We care about Aflac’s policyholders affected by the recent weather:
To help provide relief for North Dakota policyholders residing in North Dakota who were affected by the severe summer storms and tornadoes, Aflac will provide a premium grace period starting June 21, 2025, and ending Aug. 20, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Oregon who were affected by the wildfires, Aflac will provide a premium grace period starting July 16, 2025, and ending Sept. 15, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Crook County who were affected by the wildfires, Aflac will provide a premium grace period starting July 12, 2025, and ending Sept. 10, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent flooding:
To help provide relief for Texas policyholders and/or certificate holders residing in Bandera, Bexar, Burnet, Caldwell, Coke, Comal, Concho, Gillespie, Guadalupe, Kendall, Kerr, Kimble, Llano, Mason, McCulloch, Menard, Reeves, San Saba, Tom Green, Travis, and Williamson counties who were affected by the flooding, Aflac will provide an extended premium grace period starting July 2, 2025, and ending Sept. 8, 2025. This grace period also includes an extension of filing deadlines for claims and leniency for any other actions required under the policy and/or certificate. Aflac will provide a replacement copy of the policy and/or certificate upon request by the policyholder and/or certificate holder.
For Network Dental and Vision Members:
This grace period also includes an extension of filing deadlines for claims; temporary relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability of in-network providers or member displacement; and leniency for any other actions required under the certificate.
Affected members should contact Aflac Benefits Solutions (formerly Argus Dental and Vision) at 855-819-1873, option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Klamath County who were affected by the wildfires, Aflac will provide a premium grace period starting July 8, 2025, and ending Sept. 08, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Umatilla County who were affected by the wildfires, Aflac will provide a premium grace period starting July 2, 2025, and ending Sept. 02, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To provide relief for New Mexico policyholiders and/or certificate holders residing in Grant County and affected by the Trout Fire, Aflac will provide the following protections for policyholders and/or certificate holders: Provide an extended premium grace period from Thursday, Jun. 12, 2025 through Monday, Sep. 15, 2025. Offer policyholders and/or certificate holders a payment plan of no less than six (6) months if unable to pay the delinquency after the extended day grace period (This applies to all coverages except life.). Work with policyholders and/or certificate holders on premium payments to prevent lapse and cancellation of policies. Waive late fees and penalties. Waive early refill time limits on active prescriptions. Allow additional time for actions required under the policy and/or certificate and the submission of documents due to limited access to service and mobility. Provide an extension of filing deadlines for claims and leniency for any other action required under the policy and/or certificate. Provide a copy of the policy and/or certificate to the policyholder and/or certificate holder upon request.
In addition to the above, Aflac through Aflac Benefits Solutions will provide the following protections for Network Dental and Vision members and providers: Waive cost sharing and deductibles. Permit one eyeglass or contact lens replacement and one hearing aid replacement during the pendency of the Emergency Order, waiving frequency limitations. Permit one replacement for dentures or other prosthodontic devices during the pendency of this Emergency Order, waiving frequency limits. Waive additional fees, charges, referrals, eligibility and prior authorization requirements for medically necessary services, whether emergent or not. This applies to benefits and services obtained from both in- and out-of-network providers. Extend medical providers' reporting requirements for claims submissions and for additional information relating to claims. Fully reimburse out-of-network providers at the usual, customary, and reasonable rate.
Affected members should contact Aflac Dental and Vision (formerly Argus Dental and Vision) at 855-819-1873, option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Jefferson County who were affected by the wildfires, Aflac will provide a premium grace period starting June 16, 2025, and ending Aug. 18, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for California policyholders residing in Los Angeles County affected by the wildfires, Aflac will provide a premium grace period starting Dec. 9, 2024, and ending Aug. 18, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for Oregon policyholders residing in Wasco County who were affected by the wildfires, Aflac will provide a premium grace period starting June 11, 2025, and ending Aug. 11, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent weather:
To help provide relief for Maryland policyholders residing in Allegany and Garrett Counties affected by the flooding, Aflac will provide a premium grace period starting May 13, 2025, and ending July 14, 2025. This grace period also provides an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder.
For Network Dental and Vision Members:
This grace period also provides an extension of filing deadlines for claims; relaxation of prior authorization, precertification, and referral requirements; access to appropriate out-of-network providers due to unavailability on in-network providers or the members’ displacement; and leniency for any other action required under the certificate. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent weather:
To help provide relief for California policyholders residing in Trinity County affected by the Dec. 15, 2024, and Dec. 29, 2024, winter storms, Aflac will provide billing leniency for impacted insureds, an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder. Affected members should contact Aflac at 800-992-3522 for assistance.
For Network Dental and Vision Members:
This also provides an extension of filing deadlines for claims and leniency for any other action required under the certificate. Affected members are not required to obtain prior approval when accessing appropriate out-of-network providers when in-network providers are unavailable. The cost-sharing for out-of-network will be in amount equal to cost-sharing affected members would have paid for the provision of that service in-network. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent levee failure:
To help provide relief for California policyholders residing in San Joaquin County affected by the Oct. 21, 2024, Victoria Island Levee failure, Aflac will provide billing leniency for impacted insureds, an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder. Affected members should contact Aflac at 800-992-3522 for assistance.
For Network Dental and Vision Members:
This also provides an extension of filing deadlines for claims and leniency for any other action required under the certificate. Affected members are not required to obtain prior approval when accessing appropriate out-of-network providers when in-network providers are unavailable. The cost-sharing for out-of-network will be in amount equal to cost-sharing affected members would have paid for the provision of that service in-network. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
We care about Aflac’s policyholders affected by the recent wildfires:
To help provide relief for California policyholders residing in Los Angeles and Ventura Counties affected by the wildfires, Aflac will provide billing leniency for impacted insureds, an extension of filing deadlines for claims and leniency for any other action required under the policy. Aflac will provide a replacement copy of the policy upon request by the policyholder. Affected members should contact Aflac at 800-992-3522 for assistance.
For Network Dental and Vision Members:
This also provides an extension of filing deadlines for claims and leniency for any other action required under the certificate. Affected members are not required to obtain prior approval when accessing appropriate out-of-network providers when in-network providers are unavailable. The cost-sharing for out-of-network will be in amount equal to cost-sharing affected members would have paid for the provision of that service in-network. A replacement copy of the certificate will be provided upon request by the certificate holder. Affected members should contact Aflac Benefit Solutions (formerly Argus Dental and Vision) at 855-819-1873, Option 1, for assistance.
New messages from Aflac |
View Notifications opens a dialog
Close X dismisses the notification alert
Of interest to employers with fewer than 50 full-time equivalent employees
By: Carolyn Smith and John Hickman, Alston & Bird LLP
Tucked at the end of the recently enacted 21st Century Cures Act is a provision that offers certain small employers a new opportunity to help employees purchase individual market major medical coverage and pay for other medical expenses on a tax-free basis. The new arrangements, called Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs), are likely to be attractive to many qualifying small employers, but there are some features that should be looked at carefully before deciding to move forward.
The following FAQs provide useful information regarding QSEHRAs.
The new law allows small employers to provide employees with maximum flexibility and health coverage cost-savings on a pre-tax basis. Employer funds contributed to a QSEHRA are excluded from the employee’s taxable income and payroll taxes and can then be used to pay or reimburse employees for premiums on their own individual major medical insurance coverage, Medicare supplemental insurance (for small employers, e.g., with fewer than 20 employees, exempt from the Medicare secondary requirements), or other unreimbursed medical expenses on a pre-tax basis.
The new law provides savings for employers. Employer funds contributed to a QSEHRA are not subject to payroll (FICA, FUTA, and Medicare) taxes.
The new law protects employers from hefty IRS penalties: Previously, the fine was $100 per day, per employee if employers tried to make health insurance more affordable by directly paying or reimbursing their employees for premiums for individual market major medical insurance or medical expenses.
Employers must meet both of the following two requirements in order to have a QSEHRA:
(1) The employer must be a small employer. For QSEHRA purposes, a small employer is an employer that had less than 50 full-time equivalent employees in the prior calendar year. If the employer is part of a related group of companies, the employees of all the related companies are counted in determining if the employer is a small employer.
(2) The employer cannot offer a group health plan to any employee. QSEHRAs are limited to employers that do not otherwise offer a group health plan. Thus, for example, an employer cannot offer coverage under a group major medical plan to some employees and offer a QSEHRA to others.
Only employer contributions are permitted. Employees cannot contribute to a QSEHRA. Contributions cannot be deducted from employees’ pay.
The maximum allowed contribution for a year is:
These dollar amounts are prorated if an employee is covered under the QSEHRA for less than a full year. For example, if an employee and his or her spouse are covered under a QSEHRA for 6 months of a year, the maximum permitted contribution for that employee for the year would be $5,000. The dollar amounts will be indexed for inflation in the future.
In general, yes, the employer must make a contribution for all employees. However, the following employees can be excluded:
In general, yes; however, variations in contributions are permitted:
The amount of permitted variation in contributions is determined by reference to an individual market major medical policy in the relevant area. The same reference individual market policy must be used for all employees.
No.
Reimbursements that are permitted under a QSEHRA are expenses for medical care as defined under the federal tax laws. This definition includes items such as premiums for individual market major medical coverage, dental coverage, and vision coverage, and out of pocket expenses, such as copayments or deductibles that have not been reimbursed from another source. Premiums paid by the employee on a pre-tax basis for coverage under a group health plan of another employer (e.g., the spouse’s employer) do not qualify for tax-free treatment.
There are three main things employees need to be aware of.
First, in order to get tax-free treatment the employee must have what is called “minimum essential coverage” or MEC. This is the type of coverage that satisfies the individual mandate requirement under health care reform. QSEHRAs are not MEC, so the employee will need to have other coverage, such as individual major medical coverage (which can be paid for through the QSEHRA), coverage through another employer’s plan, or Medicare. If the employee does not have MEC, then payments or reimbursements from the QSEHRA are included in the employee’s income, even if the payment is for a medical expense.
Second, in order to receive a payment from a QSEHRA, the employee will need to provide substantiation of the medical expense. For example, a receipt from a health care provider for an expense not covered by insurance or proof of premiums paid by the employee for individual market insurance.
Third, for employees who purchase individual major medical coverage through a federal or state Marketplace, eligibility for and the amount of any premium tax subsidy available may be impacted if the employee is eligible for a QSEHRA.
Employers are required to notify eligible employees of a QSEHRA 90 days before the beginning of the year in which the employer will fund the arrangement. A special rule applies for 2017 which allows the notice to be provided prior to April 1st for QSEHRAs adopted before that date. The notice must include the amount of the benefit under the QSEHRA and also inform the employee that payments may be taxable if the employee does not have MEC. Employers must also report the permitted benefit on the employee’s Form W-2 for the year (even though it is not taxable).
Employers will also need to adopt a simple health reimbursement arrangement that is compliant with the QSEHRA provisions. In addition, the employer (or its TPA) must have procedures to substantiate the medical expenses that are reimbursed under the QSEHRA.
Note that for insurers, brokers and agents, some states consider individual health insurance paid for by employers to be group health insurance. Thus, insurers, brokers and agents working with small employers should carefully consider state-law implications. Some states have already started to review and change these rules in light of the law, although it may take some time.
The QSEHRA provisions became effective on January 1, 2017. This means that employers may adopt QSEHRAs now; however some planning is involved so it may take a while to make decisions and get a plan up and running.
The information above is provided for general informational purposes and is not provided as tax or legal advice for any person or for any specific situation.
Aflac herein means American Family Life Assurance Company of Columbus and American Family Life Assurance Company of New York.
