Maximize Your Group Benefits Investment
Mid-market employers can take strategic steps to get more value from their group medical insurance and employee benefits. Rob DeNinno and Harry Bickel of Precision Benefits Group share tips on using ICRAs and MEC plans to meet ACA requirements, pairing HSAs with high-deductible plans, exploring level-funding or self-funding, and leveraging wellness programs to boost employee engagement.
New Guidance Allows Fertility Services as Excepted Benefits
Federal agencies have issued ACA FAQ 72, allowing employers to offer fertility services—including IVF coverage—as excepted benefits. Benefits may be provided under a separate insurance policy as independent non-coordinated excepted benefits, through an EBHRA with annual limits ($2,200 for 2026), or via EAPs offering coaching or navigation support. Coverage as an excepted benefit does not affect HSA eligibility, but self-funded fertility benefits do not qualify. Employers should review current programs with vendors to ensure compliance and determine if excepted benefit options meet employee needs.
New York 2026 Paid Family Leave Contributions and Benefits
The New York State Department of Financial Services has set the 2026 Paid Family Leave (PFL) contribution rate at 0.432% of weekly wages, an 11.3% increase from 2025. Employee contributions are capped based on the New York Average Weekly Wage ($1,833.63 in 2026), with a maximum annual contribution of $411.91. PFL benefits remain 67% of an employee’s average weekly wage, payable for up to 12 weeks, with a maximum weekly benefit of $1,228.53. Employers should update policies and prepare for these changes starting January 2026.
HSA 2026 Contribution and Eligibility Rules
Health Savings Accounts (HSAs) continue to be a valuable tool for saving pre-tax dollars for medical expenses. Here’s what employers and employees need to know for 2026:
Contribution Limits (2026):
- Self-only coverage: $4,400
- Family coverage: $8,750
- Catch-up contribution (age 55+): $1,000
Eligibility Requirements:
- Must be enrolled in an HSA-eligible high-deductible health plan (HDHP):
- Deductible: $1,700 self-only / $3,400 family
- Out-of-pocket max: $8,500 self-only / $17,000 family
- Cannot be enrolled in a non-HSA health plan or general-purpose FSA
- Cannot be enrolled in Medicare or claimed as a dependent
Additional Rules:
- Contributions can roll over year to year
- Employees enrolled in an HSA-eligible plan as of December 1 can contribute the full year’s maximum (last-month rule) but must maintain coverage for a 12-month testing period
- Overcontributions may trigger a 6% excise tax plus income tax on excess
- HSA funds used for non-qualified expenses before age 65 are subject to a 20% penalty (after 65, only income tax applies)
Employers should ensure HSA contribution limits are properly communicated and integrated with payroll systems for 2026.
Check Medicare Status for 2026
Now is a good time for employers to review group size and determine if employees’ Medicare coverage will be primary or secondary next year. Employees 65+ may delay Part B if still working under a large group plan. Proper planning ensures coverage coordination and avoids unexpected costs when Medicare becomes primary.
Review COBRA Status
Employers should verify COBRA eligibility and status for the new year, as coverage determinations rely on prior-year group size. COBRA allows temporary continuation of group health benefits for eligible employees and dependents during job loss, reduced hours, or other qualifying events, ensuring uninterrupted coverage while maintaining compliance with notice and premium rules.
Compliance Corner! IRS Finalizes 2025 ACA Reporting Instructions
The IRS has issued its final instructions for 2025 ACA reporting under Sections 6055 and 6056, confirming no major changes from prior years. Forms 1094-B/1095-B will again be used by employers providing minimum essential coverage (MEC), while ALEs will use Forms 1094-C/1095-C to report offers of coverage—and to satisfy both 6055 and 6056 requirements if self-insured.
The IRS also reaffirmed that employers do not need to automatically furnish Forms 1095-B or 1095-C. Instead, they may post a website notice explaining how individuals can request a copy. The notice must be easy to find, posted by March 2, 2026, remain online through October 15, 2026, and employers must respond to requests within 30 days.
Action Step: Employers should review the finalized forms and prepare for electronic filing, using the IRS AIR Program or a third-party vendor.