Springfield, MO

Opinion: Law changes challenge telemedicine programs

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Several recent changes in federal laws and regulations impact numerous aspects of insurance and benefit administration.

Telemedicine programs might be most affected.

A popular trend in 2017 is providing free or low-cost telemedicine programs to offer employees simple and affordable access to medical care. However, the program might cause several compliance and excise tax issues. Companies that also provide an HDHP must ensure the company will not unintentionally prohibit covered associates from health savings account eligibility.

Telemedicine programs providing more than preventive care or employee assistance programs might be considered a disqualifying coverage.

For example, a telemedicine program offering primary care or prescription drug services qualifies as a separate group health plan under the Employee Retirement Income Security Act, COBRA, Health Insurance Portability and Accountability Act and other federal laws.

In addition, the Affordable Care Act imposes several coverage requirements on practically all group health plans. One mandate is to administer preventive care in person, which is impossible for telemedicine programs.

Here’s a quick review of other legal updates:

1. HSA and HDHP contributions. For 2018, the maximum HSA staff member and business contribution for an individual with self-only coverage will rise to $3,450 from $3,400. For an individual with family coverage, the maximum contribution will increase to $6,900 from $6,750. The out-of-pocket maximums for HDHPs also increased.

2. Wellness rewards. The IRS recently released direction regarding the possible tax results of cash benefits obtained under an employer-provided wellness program. Cash benefits must be included in income and wages if the average amounts received by laborers for partaking in a wellness program predictably surpass the after-tax contributions of the team members. Any nonmedical care reward, incentive or other cash-equivalent benefit must be included in gross income and wages.

3. ACA and union bargaining. The National Labor Relations Board recently held that ACA mandates do not release an organization from bargaining with the union concerning certain health insurance benefit plan changes. When a corporation is required to change terms and conditions of employment to comply with a statute, the enterprise must furnish the union an opportunity to bargain over the discretionary features of the modifications.

4. ACA affordability threshold percentage adjustment. The ACA mandates applicable large employers to provide minimum essential coverage that is affordable and has minimum value to full-time associates. The affordability threshold is established at 9.5 percent of household income, and it’s indexed for inflation, with the 2017 threshold being 9.69 percent. The 2018 threshold will fall to 9.56 percent.

5. Safe harbor rule. President Donald Trump recently signed a joint resolution overturning Barack Obama’s safe harbor rule permitting states to offer retirement plans to private sector workers. The repealed rule authorized states to create payroll deduction programs using automatic enrollment without becoming employee pension plans subject to ERISA rules established in 1974.

Lynne Haggerman, M.S., is president/owner of Lynne Haggerman & Associates LLC, a Springfield firm specializing in management training, retained search, outplacement and human resource consulting. She can be reached at


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