no longer request either version of the loan necessity questionnaire (SBA form 3509 for for-profit borrowers and SBA Form 3510 for not-for-profit borrowers). Also, loan necessity questionnaires previously requested are no longer required to be submitted. For PPP loans with an open request for additional documentation related to the loan necessity questionnaire, the SBA advised lenders to close the request and submit the loan back to the SBA.
Thus, to apply for loan forgiveness, the SBA Form 3508, SBA Form 3508EZ, or SBA Form 3508S (or a lender equivalent) must be completed and submitted to the lender, together with supporting documentation. Although the SBA eliminated the loan necessity questionnaire, it did not eliminate the need for borrowers requesting forgiveness of a PPP loan to document the use of loan proceeds.
For payroll, documentation should be provided for payroll periods that overlapped with the covered period. This would include bank statements or third-party payroll service provider reports documenting the amount of cash compensation paid to employees. It could also include payroll tax reported, or that will be reported, to the IRS (typically Form 941) and state quarterly employee wage reporting and unemployment insurance tax filings reported, or that will be reported, to the relevant states.
Wages may not be taken into account when calculating eligible payroll costs for loan forgiveness to the extent they are qualified wages paid during April 1, 2020, through December 31, 2021, that are taken into account for purposes of claiming the Employee Retention Credit under Section 2301 of the CARES Act.
Documentation of forgivable non-payroll costs should also be included. For example, lender amortization schedules and receipts verifying payments, or lender account statements, can document business mortgage interest payments. Similarly, copies of leases and receipts or cancelled checks can verify rent expenses. Similar documentation can confirm utility payments, eligible operations expenditures, eligible supplier costs, and eligible worker protection measures.
The loan forgiveness application and supporting documentation must be submitted to the PPP lender, usually via an online portal. It is critical for borrowers to follow up with their lender promptly regarding requests for additional documentation, and to communicate with their lender throughout the loan forgiveness process.
The SBA still has the right to undertake a review of the PPP loan and the forgiveness decision by the lender. If it does so, the lender will provide the borrower notification of the SBA review, and any subsequent SBA review decision. Borrowers have the right to appeal certain SBA review decisions.
In summary, the PPP loan forgiveness deadlines are quickly approaching, but the process has recently been made simpler by elimination of the loan necessity questionnaire previously in place for PPP loans of $2 million or greater. Despite elimination of the necessity questionnaire, the SBA has not eliminated its review of loan necessity.
PPP borrowers are urged to submit their loan forgiveness application and supporting documentation within 10 months of the last day of the covered period in order to obtain deferral of PPP loan payments and ultimately loan forgiveness.
William B. Eck, Stanley S. Jutkowitz and Suzanne L. Saxman
§ 1.57 IRS Issues Highly Anticipated Update to Qualified Plan Correction Procedures
On July 16, 2021, the IRS issued Revenue Procedure 2021-30, updating its Employee Plans Compliance Resolution System (“EPCRS”), which permits retirement plan sponsors and administrators to correct compliance failures that may adversely impact the tax-qualified status of their defined contribution (including 403(b)) and defined benefit plans. Rev. Proc. 2021-30 includes numerous highly anticipated (and mostly welcome) updates to the IRS correction procedures, including two new correction methods for defined benefit plan overpayments, an increase in certain de minimis correction thresholds, elimination of the ability to make an anonymous submission under the program, and the expansion of the Self-Correction Program (“SCP”) with respect to the use of retroactive plan amendments. Unless otherwise noted below, the changes to EPCRS are effective July 16, 2021.
Correction of Plan Overpayments
Undoubtedly, the most significant changes to EPCRS relate to the correction of plan overpayments. Several years ago, the IRS updated EPCRS to set forth the methods that could be used by a plan sponsor to correct a plan overpayment. Generally, these options included the return of overpayment method, a “make-whole” contribution by the plan sponsor for the amount of the overpayment (adjusted for earnings) or, in some cases, a retroactive plan amendment. For several years, the IRS has been considering additional changes relating to the recoupment of overpayments. The hope has been that any update would address when it may not be necessary to recoup an overpayment from a participant. Happily, the Revenue Procedure has been revised and reformatted to include helpful clarifications relating to the long-standing return of overpayment method, as well as two new correction methods that plan sponsors may use to correct defined benefit plan overpayments.
Return of Overpayment Method (Applicable to DC and DB Plans)
Under Revenue Procedure 2019-19, the prior iteration of EPCRS, plan sponsors may generally correct overpayments from defined contribution plans (including 403(b) plans) and defined benefit plans by using the return of overpayment correction method. Under this method, the plan sponsor takes reasonable steps to have the amount of the overpayment, adjusted for earnings at the plan’s earnings rate, returned to the plan by the participant. If the amount returned to the plan is less than the overpayment, adjusted for earnings, then the plan sponsor must contribute the difference to the plan unless the overpayment only occurred because the distribution was made in the absence of a distributable event and the amount of the distribution was otherwise consistent with the plan’s terms. The plan sponsor must also notify the participant that the amount of the overpayment was not eligible for tax-free rollover.
Rev. Proc. 2021-30 expands upon the return of overpayment correction method, providing that plan sponsors may give the recipient of an overpayment a choice of how they would like to repay. Specifically in the context of defined benefit plans, plan sponsors may allow overpayment recipients to repay as follows:
- As a single, lump sum payment,
- Through an installment agreement (provided the overpayment recipient is not a “disqualified person” or an owner-employee), OR-
- By having future periodic benefit payments reduced by an amount necessary to recoup the amount of the overpayment, if applicable. Note that under this option a spouse’s survivor benefit may not be reduced to recoup the overpayment, even if the overpayment amount has not been fully recouped during the participant’s lifetime.
Note, if the amount repaid to the plan by the overpayment recipient as a lump sum payment or through an installment agreement is less than the amount of the overpayment adjusted for earnings, the plan sponsor must contribute the difference to the plan. This “make-whole” rule, however, does not apply if future periodic benefit payments are reduced to recoup the amount of the overpayment, even if the participant dies, for example, before the entire amount of the overpayment has been recouped.
Revenue Procedure 2021-30 does allow plan sponsors of defined contribution plans to give overpayment recipients a choice as to the method of repayment, but does not point directly to the specific repayment methods permitted for defined benefit plans. We would expect the IRS to interpret this ability to choose in the defined contribution space to include similar methods as described for defined benefit plans, as appropriate.
For both defined benefit and defined contribution plans, the new Revenue Procedure retains language indicating that other appropriate correction methods (presumably those not detailed therein) may be used to correct an overpayment.
New Correction Methods for Overpayments (Applicable to DB Plans)
Revenue Procedure 2021-30 adds two new correction methods that employers may use when correcting overpayments from a defined benefit plan: (1) the funding exception correction method and (2) the contribution credit correction method. As described in more detail below, these new correction methods reduce the amounts necessary for plan sponsors to recoup from participants or to contribute to the plan to make the plan “whole” when overpayment errors occur.
Note, these two new correction methods may not be used if the overpayment is associated with a failure to satisfy a statutory limit, such as Code Sections 401(a)(17), 415(b) and 436, and may also not be used to correct an overpayment made to a disqualified person or an owner-employee.
The Funding Exception Correction Method
As its name suggests, this new correction method is generally tied to a defined benefit plan’s adjusted funding target attainment percentage, or “AFTAP.” Specifically, no corrective payment to the plan (by either the recipient of the overpayment or the plan sponsor) is necessary if, in the case of a plan subject to Code Section 436, the plan’s certified or presumed AFTAP applicable at the time of correction is equal to at least 100% (or, in the case of a multiemployer plan, the plan’s most recent annual funding certification indicates that the plan is not in critical, critical and declining, or endangered status, determined at the date of correction). If these requirements are met, then for purposes of EPCRS:
- No further corrective payments from any party are required,
- Reductions to future benefit payments to the recipient of an overpayment (or the spouse or beneficiary of an overpayment recipient) to recoup the amount of an overpayment are not permitted, and
- Corrective payments from the recipient of an overpayment (or the spouse or beneficiary of an overpayment recipient) are not permitted.
Future benefit payments must be reduced, however, to the correct benefit payment amount, if applicable.
“Contribution Credit” Correction Method
This new correction method limits the amount of an overpayment that is required to be repaid to a plan. Under this method, the amount of an overpayment that must be repaid to the plan is equal to the amount of the overpayment reduced (but not below zero) by a “contribution credit” that is equal to the following:
- The cumulative increase in the plan’s minimum funding requirements attributable to the overpayments (including the increase attributable to the overstatement of liabilities, whether funded through cash contributions or through the use of a funding standard carryover balance, prefunding balance, or funding standard account credit balance), beginning with (1) the plan year for which the overpayments are taken into account for funding purposes, through (2) the end of the plan year preceding the plan year for which the corrected benefit payment amount is taken into account for funding purposes; AND
- Certain additional contributions in excess of minimum funding requirements paid to the plan after the first of the overpayments was made.
If, after applying the contribution credit, the amount of the overpayment is reduced to zero, then (1) no further corrective payments from any party are required, (2) no further reductions to future benefit payments to the recipient of an overpayment (or their spouse or beneficiary) are permitted, and (3) no corrective payments from the recipient of an overpayment (or their spouse or beneficiary) are permitted.
If a net amount of an overpayment remains after applying the contribution credit, the plan sponsor must make a contribution to the plan of the remaining amount or take action to recoup the remaining amount from the overpayment recipient. The amount may be recouped from the overpayment recipient using a method described above (i.e., single sum payment, installments, reduction of future benefit payments), but additional special rules apply when recouping a net overpayment after applying the contribution credit. Also, when requesting a repayment of that net overpayment from a recipient, the plan sponsor must provide the recipient of the overpayment with a special written notice that includes information about the overpayment and about the three repayment options available to the recipient. If the recipient does not choose a repayment option within a reasonable period of time (deemed to be at least 30 days), then the notice must explain that the default repayment option will be the adjustment of future payments, provided the recipient is entitled to future payments under the plan, or a single sum payment if not entitled to future payments. Note, this notice requirement does not appear to apply when providing a recipient with options for repayment under the general repayment of overpayment correction method described above.
In order to be eligible to use the contribution credit correction method, the plan may not have a funding deficiency or an unpaid minimum required contribution as of the end of the last plan year before the plan year for which the plan sponsor takes into account the corrected benefit payment amount for funding purposes (taking into account contributions made after the end of the plan year that are credited to that plan year).
Additional Correction Principles for Overpayments
Revenue Procedure 2021-30 provides that when correcting overpayments, the following correction rules/principles apply (some of these are not new):
- If periodic payments are involved, any future benefit payments must be reduced to the correct benefit payment amount (i.e., plan sponsors must “stop the bleeding”).
- Generally, the plan sponsor must notify the recipient of the overpayment (in writing) that the amount of the overpayment is not an eligible rollover distribution (i.e., is not eligible for tax-free rollover), even if the recipient of the overpayment is not required to repay the amount of the overpayment under the applicable correction methods described above.
- In many circumstances, with a few exceptions, if the overpayment is not repaid, the plan sponsor must make the plan whole. For example, if a net overpayment amount remains after the contribution credit from (2) above is applied and the participant does not repay the overpayment amount, the plan sponsor must reimburse the plan for the remaining amount of the overpayment (adjusted for earnings).
Other Meaningful Updates to EPCRS
Increase in De Minimis Threshold
A welcome change in Rev. Proc. 2021-30 is an increase to the de minimis threshold that applies to plan overpayments and excess amounts (e.g., excess employee or employer contributions) from $100 to $250. For example, if the total amount of a plan overpayment is $250 or less (after adjustment for earnings), the plan sponsor is not required to seek return of the overpayment from the participant, or notify the participant that the overpayment was not eligible for tax-free rollover. Note, however, plan sponsors must still notify participants that overpayment amounts resulting from exceeding a statutory limit are not eligible for favorable tax treatment.
Replacement of Anonymous VCP Submissions with New Procedures
Effective January 1, 2022, the anonymous VCP submission procedures are eliminated, and replaced with new pre-submission procedures. Under the new pre-submission procedures, beginning January 1, 2022, plan sponsors may request (at no fee) an anonymous, pre-submission meeting with the IRS regarding issues for correction under VCP when their requested correction methods are not any of the safe harbor correction methods described in the EPCRS guidance.
Correction of Operational Issues via Plan Amendment
Revenue Procedure 2021-30 further expands the correction of operational errors by plan amendment under the IRS’ Self-Correction Program (“SCP”). Previously, the IRS had expanded the SCP to allow for the correction of certain operational failures via a retroactive plan amendment under the following conditions:
- The corrective amendment must result in an increase of a participant’s benefit, right or feature;
- The increase in benefit, right or feature is provided to all employees eligible to participate in the plan;
- The increase in benefit, right or feature (a) was permitted under IRS rules and (b) satisfied certain applicable correction principles under Revenue Procedure 2019-19.
With respect to the second requirement above, the IRS’ prior informal position was that all employees eligible to participate in the plan really meant every single employee eligible to participate, making this a difficult requirement to meet. In many cases, an error only occurs with respect to a subset of participants in a plan and not all employees eligible to participate (e.g., erroneous exclusion of overtime wages from the definition of compensation only affects non-exempt employees eligible for overtime). In Rev. Proc. 2021-30, the IRS completely eliminated the requirement that the increase in benefit, right or feature must be provided to all eligible employees, thus making it easier to retroactively amend a plan under SCP without having to file an application under VCP in these circumstances.
Extension of SCP Correction Period for Significant Failures
Historically, plans have had until the last day of second plan year following the plan year for which a significant operational or plan document failure occurred to self-correct under the SCP. Rev. Proc. 2021-30 extends this correction period by an additional year, until the last day of the third plan year following the plan year for which the failure occurred. The change to this SCP correction period also results in an extension of the deadline for self-correcting certain elective deferral failures (under the special safe harbor correction method) lasting more than three months but not longer than the SCP correction period for significant failures.
Extension of Sunset Safe Harbor Correction Method
Revenue Procedure 2015-28 added a safe harbor correction for certain automatic contributions failures that generally were corrected by the end of the 9½ month period after the end of the plan year when the failure first occurred. Under the safe harbor correction, a plan sponsor was not required to make-up missed employee contributions (pre-tax or Roth) if the plan had an automatic enrollment feature and certain other requirements, including a 45-day notice, were met. Unfortunately, under Rev. Proc. 2015-28 and subsequent EPCRS Revenue Procedures (including Rev. Proc. 2019-19), this special correction option was available only for failures that began on or before December 31, 2020. Revenue Procedure 2021-30 extends this correction method by an additional three years, so this safe harbor may continue to be used for failures that begin on or before December 31, 2023. This extension is retroactively effective back to January 1, 2021.
Revenue Procedure 2021-30 is lengthy, and this is a only summary of many of the new provisions. For further information and updates, check back here and follow our blog, or contact your Seyfarth employee benefits attorney.
Sarah J. Touzalin and Christine M. Cerasale
§ 1.58 Write Well – ERISA Plan Terms Control Against Defendants Too
Seyfarth Synopsis: The Court of Appeals for the Ninth Circuit recently rejected the application of the doctrine of equitable estoppel to prevent a plan trustee from enforcing the clear terms of the plan. So, it bears repeating that drafters of ERISA plans are well advised to draft as clearly and carefully as possible.
In Wong v. Flynn-Kerper, 999 F.3d 1205 (9th Cir. 2021), an ESOP trustee sued to enforce the terms of the Plan. The operative Plan terms mandated that the Plan not pay more than fair market value for company stock, as determined at the time of the transaction by an independent appraiser. The Plan sought revision of a transaction where the Plan had promised to pay for stock, by alleging that the stock was overvalued. The Plan claimed that the independent appraiser was unaware that the Plan sponsor was carrying substantial uncollectable debt and facing mounting attorney’s fees and administrative penalties.
The defendant holder of the promissory note attempted to invoke the doctrine of equitable estoppel to dismiss the claim, relying on a side agreement between the defendant and the trustee that affirmed an obligation to pay for the stock even if overvalued. The defendant thus argued that the Plan was equitably estopped from reducing the value of the note. The district court agreed and granted the defendant’s motion to dismiss. The Ninth Circuit reversed, holding that the doctrine of equitable estoppel could not be invoked against an ERISA plan trustee to contradict the terms of the plan. Allowing the terms of the side agreement to prevail, the court stated, would plainly violate those Plan terms mandating that the Plan not pay more than fair market value. The Ninth Circuit thus joined the Fourth Circuit in barring the defensive use of equitable estoppel to contradict an ERISA plan’s express terms. See Ret. Comm. of DAK Ams. LLC v. Brewer, 867 F.3d 471 (4th Cir. 2017).
We note as well that the Ninth Circuit did not apply a wholesale ban on the application of equitable estoppel in ERISA actions. Rather, the court said that equitable estoppel could apply if, in addition to meeting the traditional elements of equitable estoppel, a party established (1) extraordinary circumstances, (2) that the provisions of the plan are ambiguous, and (3) that the representations made about the plan were an interpretation, and not a modification, of the plan.
Takeaway — We have previously discussed the importance of careful drafting of ERISA plans. See here and here. That admonition bears repeating. As the Supreme Court has stated: “The plan, in short, is at the center of ERISA.” See US Airways, Inc. v. McCutchen, 569 U. S. 88 (2013). And even the Ninth Circuit agrees in Wong v. Flynn-Kerper.
Mark Casciari and Michael Cederoth
§ 1.59 Cross-Border Transactions: Key Items to Review When Performing Human Resource and Employment Due Diligence
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In the world of cross-border mergers and acquisitions, complex human resource and employment considerations arise during the transaction’s due diligence process. Depending on the transaction’s structure, these issues can be diverse and range in topics from immigration requirements to employee benefit matters to employee representative consultation obligations.
From the purchaser’s perspective, proper human resource and employment due diligence can help structure a transaction’s terms and limit any unwanted surprises after the deal is signed or closes. Conversely, failure to spot key human resource and employment diligence issues can cause business interruptions and liabilities and negatively impact employee morale.
In this short article, we outline some essential human resource and employment items for cross-border transaction due diligence. This is not intended to be an exhaustive list of due diligence matters and, as with any piece of this kind, should not be relied upon as legal advice.
Employee Consultation Obligations and Collective Bargaining Agreements
In many countries, a target company’s employees may be represented by a union, works council, or other employee representative body and covered by a collective bargaining agreement.
Closely analyze employee representative arrangements to assess if there are notification or consultation obligations that must occur before the transaction is signed and/or the deal is closed. It may take anywhere from a few weeks to a few months to satisfy the applicable requirement, so it’s important to build sufficient time into the deal timeline to account for the necessary processes. In some cases, employee representatives may also have co-determination rights, which require the applicable employee representative to consent to the transaction before it proceeds.
Failure to properly observe applicable notification, consultation, or co-determination rights can result in criminal liability. It can also result in litigation and materially delay the transaction’s consummation.
Change in Control and Severance Provisions
To determine whether any meaningful payouts or entitlements will be triggered by the transaction, review key employees’ agreements.
In particular, perform diligence on any agreements containing transaction bonuses, severance provisions, equity acceleration clauses, or so-called “change in control” terms. Assessing this before signing the transaction will help the purchaser determine if new employment agreements should be provided in connection with the transaction (or as a condition of the transaction) to supersede existing entitlements.
If the transaction will trigger such payments or entitlements, this may also result in material tax issues. As a result, tax diligence should also be performed as part of this review.
Review employee retirement and pension schemes, and pay particularly close attention to the types of pension plans the target company has in place in any asset purchase transaction or transaction where employees are changing employers outside the US. If the target company participates in or has participated in a defined benefit pension scheme outside the US (as opposed to a defined contribution pension scheme), there may be significant liabilities. In such case, perform robust due diligence before the transaction’s signing to ensure all legal requirements are followed, the transaction agreement adequately protects the purchaser from the target company’s existing liabilities, and the purchaser understands its pension obligations if it moves forward with the transaction.
Independent Contractor Status
Many companies engage individuals as independent contractors, but treat them like employees in practice. Most countries require a company to reclassify an individual as an employee if the individual is being incorrectly categorized as an independent contractor. If the misclassified individual who provides services to the company is not employed by another entity that is properly treating the individual like an employee (e.g. withholding taxes and remitting social security contributions, accounting for overtime, etc.), liabilities for the company can be significant. This is especially true if the company’s relationship with the individual has gone on for a significant period of time at a high pay rate.
Review a global census of the target company’s independent contractor engagements to assess if independent contractor misclassification might be a material issue. If it is, conduct additional diligence to determine if the purchaser should seek a specific compliance representation with a corresponding indemnity in the transaction agreement.
Companies that have multinational workforces often employ individuals with visa requirements or other immigration needs. When a change in ownership of the company or corporate structure that sponsors the applicable employee visa or work permit occurs, the change typically requires a filing or notification with the local immigration authority. Failure to adhere to applicable immigration filing and notification requirements can result in stiff fines, the suspension of the sponsored employee’s ability to work, and the inability to sponsor employees in the future.
Assess whether the transaction triggers a change of corporate ownership or employer that will require updates to any employee’s visa or work permit. If updates are required (including obtaining a new visa or work permit), bake sufficient time and terms into the transaction to account for them (e.g., filings and approvals from the local immigration offices). Such authorizations can take several months depending on the country and type of change. Review any immigration restrictions or waiting times that may also be in place due to COVID-19.
If the target company is a company with a moderate US headcount, conduct diligence on the target company’s I-9 compliance. Failure to comply can result in material fines and other criminal penalties. Performing diligence on this issue will also help the purchaser assess whether it should redo target company employee I-9s within the prescribed post-closing time period to mitigate any legacy liability.
Unique State or Local Requirements
Depending on the transaction type and jurisdictions involved, conduct targeted local due diligence. For example, California has several notable state and local laws on employee privacy, restrictive covenants, paid sick leave, vacation payout, and employee classification that do not apply to many other US states. If the transaction has a material nexus to California, perform diligence into the target company’s compliance with California specific employment laws. Similarly, depending on the nature of the target company’s business and the transaction’s nexus to the EU, performing due diligence on employee staff leasing, GDPR compliance, and pay equity obligations may be worthwhile.
While there are many other important diligence items that should be reviewed as part of standard human resource and employment due diligence on a cross-border transaction, do not overlook the foregoing items. As a best practice, ensure the purchaser’s deal team has a thorough checklist of all due diligence items it wants to cover as part of the transaction’s due diligence process. As due diligence progresses, hone in on key issues based on the information gleaned from the target company’s diligence responses. Submit supplemental diligence requests to flesh out any material open issues.
Marjorie, Jeremy, and Dan are all part of Seyfarth’s leading International Employment team who help leading employers navigate global workforce issues. To find out more about cross-border transaction human resource and employment issues, and how they might affect your business, please reach out to them or anyone else on our specialist team.
Marjorie Culver, Jeremy Corapi and Dan Waldman
§ 1.60 Never Fear: More COBRA Subsidy Guidance Is Here
On July 26, 2021, the U.S. Internal Revenue Service (“IRS”) issued Notice 2021-46, providing additional guidance on the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) and premium assistance and tax credit provisions of the American Rescue Plan Act of 2021 (“ARPA”). As described in our Legal Update, ARPA requires employers to cover 100% of the cost of continuing group health coverage under COBRA from April 1, 2021 through September 30, 2021 for assistance eligible individuals (i.e., individuals who lose coverage due to an involuntary termination of employment or reduction of hours ). On May 18, 2021, the IRS issued guidance in IRS Notice 2021-31 as we described in our prior blog post to provide clarification for employers, plan administrators, and health insurers regarding this subsidy. Notice 2021-46 expands on that guidance.
The key points from IRS Notice 2021-46 are summarized below.
How Does the Subsidy Apply to Assistance Eligible Individuals Who Are Entitled to Extended Coverage Periods?
Notice 2021-46 clarifies that assistance eligible individuals may be entitled to the COBRA subsidy for extended coverage periods (e.g., disability extensions, second qualifying events or an extension under State mini-COBRA laws), even if the assistance eligible individual didn’t elect extended coverage before April 1, 2021.
The Notice provides an example of an individual who is involuntarily terminated and elects COBRA continuation coverage effective October 1, 2019. The individual’s 18-month COBRA continuation period would have lapsed March 31, 2021. However, on March 1, 2020, a disability determination letter was issued by the Social Security Administration providing that the individual was disabled as of November 1, 2019. This disability determination entitles the individual to the 29-month extended COBRA continuation coverage, but the individual failed to notify the plan of the disability determination by April 30, 2020, which is 60 days after the date of the issuance of the disability determination letter (as would normally be required to qualify for the COBRA disability extension period). However, under the EBSA Disaster Relief Notices 2020-01 and 2021-01, the individual has one year and 60 days from the issuance of the disability determination letter to notify the plan of the disability to extend COBRA continuation coverage. On April 10, 2021, the individual notifies the plan of the disability and elects ongoing COBRA coverage from April 1, 2021. Assuming the individual is not eligible for other disqualifying group health plan coverage or Medicare, the individual is an assistance eligible individual and is entitled to the COBRA premium assistance.
Does Eligibility For Other Health Coverage That Does Not Include Vision or Dental Benefits Terminate an Assistance Eligible Individual’s Eligibility For the COBRA Subsidy for Vision-Only or Dental-Only Coverage?
Yes. Eligibility for the COBRA premium assistance ends when the Assistance Eligible Individual becomes eligible for coverage under any other disqualifying group health plan or Medicare, even if the other coverage does not include all of the benefits provided by the COBRA coverage.
Which Entity May Claim the Tax Credit for the COBRA Subsidy?
Where a group health plan (other than a multiemployer plan) subject to COBRA covers employees of two or more employers, each common-law employer is generally treated as the premium payee entitled to claim the premium assistance tax credit with respect its own employees and former employees, even where such common-law employers are part of a controlled group.
The Notice also clarifies that an entity that provides health benefits to employees of another entity, but is not a third-party payer of their wages, will not be treated as a third-party payer for purposes of applying Notice 2021-31. For example, if a group health plan covers employees of two or more unrelated employers in a multiple employer welfare arrangement (“MEWA”), the entity entitled to claim the tax credit is generally the common law employer; the association that sponsors the MEWA is not entitled to claim the tax credit for the COBRA subsidy.
Reminder: Tell Participants that the Subsidy Period is Ending
As we mentioned in our previous Legal Update, ARPA requires plan sponsors to notify participants 15-45 days before their COBRA subsidy ends. Participants will need to be informed (i) when their subsidy ends, and (ii) how much their non-subsidized COBRA premium will be. Employers may already have sent this notice on a “one-off” basis to COBRA qualified beneficiaries whose 18 or 36 months of COBRA coverage has ended or will end before September 30th. However, the subsidy will expire on September 30, 2021 for all COBRA qualified beneficiaries (even if they may still have time remaining in their 18 or 36 month COBRA period); thus, employers may need to do one last bulk mailing. The mailing needs to go out any time between August 16, 2021 and September 15, 2021. The Department of Labor’s model notice is here.
Please contact Irine Sorser ([email protected]), Kelly Joan Pointer([email protected]) or any member of Seyfarth’s Employee Benefits Group if you would like further information about these updates.
Irine Sorser and Kelly Joan Pointer
§ 1.61 Anti-Vax Tax Facts: Legal Considerations for Premium Differentials Based on Vaccination Status
Seyfarth Synopsis: As employers continue to struggle with strategies for safely re-opening their workplaces, we have previously discussed the possibility of mandating a vaccine or providing incentives for getting the vaccine [Here]. As employers shift their focus toward the cost of COVID hospitalizations (which studies show are a much greater risk for unvaccinated individuals), employers are increasingly considering imposing a premium differential between vaccinated and unvaccinated covered participants. Imposing such a premium differential is doable, but likely creates a group health plan wellness program, which implicates both HIPAA (under rules issued by HHS), and the ADA and GINA (governed by the EEOC) wellness program rules.
There are myriad intricacies to consider when setting up a wellness program. We will hit some of the highlights here:
HIPAA Wellness Programs
HIPAA’s rules divide the world of wellness programs into two main categories:
- Participation-only programs. These are programs that do not require any conditions for receiving a reward and have very few requirements associated with them, except that they must be available to all similarly situated individuals.
- Health-contingent programs. These are programs that base rewards on satisfying a standard related to a health factor, which are further subdivided into
- activity-only, and
- outcomes-based programs
While at first blush it may seem like getting a vaccine is participation-only as a person simply needs to get the shot, and does not need to remain free from COVID-19, there is some thought that it may actually be health-contingent because not everyone can get the vaccine due to underlying health conditions.
Most practitioners do not believe such a program is a health-contingent “outcomes-based” program, as the reward does not depend on staying COVID-19-free. However, at least one consultant has taken the position that this type of program could even be outcomes-based if having simply received the vaccine is considered a “health status.”
Although HHS has not provided any direct guidance here, we think it is more likely that such a program would be a health-contingent “activity-only” program. In general, a health-contingent activity-only wellness program must meet the following requirements:
- Incentive Limit:
- Limit the incentive to 30% of the cost of coverage (this limit is increased to 50% if the program includes a tobacco cessation component);
- The limit is based on the overall cost of coverage — i.e., the COBRA rate — applicable to the value of coverage elected — i.e., self-only, family, etc.;
- This incentive would need to be combined with any other “health contingent” wellness program offered under the plan when determining whether the incentives exceed the limit (except that if any incentive is linked to smoker status, the limit is increased to 50%)
- Reasonable Alternative
- A reasonable alternative must be offered to persons who cannot get vaccinated because it is medically inadvisable or, as a result of the overlay of Title VII, due to a sincerely held religious belief.
- Participants must be notified of the availability of the reasonable alternative in all materials substantially describing the program.
- Annual Opportunity to Qualify:
- Provide an opportunity to qualify for the reward at least once per year
- Be uniformly available to all similarly situated individuals; and
- Not be a subterfuge for discrimination.
(Note: There are additional requirements for health contingent wellness programs that are outcomes-based programs.)
EEOC and the ADA
The EEOC has modified its wellness program rules a few different times in the last few months. Ultimately, we read the current loosening of the EEOC’s wellness program rules as the administration’s attempt to not discourage incentives.
If the wellness program is for a health-contingent activity-only program, the EEOC is okay if the plan meets the HIPAA/HHS standards. (The new EEOC wellness program rules will also allow an incentive for participatory programs that is not overly large (i.e., considered coercive).)
Similarly, recent EEOC guidance has indicated that vaccine status alone is not a “medical exam or disability-related inquiry” under the ADA. So, if an employer simply requests proof of vaccination status but does not require the employee to get the vaccine directly from the employer (or its contractor), the program is arguably outside of the scope of the EEOC’s wellness guidelines entirely.
Affordable Care Act
For ACA purposes, if the “incentive” is structured as an increased premium, the employer must treat all employees as if they failed to get vaccinated and were required to pay the increased amount for purposes of determining the affordability of coverage, regardless of whether that’s the case. However, there are ways for plan sponsors to mitigate this concern. For instance, the employer could design its “penalty” as a deductible increase rather than a premium increase, which would not impact affordability. (It would impact minimum value, but the employer likely has more flexibility there.) Similarly, because the ACA only requires that employers offer one affordable option, the employer could link the incentive only to its higher-cost benefit options (leaving untouched its lower-cost, “affordable” option.)
* * *
While beyond the scope of this legal update, employers should also be cautious of how they structure the program considering collective bargaining obligations, HIPAA privacy concerns and Section 125 requirements (for mid-year implementations). We will continue to monitor trends in this space with an eye toward any agency indications as to whether they intend to regulate these types of programs.
Benjamin J. Conley and Diane V. Dygert
§ 1.62 If You Have Been Racing to Meet these Deadlines… You May Have Just Gotten an Extension
Seyfarth Synopsis: The Departments of Labor, Health and Human Services, and Treasury (the “Departments”) have issued FAQs which address certain provisions of the Affordable Care Act (ACA) and Title I (No Surprises Act) and Title II (Transparency requirements) of the Consolidated Appropriations Act of 2021 (CAA). The FAQs provide welcome relief for group health plans as they postpone many compliance deadlines and allow for some breathing room.
The ACA requires “transparency in coverage” cost-sharing disclosures by most health plans. In November of 2020, the Departments issued Final Transparency in Coverage Rules (TiC Rules) which require group health plans and health insurance issuers to disclose cost-sharing information to participants, beneficiaries, and, in some cases, the public. See our legal update here. The CAA also includes Transparency requirements, some of which overlap with the TiC Rules.
The No Surprises Act protects plan participants from surprise medical bills for services provided by out-of-network or nonparticipating providers and facilities. The No Surprises Act also contains extensive provisions regarding reporting and disclosure of charges and benefits. The first round of guidance on the surprise billing requirements was issued in July, 2021 (see our legal update here).
The FAQs address some of the guidance expected under the TiC Rules and the CAA, and announce that no further guidance will be issued for certain provisions. This legal update addresses what requirements will apply to group health plans, and when.
For plan years beginning on or after January 1, 2022, the TiC Rules require plans to disclose on a public website information regarding in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for covered items and services, and negotiated rates and historical net prices for covered prescription drugs in three separate machine-readable files. (According to the preamble to the TiC Rules, this will allow the public to have access to health coverage information that can be used to understand pricing and potentially dampen the rise in health care spending.)
FAQ Takeaways – According to the FAQs, the Departments will enforce the machine-readable file provisions in the TiC Rules, subject to two exceptions.
- The requirement that plans publish machine-readable files relating to prescription drug pricing is deferred pending further rulemaking to determine if these requirements remain appropriate.
- The requirement to publish in-network rates and out-of-network allowable amounts and billed charges is deferred until July 1, 2022. The FAQs state, however, that on July 1, 2022, the Departments will begin enforcing the requirement that plans publicly disclose information for plan years beginning on or after January 1, 2022.
Price Comparison Tools
Both the TiC Rules and the CAA require plans to create an internet-based self-service tool to disclose cost-sharing information to participants. The TiC Rules require a plan to provide cost-sharing information for a covered item or service: (i) by billing code or description, and/or (ii) in connection with an in-network provider, or an out-of-network allowed amount for a covered item or service provided by an out-of-network provider. The CAA’s price comparison is mostly repetitive of the TiC Rules, but it added the requirement that this information must also be provided over the telephone, if requested. The TiC Rules’ effective date is January 1, 2023 with respect to 500 items and services listed in the preamble to the TiC Rules, and January 1, 2024 with respect to all covered items and services. The CAA’s effective date is January 1, 2022.
FAQ Takeaways – The Departments will:
- Propose rulemaking and seek public comment to determine if the internet-based self-service tool requirements of the TiC Rules satisfy the requirements under the CAA.
- Propose rulemaking to require that the pricing information required under the TiC Rules must also be provided over the telephone if requested.
- Defer enforcement of the requirement to provide a price comparison tool until January 1, 2023. Until that time, the Departments will focus on compliance assistance.
Plan or Insurance Identification Cards
The No Surprises Act requires plans to include, in clear writing, on physical or electronic insurance identification (ID) cards, any applicable deductibles and out of pocket maximum limitations, and a telephone number and website address for individuals to seek consumer assistance. This requirement is effective January 1, 2022.
FAQ Takeaways – The Departments:
- Do not intend to issue regulations addressing the ID card requirements before the effective date. Instead, plans are expected to make a good faith interpretation of the law to reasonably design the ID cards to provide the required information.
- When analyzing a plan’s compliance efforts, the Departments will consider whether the ID cards are reasonably designed and implemented to provide the required information to all participants, beneficiaries, and enrollees.
Good Faith Estimate of Expected Charges
The No Surprises Act requires providers and facilities, upon an individual’s scheduling of items or services, or upon request, to provide a notification of a good faith estimate of the expected charges for furnishing the scheduled item or service and any items or services reasonably expected to be provided in conjunction with those items and services. If the individual is enrolled in a health plan and is seeking to have a claim submitted to the plan, the provider must provide this notification to the plan. Otherwise, the notification must be provided to the individual.
The effective date is January 1, 2022. Because uninsured individuals do not have the claims and appeals processes in place to protect them as do individuals covered by a group health plan, with respect to uninsured individuals, HHS intends on enforcing the good faith requirements beginning January 1, 2022, and issuing regulations prior to January 1, 2022.
FAQ Takeaways – The Departments will:
- Defer enforcement for individuals enrolled in a health plan until future rulemaking is issued.
- Issue regulations implementing good faith estimate requirements for uninsured individuals prior to January 1, 2022.
Advanced Explanations of Benefits
The No Surprises Act requires that plans, upon receiving a good faith estimate, provide participants with an Advanced Explanation of Benefits (the “AEOB”) in clear and understandable language. The AEOB must include whether the provider or facility is in-network; the contracted rate for the item or service, or an explanation as to how the individual can obtain information on participating providers; the good faith estimate received from the provider; an estimate of what the plan will pay and the participant’s cost-sharing obligation; and whether any medical management techniques apply. The statutory effective date is January 1, 2022.
FAQ Takeaway – The Departments intend to undertake notice and comment rulemaking in the future to establish appropriate data transfer standards between plans and providers to implement the AEOB requirement. In the meantime, the Departments will not enforce the requirement.
Prohibition on Gag Clauses
Effective December 27, 2020, the Transparency requirements of the CAA prohibit plans from entering into an agreement that would restrict the plan from accessing or sharing certain information with a provider, network of providers, third-party administrator, or other service provider offering access to a network. Specifically, an agreement cannot restrict a plan from: (i) providing provider-specific cost or quality of care information to referring providers, the plan sponsor, participants and beneficiaries, or individuals eligible for coverage; (ii) electronically accessing certain de-identified claims information for each participant; or (iii) sharing such information with a HIPAA business associate.
FAQ Takeaway – The Departments will not be issuing regulations and expect plans to implement the requirements using a good faith, reasonable interpretation. The Departments will begin collecting attestations of compliance in 2022 and intend on issuing guidance to explain how plans should submit their attestations.
The No Surprises Act requires plans to establish a process to update and verify the accuracy of provider directory information and to establish a protocol for responding to requests by telephone and electronic communication from a participant, beneficiary, or enrollee about a provider’s network participation status. Under a correction method provided, if a participant is provided with incorrect information that a provider is in-network and a service or item is provided by a nonparticipating provider, then the plan cannot impose a cost-sharing amount that is greater than the cost-sharing amount that would be imposed for items and services furnished by a participating provider and the plan must count cost-sharing amounts toward any in-network deductible or in-network out-of-pocket maximum. The effective date is January 1, 2022.
FAQ Takeaways – The Departments will not:
- Issue regulations until after January 1, 2022. Until then, plans are expected to implement these provisions using good faith, reasonable interpretation of the law.
- Deem a plan out of compliance, provided the correction method is used.
Balance Billing Disclosures
The No Surprises Act requires plans to make publicly available, post on a public website of the plan and include on each explanation of benefits (EOB) for an item or service information on the prohibitions on balance billing. The disclosure provisions are effective January 1, 2022.
FAQ Takeaways – The guidance states:
- The Departments may provide guidance in the future. Until then, plans are expected to implement these requirements using a good faith, reasonable interpretation of the law.
- A model notice that may be used to satisfy the disclosure requirements is available on the CMS website. (See here)
Continuity of Care
The No Surprises Act ensures that participants won’t lose coverage when changes in provider or facility network status occur. These provisions are effective January 1, 2022.
FAQ Takeaway – The FAQs state that the Departments expect to issue further guidance to fully implement these provisions and provide a new, prospective effective date. Until then, plans are to implement the requirements using a good faith, reasonable interpretation of the law.
Grandfathered Health Plans
The FAQs provide that the CAA does not include an exception for grandfathered health plans.
Reporting on Pharmacy Benefits and Drug Costs
The Transparency requirements of the CAA require that by December 27, 2021, and by each June 1st thereafter, plans submit relevant information to the Departments regarding plan coverage for prescription drugs. This includes, but is not limited to, a list of the 50 most frequently dispensed brand prescription drugs, and the total number of paid claims for each such drug; the 50 most costly prescription drugs by total annual spending, and the annual amount spent by the plan for each such drug; and the 50 prescription drugs with the greatest increase in plan expenditures over the plan year preceding the plan year that is the subject of the report, and, for each such drug, the change in amounts expended by the plan or coverage in each such plan year.
Additionally, plans must report (i) total spending on health care broken down by type of costs (i.e. hospital, provider costs for primary care and specialty care, costs for prescription drugs and other medical costs), and spending on drugs by the plan and participants; (ii) average monthly premium paid by employer and employee; (iii) any impact on premiums by rebates, fees and other amounts paid by drug manufacturers to the plan; and (iv) any reduction in premiums and out-of-pocket costs associated with rebates, fees, and other amounts paid by drug manufacturers.
FAQ Takeaways – The Departments:
- Will issue regulations to address these reporting requirements.
- Will defer enforcement of the requirement to report the specified information until the issuance of regulations or further guidance.
- Strongly encourage plans to start working to ensure they are in a position to report the data for 2020 and 2021 by December 27, 2022.
To stay up to date with future guidance, be on the lookout for additional Seyfarth Legal Updates.
Joy Sellstrom and Sarah N. Magill
§ 1.63 Seventh Circuit Rejects Plan’s Attempt to Compel Individual Arbitration of Participant’s Fiduciary Breach Claims
Seyfarth Synopsis: Recognizing that the Plan contained an unambiguous arbitration provision, and that “ERISA claims are generally arbitrable,” the Seventh Circuit Court of Appeals nonetheless found that arbitration could not be compelled where the provision prospectively barred the plaintiff from pursuing certain statutory remedies.
In Smith v. Bd. of Dirs. of Triad Mfg., Inc., a Plan participant brought a putative class action suit asserting that the Plan’s fiduciaries breached their fiduciary duties and engaged in prohibited transactions in connection with the sale of all of the Plan sponsor’s stock to the Plan. Within two weeks of the transaction, the shares’ ostensible value dropped from $106 million to less than $4 million.
After the stock transaction—but before the suit was filed—the Plan sponsor amended the Plan to add an arbitration provision with a class action waiver. The provision prohibited an individual from bringing claims in anything other than an individual capacity, and further stated that an individual could not “seek or receive any remedy which has the purpose or effect of providing … relief to any [person] other than the Claimant.”
Based on this language, the Plan moved to compel individual arbitration of Plaintiff’s suit. The district court denied the motion. On appeal, the Seventh Circuit stated it was guided by the “liberal federal policy favoring arbitration agreements,” but nonetheless affirmed the decision of the district court, based on the “effective vindication” exception to the FAA. This exception invalidates arbitration agreements that operate as prospective waivers of a party’s right to pursue statutory remedies. Here, the plaintiff sought a variety of equitable remedies—including the potential removal of the Plan’s trustee—which would inescapably have had the effect of providing relief to individuals beyond the Plaintiff. As such, Plaintiff’s requested relief was impermissibly in conflict with the Plan’s arbitration provision.
The Seventh Circuit stated that its holding is limited to the language of the arbitration provision at issue, and that it was not deciding whether a claimant could be bound by an amendment enacted after his employment ended, or whether a plan sponsor can unilaterally amend a plan to require arbitration as to all participants. The Court was also quick to say that it did not view its decision as creating conflict with the Ninth Circuit’s holding in Dorman v. Charles Schwab Corp. (discussed here), in which that court held a that an ERISA plan’s mandatory arbitration and class action waiver provision was enforceable, and could require individualized arbitration of fiduciary breach claims. Still, the tension between the Seventh Circuit’s holding in Smith and the Ninth’s in Dorman—together with the Supreme Court’s repeated statements encouraging enforcement of arbitration provisions—has already lead to speculation that a petition for certiorari will be filed.
Thus, while the Seventh Circuit in Smith stated that ERISA claims are generally arbitrable, Smith leaves open many questions about the proper scope of such provisions and how those provisions (to the extent they are enforceable) will shape ensuing arbitration and litigation. Stay tuned as we continue to track this evolving area of the law.
Tom Horan, Ian Morrison and Sam Schwartz-Fenwick
§ 1.64 More Vax Facts – The Agencies Weigh In
Seyfarth Synopsis: We previously discussed how to apply the HIPAA wellness rules to a premium differential based on a participant’s vaccination status in our Legal Update. At the time, we were left to interpret the existing rules to the brave new world of COVID-19 vaccination incentive programs. Well, the Departments of Labor, Health and Human Services, and Treasury have now weighed in. FAQs about Affordable Care Act Implementation Part 50, Health Insurance Portability and Accountability Act and Coronavirus Aid, Relief, and Economic Security Act Implementation (dol.gov) And, fortunately, our analysis held up. See below for highlights of the FAQs.
What Kind of Wellness Program Is It?
The agencies confirmed that a plan may impose a premium differential based on vaccination status if it complies with the HIPAA wellness plan rules. In this regard, the agencies confirmed that a premium differential based on vaccination status will be a “health-contingent activity-only” wellness program. Recall that there was some debate about whether such a program would be “participatory only” or whether it might even be considered a “health-contingent outcomes-based” wellness program. While the agencies did not go into any deep analysis, at the time we based our view that the program would be “activity-only” on the fact that some individuals may not be able to get the vaccination due to their personal health status (e.g., someone undergoing chemotherapy treatment) making getting the vaccine health-contingent. And, the agencies settled that getting a COVID-19 vaccination is an activity related to a health factor.
Can Cost Sharing Be Imposed on Vaccines?
The agencies reiterated that effective January 5, 2021, plans and issuers must cover COVID-19 vaccines along with their administration without cost sharing immediately upon a vaccine becoming authorized under an Emergency Use Authorization (EUA) or approved under a Biologics License Application (BLA). The agencies clarified that this includes immediate required coverage for any authorized booster shots upon the date authorized and immediate required coverage for any expanded age group (e.g., children under age 12) on the date authorized. Due to apparent confusion about the effective date of required coverage for expanded vaccinations under any amended EUA or BLA, this requirement will be effective prospectively only.
Can Group Health Plan Eligibility or Benefits Be Conditioned on Vaccination Status?
This is a hard no, as it would be considered discriminating based on a health factor. To be clear, while a health plan cannot condition eligibility or benefits on vaccination status, the agencies have noted that plans may condition premiums or cost-sharing on vaccination status, within the parameters of HIPAA as described in our earlier alert.
How Does a Premium Differential Impact ACA Affordability?
The agencies also confirmed our prior view that premium incentives will be treated as not earned for purposes of measuring affordability under the ACA. This is true for all wellness incentives, other than for those related to tobacco use.
Benjamin J. Conley and Diane V. Dygert
§ 1.65 We Have No Idea When the Outbreak Period Will End, But We Have a Better Idea When COBRA Payments Are Due
Seyfarth Synopsis: The IRS has attempted to provide clarity (following the DOL’s earlier attempt) on how the coronavirus Outbreak Period will work and how it applies to COBRA election and premium payment deadlines, in Notice 2021-58.
At the beginning of the COVID-19 National Emergency, in May of 2020, the Department of Labor (DOL) and the Internal Revenue Service (IRS) issued a Joint Notice that extended certain timeframes applicable to COBRA continuation coverage under a group health plan by requiring plans to disregard the period from March 1, 2020 until 60 days after the announced end of the COVID National Emergency or such other date announced by the relevant agencies (the “Outbreak Period”). (See our prior legal update).
The Joint Notice provided extensions for the following COBRA timeframes:
- The 60-day election period for COBRA continuation coverage,
- The dates for making COBRA premium payments,
- The date for individuals to notify the plan of a qualifying event or determination of disability, and
- The date for providing a COBRA election notice for group health plans.
In February of 2021, we explained how the DOL clarified that the extensions would apply separately to each individual and would last until the earlier of (1) one year from the date relief was first available (e.g. an individual’s original election due date or payment due date), or (2) the end of the Outbreak Period. At the end of this disregarded period, the applicable timeframes that were disregarded resume.
Recently the IRS issued Notice 2021-58 to clarify certain questions that have arisen as to how the disregarded period applies to COBRA election and premium payment deadlines.
COBRA Payment Deadlines
We now know that the periods run concurrently. For example, an individual may not delay electing COBRA for a year and then add another year to make payment. The following timeframes will apply to individuals making initial COBRA premium payments:
- If an individual elected COBRA continuation coverage more than 60 days after receipt of the COBRA election notice, that individual generally will have one year and 105 days after the date COBRA notice was provided to make the initial COBRA premium payment.
- If an individual elected COBRA continuation coverage within 60 days of receipt of the COBRA election notice, that individual will have one year and 45 days after the date of the COBRA election to make the initial COBRA premium payment.
For each subsequent COBRA premium payment, the maximum time an individual has to make a payment while the Outbreak Period continues is one year from the date the payment originally would have been due in the absence of previous extensions, but subject to the transition relief provided below.
Transitional Relief for COBRA Payments
Despite the new guidance that the periods run concurrently, an individual cannot be required to make an initial premium payment before November 1, 2021 (even if November 1, 2021 is more than one year and 105 days after the election notice is received), provided that the individual makes the initial payment within one year and 45 days after the date of the election.
Coordination with ARPA’s COBRA Subsidy
The American Rescue Plan Act (ARPA) provided a temporary 100% COBRA premium subsidy for “Assistance Eligible Individuals” for periods of coverage beginning on or after April 1, 2021 through September 30, 2021.
ARPA also gave individuals who either (a) were eligible for COBRA but did not elect COBRA as of April 1, 2021, or (b) elected and discontinued COBRA coverage before April 1, 2021 another chance to elect COBRA during the period beginning April l, 2021 and ending 60 days after notice of the “extended election period” is received. Employers were required to give notice of this extended election period (ARPA Notice) by May 31, 2021. (See legal update).
Notice 2021-58 reiterates that the extensions of the timeframes do not apply to the periods for providing the required ARPA Notice, or for electing subsidized COBRA. A plan may require an individual to elect COBRA retroactive to the date of loss of coverage within 60 days of receiving the ARPA Notice or lose eligibility for retroactive COBRA. For example, an individual who receives a COBRA election notice on August 1, 2020 would have until September 30, 2021 (one year and 60 days) to elect COBRA retroactive to August 1, 2020. But if the individual elects subsidized COBRA under ARPA, the individual would only have 60 days after the receipt of the ARPA Notice to elect retroactive COBRA coverage. If the individual receives the ARPA Notice on May 31, 2021 and elects subsidized COBRA beginning April 1, 2021, but does not elect retroactive COBRA, the individual cannot later elect retroactive COBRA.
Payment for Retroactive COBRA under ARPA
Notably, the disregarded periods continue to apply to payments of COBRA premiums after subsidized COBRA ends, to the extent that the individual is still eligible for COBRA continuation coverage and the Outbreak Period has not ended. Notice 2021-58 provides this example:
On November 1, 2020, Charley is involuntarily terminated and receives a COBRA election notice. On April 30, 2021, Charley receives notice of the ARPA extended election period. On May 31, 2021, Charley elects both retroactive COBRA coverage beginning on November 1, 2020, and subsidized COBRA beginning April 1, 2021.
Charley has until February 14, 2022 to make the initial COBRA premium payment (one year and 105 days after November 1, 2020). The initial COBRA payment would include premium payments for November 2020 through January 2021. The February 2021 premium payment would be due by March 3, 2022 (one year and 30 days after February 1, 2021), and the March 2021 premium payment would be due by March 31, 2022 (one year and 30 days after March 1, 2021). Premium payments would be due every month after that for the months Charley is eligible for COBRA coverage, except that no payments would be due for the periods beginning on or after April 1, 2021, through September 30, 2021.
Other helpful examples are provided that should help plan administrators and COBRA administrators in collecting COBRA premium payments. Please contact the employee benefits attorney at Seyfarth Shaw LLP with whom you usually work if you have any questions.
The Notice uses both the date “provided” and the date “received” in explaining when the initial COBRA premium must be paid. Additional clarification as to whether “provided” means the date sent or date received would be helpful.
§ 1.66 ERISA Fiduciary Breach Litigation Can Involve Complicated Damages Analyses
Seyfarth Synopsis: If an ERISA plaintiff establishes a fiduciary breach, expect the computation of damages to be a complicated process that may enhance damages through judgment. And a court judgment in complicated cases can take years to issue. This is the lesson from a recent decision of the Court of Appeals for the Second Circuit.
Browe v. CTC Corporation, 2021 WL 4449878 (2d Cir. 9/29/21) is a complex ERISA case, both procedurally and substantively. This article focuses on the portion of the ruling that relates to the calculation of fiduciary breach damages. This is because the computation of ERISA fiduciary breach damages is central to successful discovery and settlement negotiations.
In Browe, former employees and officers of a defunct corporation asserted ERISA claims against the corporation and its former CEO for mismanagement of the firm’s deferred compensation plan. The controversy arose from a decision to terminate the Plan and use its funds to pay business operating expenses. The district court found in favor of plaintiffs and awarded damages based on the projected account balances as of Plan termination, after rejecting plaintiffs’ assertion that ERISA required restoration of Plan losses through judgment.
The Second Circuit overturned the restoration award. It found that the Plan was improperly terminated — so it was not terminated at all. The Court then held that ERISA required that the award “return the participants to the position they would have occupied” but for this fiduciary breach. This included all losses, including unrealized gains, through the date of judgment. It remanded the case back to the district court for recalculation of award to capture losses through the date of judgment.
Citing to Donovan v. Bierwirth, 754 F.2d 1049 (2d Cir. 1985), the Court instructed that the award be based on the assumption that Plan funds were prudently invested, with the caveat that if several investment strategies were equally plausible, the district court should presume that the funds would have been invested in the most profitable of various options. The Court added that uncertainties in fixing damages must be resolved against the breaching fiduciary.
Damage Computation Takeaway – By computing damages for a fiduciary breach through judgment, the Court is advising fiduciary breach litigants that there will be a battle of the experts in determining what investment likely “would have happened.” If a fiduciary breach case survives a motion to dismiss, expect complicated and expensive expert damage discovery that serve to inflate settlement demands.
Mark Casciari and Michael Cederoth