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To protect both buyers and sellers, life settlements and viaticals are well-regulated by statute in 45 of the 50 states.

“,”

Within the context of the regulatory framework, it is possible to divide the parties to a life settlement transaction into three groups: the seller’s side, the buyer’s side and the intermediaries.

“,”

In most states, there are licensing requirements for most of the parties.

“,”

Seller’s Side Parties: Owner/Insured, Producer, Life Settlement Broker

“,”

The seller’s side, of course, begins with a policy owner who no longer wants, needs, or can afford a life insurance policy.

“,”

Where the policy owner and insured are not the same, as in a business-owned or trust-owned arrangement, both must agree to and be parties to the transaction.

“,”

Typically, the producer is the policy owner’s life insurance agent.

“,”

Unlike many life insurance transactions, the producer represents the policy owner only, is legally considered a life settlement broker, and acts in a fiduciary capacity.

“,”

Satisfying the fiduciary obligation means, in part, obtaining the highest price that is reasonably possible.

“,”

To accomplish this, the policy should be exposed to as many potential buyers as is feasible.

“,”

Because most insurance agents don’t handle many life settlements, they usually rely on a trusted life settlement broker, working full-time in the business and also in a fiduciary capacity, for their expertise to properly shop the policy to a good number of buyers to get the most out of the policy for the seller.

“,”

Buyer’s Side Parties: Providers, Investment Institutions and Investors

“,”

The provider acts as a buyer’s broker, but just the opposite of the settlement broker; the provider acts solely on behalf of the buyer, with the mission to obtain policies as cheaply as possible.

“,”

The provider is the primary contact for the seller’s settlement broker.

“,”

A provider acts as an aggregator of policies on behalf of one or more investment institutions.

“,”

Providers acquire policies under several different arrangements.

“,”

Frequently, the provider has an agreement with an investment institution to acquire policies that meet certain parameters.

“,”

Other times, the provider identifies attractive policies for purchase and presents them to institutions that are looking to acquire policies.

“,”

The investment institution might be a bank, investment bank, mutual fund, pension fund, hedge fund, insurance company, etc.

“,”

Although the investment institution may be buying on its own behalf, frequently it is representing a group of investors, like the shareholders of a mutual fund.

“,”

Occasionally, much like a builder constructing a home \”on spec,\” a provider might acquire an attractive policy on its own with the hope of reselling it to an investment institution at a future time.

“,”

Finally, some providers may acquire policies for their own account.

“,”

The provider, on the buyer’s behalf, does comprehensive due diligence on any policy it has decided to purchase, which includes confirming ownership, policy values, eliminating the possibility of fraud on the policy’s origination, assuring that the policy has not lapsed and validating information provided on the life settlement questionnaire completed by the seller/insured.

“,”

It is also customary for the investment institution to do its own separate review of the policy.

“,”

This review is done only after the provider has signed off. Sometimes additional issues come up, even though the provider has approved the transaction.

“,”

Intermediaries: Life Expectancy Company, Insurance Company, Escrow Agent

“,”

Intermediaries also play significant roles in the transaction.

“,”

Life expectancy companies are independent third parties comprised of doctors, nurses, actuaries, and underwriters that give appraisals of an insured’s life expectancy using medical records.

“,”

No physical examination is required.

“,”

Investment institutions frequently require at least one or two of these independent appraisals before they will allow a provider to make an offer on a policy.

“,”

A life settlement is typically, but not always, transacted using the services of an escrow agent (a bank, trust company, or other entity) that holds the policy and the sales proceeds while the closing takes place.

“,”

The other intermediary, the insurance company, is asked to confirm various details about the policy, often including premium and ownership history.

“,”

Policy values and other details are obtained from the insurer using a form called a V.O.C. (verification of coverage).

“,”

Once the closing takes place, the insurance company is asked to provide confirmation that the ownership and beneficiary of the policy have been changed.

“,”

These final steps can take several days to a few weeks, and when completed, the escrow company finally releases the proceeds to the seller.

“,”

As you can see, a life settlement is a complex, highly-regulated transaction that involves lots of due diligence, loads of records and paperwork and, as a result, takes a long time – about 3 to 4 months.

“,”

All in all, many hands play a part in the transaction, which can sometimes make it tedious and time-consuming.

“,”

But the additional value a seller receives for a policy they were about to lapse or surrender can make it very worthwhile.

“,”

Bottom line: If a policy is about to be lapsed or surrendered, you owe it to the policyowner to explore the option of a life settlement.

“,”

Remember, it can’t hurt to try — it can only hurt not to.

“,”

[email protected]\”>Robin S. Weinberger, CLU, ChFC, CLTC, is the director of national accounts for Life Insurance Settlements Inc. She has been a general agent and director of national accounts for Connecticut Mutual and vice president of marketing for Sun Life of Canada.

“,”

[email protected]\”>Peter N. Katz, JD, CLU, ChFC, RICP, is a life settlement broker and co-director of national accounts with Life Insurance Settlements. He is also a consultant specializing in life insurance advanced sales illustrations, and he has served as an advanced markets attorney and in product development.

“,”

Ramcreative/Adobe Stock

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\n
\nEditor’s Note: In response to the COVID-19 pandemic, the CARES Act allowed HDHPs to cover the cost of telehealth services without cost to participants before the HDHP deductible is satisfied. HDHPs providing telehealth coverage do not jeopardize their status as HDHPs. Plan members similarly retained the right to fund HSAs after taking advantage of cost-free telehealth services. The Consolidated Appropriations Act of 2022 (CAA 2022) extended the CARES Act relief so that HDHPs could provide first-dollar telehealth services from April 2022 through December 2022 (regardless of the plan year) without jeopardizing HDHP status. The remote services did not have to be related to COVID-19 or preventative in nature to qualify. Plans and participants should note that if the HDHP is a calendar year plan, the usual rules regarding the plan deductible applied between January 2022 and March 2022. The 2023 year-end omnibus spending bill extended this relief again, although it should be noted that instead of beginning on January 1, 2023, the relief is effective for plan years beginning after December 31, 2022 and before January 1, 2025 (that means a gap existed for non-calendar year plans from January 1, 2023 until the date that the plan year began). The ability to provide pre-deductible remote health services is optional for employers. At the last minute, a provision that would have extended telehealth coverage was stripped from the 2025 American Relief Act that was signed into law late in December of 2024.  As a result, as of January 1, 2025 HDHPs are no longer permitted to reimburse telehealth and remote healthcare services on a pre-deductible basis to participants with health savings accounts (HSAs).  Note that extending HDHP-related telehealth flexibilities was not included in the Continuing Resolution passed in March of 2025.
\n
\nIn Notice 2023-37, the IRS confirmed that that the special rules allowing pre-deductible coverage of COVID-related testing and treatment will end as of December 31, 2024. The guidance also states that the preventive care safe harbor does not include COVID-19 testing as of July 24, 2023.
\n
\nUnder the Inflation Reduction Act, HDHPs will be permitted to cover insulin prior to the participant satisfying the plan deductible effective for tax years beginning after December 31, 2022. This insulin coverage will not adversely affect a participant’s eligibility to contribute to an HSA. Going forward, HDHPs will be permitted to cover selected insulin products before the deductible is satisfied regardless of whether the participant has been diagnosed with diabetes. “Selected insulin products” is defined to include any dosage form, including vials, pumps, or inhalers of any type of insulin.
\n
\nThe requirements for a high deductible health plan (HDHP) differ depending on whether individual or family coverage is provided. In this context, family coverage includes any coverage other than self-only coverage.1
\n
\nFor 2026, an HDHP is a plan with an annual deductible of not less than $1,700 for self-only coverage ($1,650 in 2025). The family coverage deductible limit is $3,400 in 2026 ($3,300 in 2025). Annual out-of-pocket expenses for an HDHP cannot exceed $8,500 in 2026 ($8,300 in 2025) for self-only coverage. For family coverage, the annual out-of-pocket expense limitation is increased to $17,000 in 2026 ($16,600 in 2025).2 These annual deductible amounts and out-of-pocket expense amounts are adjusted annually for cost of living.3 Increases are made in multiples of $50.
\n
\nDeductible limits for HDHPs are based on a 12-month period. If a plan deductible may be satisfied over a period longer than twelve months, the minimum annual deductible under IRC Section 223(c)(2)(A) must be increased on a pro-rata basis to take the longer period into account.4
\n
\nAn HDHP may impose a reasonable lifetime limit on benefits provided under the plan as long as the lifetime limit on benefits is not designed to circumvent the maximum annual out-of-pocket limitation.5 A plan with no limitation on out-of-pocket expenses, either by design or by its express terms, does not qualify as a high deductible health plan.6 Beginning in 2016, the CMS has provided guidance stating that the self-only limitation applies to each individual, regardless of whether the individual is enrolled in self-only or family coverage. This is the case even if the limitation for self-only coverage is below the family deductible limit. Family coverage can continue to be offered as long as the self-only limitation is applied separately to each individual under the plan.7
\n
\nAn HDHP may provide preventive care coverage without application of the annual deductible.8 The IRS has provided guidance and safe harbor guidelines on what constitutes preventive care. Pursuant to the IRS safe harbor, preventive care includes, but is not limited to, periodic check-ups, routine prenatal and well-child care, immunizations, tobacco cessation programs, obesity weight-loss programs, and various health screening services. Preventive care may include drugs or medications taken to prevent the occurrence or reoccurrence of a disease that is not currently present.9
\n
\n


\n
\nPlanning Point: In 2020, the IRS announced that high deductible health plans can cover costs associated with COVID-19. HDHPs can cover coronavirus-related testing and equipment needed to treat the virus. Generally, HDHPs are prohibited from covering certain non-specified expenses before the covered individual’s deductible has been met. Certain preventative care expenses are excepted from this rule. HDHPs will not jeopardize their status if they pay coronavirus-related expenses before the insured has met the deductible, and the insured will remain HSA-eligible. The guidance applies only to HSA-eligible HDHPs. Participants in HDHPs should pay attention to IRS guidance in specific future situations.10
\n
\n


\n
\nNotice 2013-57 clarifies that a health plan will not fail to qualify as an HDHP merely because it provides preventative services under the ACA without requiring a deductible.11
\n
\nFor months before January 1, 2006, a health plan would not fail to qualify as an HDHP solely based upon its compliance with state health insurance laws that mandate coverage without regard to a deductible or before the high deductible is satisfied.12 This transition relief only applied to disqualifying benefits mandated by state laws that were in effect on January 1, 2004. This relief extended to non-calendar year health plans with benefit periods of twelve months or less that began before January 1, 2006.13
\n
\nOut-of-pocket expenses include deductibles, co-payments, and other amounts that a participant must pay for covered benefits. Premiums are not considered out-of-pocket expenses.14
\n
\n

\n

\n
\n


\n
\n1.      IRC § 223(c)(5).
\n
\n2.      Rev. Proc. 2024-25, Rev. Proc. 2025-19.
\n
\n3.      IRC § 223(g).
\n
\n4.      Notice 2004-50, 2004-2 CB 196, A-24.
\n
\n5.      Notice 2004-50, 2004-2 CB 196, A-14.
\n
\n6.     Notice 2004-50, 2004-2 CB 196, A-17.
\n
\n7.      See DOL FAQ, available at www.dol.gov/ebsa/faqs/faq-aca27.html.
\n
\n8.      IRC § 223(c)(2)(C).
\n
\n9.      Notice 2004-50, 2004-2 CB 196, A-27; Notice 2004-23, 2004-1 CB 725.
\n
\n10.    Notice 2020-15.
\n
\n11.    2013 IRB LEXIS 465.
\n
\n12.    Notice 2004-43, 2004-2 CB 10
\n
\n13.    Notice 2005-83, 2005-2 CB 1075.
\n
\n14.    Notice 2004-2, 2004-1 CB 269, A-3; Notice 96-53, 1996-2 CB 219, A-4.
\n
\n

“,”breadcrumb”:[]},{“publication”:”Tax Facts”,”baseDomain”:”www.thinkadvisor.com/tax-facts”,”presentedBy”:””,”uri”:”/tax-facts/2025/04/08/3640-remote-workers-eligible-for-leave-under-the-family-and-medical-leave-act-fmla/”,”title”:”3640.03 / Are remote workers eligible for leave under the Family and Medical Leave Act (FMLA)?”,”byline”:”John Manganaro”,”kicker”:””,”timeToRead”:”11 minute”,”authors”:[{“name”:”John Manganaro”,”webUrl”:”/author/profile/john-manganaro/”}],”kickerNode”:[],”categories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”allCategories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”prettyDate”:”April 08, 2025″,”pubDate”:”2025-04-08 08:20:36″,”prettyModifiedDate”:”February 17, 2025 at 01:29 PM”,”readtime”:”11″,”primaryCategory”:{“channelName”:””,”sectionName”:””,”uri”:””},”image”:{“uri”:” Note: The DOL has released a bulletin clarifying its position on employer obligations when determining whether a remote employee is eligible for FMLA leave. Employers must generally provide FMLA leave if they employ at least 50 employees within a 75-mile radius. When employees work from home, the worksite for FMLA eligibility purposes is the office to which they report or from which their assignments are generated. So, if at least 50 employees (including remote workers) are employed within 75 miles of the office to which the employee reports or from which assignments are generated, the remote employee is eligible for FMLA leave (even if no other employees are employed within 75 miles of the employee’s remote office).
\n
\nThe Family Medical Leave Act (FMLA) is a federal law that gives covered employees the right to 12 weeks of unpaid leave each year for any covered reason. While it may seem that employees who are not required to report to a physical location would be less likely to need time off to handle family and medical issues, the reality is that many are equally unable to work while a covered reason is ongoing. Employers with remote workers should be aware that they may be required to grant an employee’s request for unpaid time off even if the employee does not report to a physical worksite.
\n
\nCovered reasons under the FMLA include:
\n

    \n \t

  • For the birth and care of the newborn child of an employee,
  • \n \t

  • For placement with the employee of a child for adoption or foster care,
  • \n \t

  • To care for an immediate family member (spouse, child, or parent) with a serious health condition, or
  • \n \t

  • For medical leave if the employee is unable to work because of a serious health condition.
  • \n

\nPlanning Point: Note that the Sixth Circuit2 has ruled that employers may be required to grant FMLA leave when an employee must care for an adult sibling.  The issue to consider is whether an \”in loco parentis\” relationship exists between the two parties.  Factors listed by the Sixth Circuit as relevant to the determination include whether the person (1) is in close physical proximity to the adult, (2) assumes responsibility for supporting the adult, (3) exercises control over the adult or has rights over them and (4) shares a close emotional or familial bond (similar to that of an adult child).  While the case is limited to the Sixth Circuit, it makes clear that employers should carefully consider the facts before denying a request for FMLA leave.
\n
\nNot all employees are eligible for unpaid FLMA leave and not all employers are subject to the law. Employees are eligible for FMLA leave if they:
\n

    \n \t

  • Have worked for their employer at least 12 months,
  • \n \t

  • Have worked at least 1,250 hours over the 12 months preceding the request for FMLA leave, and
  • \n \t

  • Work at a location where the company employs 50 or more employees within a 75-miles radius.3
  • \n

\nThis law may create unanticipated complications for employers who permit employees to work on a remote basis. In some cases, remote workers report to an office that is in their same geographic location. However, it is becoming more common for workers to report to managers and supervisors who are also working remotely from different locations.
\n
\nWhen a remote employee requests FMLA leave, questions involving whether the employee is entitled to the FMLA leave often arise. The issue in these cases is whether the employer has at least 50 employees within a 75-mile radius of the remote employee’s workplace.
\n
\n


\n
\nPlanning Point: Employers who continue to permit remote work should be aware that existing and evolving state and local paid leave laws may apply. For example, Illinois has enacted a new paid bereavement act that became effective January 1, 2023. Under the law, the same requirements that apply in determining FMLA eligibility apply. An employee is eligible to take leave if the employee has worked for a covered employer for at least 1,250 hours within the previous 12 months, and also works at a location where the employer has 50 or more employees within a 75-mile radius.4
\n
\nThe Healthy Delaware Families Act provides up to 12 weeks of paid family and medical leave beginning in 2026 (employers will be required to begin implementing payroll deductions as of January 1, 2025). The law is similar to the federal FMLA, but applies to smaller employers, so that any employer with 10 or more employees who report to a Delaware worksite will be required to comply. It remains to be seen whether the law will apply to employers with ten or more employees who work remotely from Delaware.5
\n
\n


\n
\nA Texas court6 recently refused to grant a motion to dismiss a case where a company denied an employee’s request for FMLA leave. The company claimed they did not have 50 employees within a 75-mile radius in Texas. The employer’s headquarters was in Ohio, yet the employee was working remotely from Texas (the employee’s supervisor was also working remotely from Texas). The employee claimed that her “worksite” for FMLA purposes was Ohio, where the company was headquartered.
\n
\nTo have won summary judgement, the court found the company must establish that Ohio was not:
\n

    \n \t

  • The employee’s “home base”,
  • \n \t

  • The site that assigns the employee’s work, or
  • \n \t

  • The site to which the employee reports
  • \n

\nThe court found that the term “worksite” had to be a location where the employee was physically present and that it referred not to the physical base of the employer’s operations, but to the physical base of the employee. The employee in this case was never physically present in Ohio, so she could not prove Ohio was her home base. However, the court found an issue of fact with respect to where the employee’s assignments were created and originated. The court found that this location is the site from which the employee’s day-to-day instructions were provided and that there was an issue of fact as to whether the assignments originated at the Ohio headquarters.
\n
\nThe Texas case settled privately before the court provided a final resolution of the issues. The case does, however, point to the fact-intensive nature of the inquiry as to whether any given remote employee may be eligible for FMLA leave. Employers should be aware that is possible that they may be required to provide FMLA leave even if they do not have 50 employees within a 75-mile radius of the remote employee’s physical location. That may be the case if the employee can establish that assignments were created or originated from the employer’s central location or if the employee sends assignments to a central location where they are evaluated (i.e., if the employee’s reporting worksite is where the employer has at least 50 employees).
\n”,”breadcrumb”:[]},{“publication”:”Tax Facts”,”baseDomain”:”www.thinkadvisor.com/tax-facts”,”presentedBy”:””,”uri”:”/tax-facts/2025/01/08/8791-is-the-value-of-employer-provided-coverage-under-accident-or-health-insurance-taxable-income-to-an-employee-when-the-coverage-is-provided-for-the-employees-spouse-children-or-dependent/”,”title”:”8791 / Is the value of employer-provided coverage under accident or health insurance taxable income to an employee when the coverage is provided for the employee’s spouse, children or dependents?”,”byline”:”John Manganaro”,”kicker”:””,”timeToRead”:”11 minute”,”authors”:[{“name”:”John Manganaro”,”webUrl”:”/author/profile/john-manganaro/”}],”kickerNode”:[],”categories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”allCategories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”prettyDate”:”January 08, 2025″,”pubDate”:”2025-01-08 08:55:31″,”prettyModifiedDate”:”December 30, 2024 at 01:29 PM”,”readtime”:”11″,”primaryCategory”:{“channelName”:””,”sectionName”:””,”uri”:””},”image”:{“uri”:”https://images.thinkadvisor.com/contrib/content/uploads/sites/415/2021/12/Curtis_Scott_Raymond-James_640x640.jpg”,”width”:”640″,”height”:”640″},”summary”:”

Employer-provided accident and health coverage for an employee and the employee’s spouse and dependents, both before and after retirement, and for the employee’s surviving spouse and dependents after the employee’s death, does not have to be included in gross income by the active or retired employee or, after the employee’s death, by the employee’s survivors.1

\n

\n
\nIn 2010, the Affordable Care Act (“ACA”), expanded the exclusion from gross income for amounts expended on medical care to include employer-provided health coverage for any adult child of the taxpayer if the adult child has not attained the age of 27 as of the end of the taxable year. The IRS has released guidance indicating that the exclusion applies regardless of whether the adult child is eligible to be claimed as a dependent for tax purposes.2
\n
\n

\n

\n
\n


\n
\n1.  Rev. Rul. 82-196, 1982-2 CB 53; GCM 38917 (11-17-82).
\n
\n2.  IRC § 105(b), as amended by the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010. Notice 2010-38, 2010-20 IRB 682.
\n
\n

“,”breadcrumb”:[]},{“publication”:”Tax Facts”,”baseDomain”:”www.thinkadvisor.com/tax-facts”,”presentedBy”:””,”uri”:”/tax-facts/2025/01/08/3757-auto-enrollment-rules-apply-to-401k-plans-starting-in025/”,”title”:”3757.01 / What auto-enrollment rules apply to 401(k) plans starting in 2025?”,”byline”:”John Manganaro”,”kicker”:””,”timeToRead”:”11 minute”,”authors”:[{“name”:”John Manganaro”,”webUrl”:”/author/profile/john-manganaro/”}],”kickerNode”:[],”categories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”allCategories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”prettyDate”:”January 08, 2025″,”pubDate”:”2025-01-08 08:47:26″,”prettyModifiedDate”:”January 13, 2025 at 01:29 PM”,”readtime”:”11″,”primaryCategory”:{“channelName”:””,”sectionName”:””,”uri”:””},”image”:{“uri”:”https://images.thinkadvisor.com/contrib/content/uploads/sites/415/2021/12/Curtis_Scott_Raymond-James_640x640.jpg”,”width”:”640″,”height”:”640″},”summary”:”Starting with the 2025 tax year, the SECURE Act 2.0 requires employers that establish new 401(k) or 403(b) plans to auto-enroll employees in the savings plans.  
\n
\nThe minimum auto-enrollment contribution rate will range from 3% to 10%.  Each year, the minimum contribution rate will then increase by 1% until the rate reaches 15%.  
\n
\nThe IRS has released proposed regs confirming that there is no delay–meaning that new plans are currently subject to the auto-enrollment rule starting in 2025.  The rules contained in the proposed regulations will be effective six months after the date that final regulations are published.  In the meantime, a reasonable, good faith interpretation of the law is required.   
\n
\nThe regulations clarify that there is no provision that excludes any class of participant from auto-enrollment, meaning that long-term part-time employees must also be automatically enrolled if they are otherwise eligible and the plan is subject to the rule.  Participants with an affirmative election to opt out of auto-enrollment on file do not have to be automatically enrolled in the plan.  The preamble to the proposed regulations clarifies that when plans did not automatically enroll participants who were already participating in the plan, yet did not make an affirmative election, they must automatically enroll the participant by the first plan year when final regulations are effective (presumably, 2027).  The participant’s default deferral rate must be calculated as though they had been auto-enrolled since 2025.  
\n
\nUnder the law, small business employers who normally employ 10 or fewer employees and new businesses are exempt from the auto-enrollment requirement.  The proposed regulations clarify that self-employed individuals, independent contractors and corporate directors do not count toward the  10-employee threshold (only common law employees must be included).“,”breadcrumb”:[]},{“publication”:”Tax Facts”,”baseDomain”:”www.thinkadvisor.com/tax-facts”,”presentedBy”:””,”uri”:”/tax-facts/2025/01/08/3511-what-are-the-payment-options-that-must-be-made-available-to-employees-on-fmla-leave/”,”title”:”3511 / What are the payment options that must be made available to employees on FMLA leave?”,”byline”:”John Manganaro”,”kicker”:””,”timeToRead”:”11 minute”,”authors”:[{“name”:”John Manganaro”,”webUrl”:”/author/profile/john-manganaro/”}],”kickerNode”:[],”categories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”allCategories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”prettyDate”:”January 08, 2025″,”pubDate”:”2025-01-08 08:35:59″,”prettyModifiedDate”:”January 27, 2025 at 01:29 PM”,”readtime”:”11″,”primaryCategory”:{“channelName”:””,”sectionName”:””,”uri”:””},”image”:{“uri”:”https://images.thinkadvisor.com/contrib/content/uploads/sites/415/2021/12/Curtis_Scott_Raymond-James_640x640.jpg”,”width”:”640″,”height”:”640″},”summary”:”

Editor’s Note: The 2017 Tax Act created a new tax credit for employers that provide paid family and medical leave to employees. See Q for details.

\n
\nWhatever payment options are available to employees on non-FMLA leave must also be made available to employees on FMLA leave.1 Employers must continue to contribute the same share of the premium cost that they were paying prior to the FMLA leave. Employees who choose to continue health coverage during an FMLA leave must pay the same portion of the cost of such coverage that they paid while actively at work.2 Employers may choose to waive this requirement, provided that they do so on a nondiscriminatory basis.
\n
\nA cafeteria plan may generally offer employees on unpaid FMLA leave up to three options for paying for their health coverage under a cafeteria plan or health FSA.3 These rules do not apply where paid leave is substituted for unpaid FMLA leave, in which case the employer must offer the payment method normally available during other types of paid leave.4
\n
\nAny of the three payment options discussed below may generally be made on a pre-tax salary reduction basis to the extent that the employee on FMLA leave has any taxable compensation (including the cash value of unused sick days or vacation days). A restriction applies when an employee’s FMLA leave spans two plan years. In such a case, the plan may not operate in a manner that would allow employees on FMLA leave to defer compensation from one plan year to a subsequent plan year.5 Any of the three payment options may also be made on an after-tax basis.
\n
\nA cafeteria plan may offer one or more of the following payment options, or a combination of these options, to an employee who continues group health plan coverage (including a health FSA) while on unpaid FMLA leave; provided that the payment options for employees on FMLA leave are offered on terms at least as favorable as those offered to employees not on FMLA leave.
\n
\n“Pre-pay” Option. Under this option, the employer allows the employee to pay the amounts due for the FMLA leave period prior to the commencement of FMLA leave.6 Under no circumstances may the pre-pay option be the only option offered to employees on FMLA leave. The employer may offer the pre-pay option to employees on FMLA leave even if such option is not offered to employees on other types of unpaid leave.7
\n
\n“Pay-as-you-go” Option. Under this option, employees pay their portion of the health care costs according to a payment schedule. This schedule may be (1) the same as the schedule that would be in effect if they were not on FMLA leave; (2) the same schedule upon which COBRA payments would be made (see Q 368); (3) the same schedule as applies to other employees on other, unpaid non-FMLA leave; or (4) any other schedule that (a) the employee and the employer voluntarily agree upon and (b) is not inconsistent with the regulations. The employer may not offer employees on FMLA leave only the pre-pay option and the catch-up option if the pay- as-you-go option is offered to employees on unpaid non-FMLA leave.8
\n
\n“Catch-up” Option. Under this option, an employer continues providing coverage during FMLA leave. The catch-up option may be the sole option offered by the employer only if it is the sole option offered to employees on unpaid non-FMLA leave.9
\n
\nIn general, the employer and the employee must agree in advance that (1) coverage will continue during the FMLA leave, (2) the employer assumes responsibility for the payment of employee’s portion of the health care costs during the FMLA leave, and (3) the employee will repay such amounts when he returns from FMLA leave.
\n
\nPlanning Point: Many states have developed their own state-level paid family and medical leave programs (PFML programs).  That raised questions over how these programs are treated for federal and employment tax purposes.  The IRS clarified that employer contributions to state PFML programs are excluded from employees’ income and not subject to FICA, FUTA or federal tax withholding.  Employer contributions are treated as after-tax contributions.  However, if the employer makes the employee’s required contribution on their behalf, that contribution is included in the employee’s compensation and subject to FICA, FUTA and federal tax withholding.  When employees receive benefits under state PFML programs, they are treated as compensation to the extent they are designed to replace the employee’s wages (unless the amounts qualify for exclusion based on the rules governing accident and health plans, meaning that they’re paid for medical reasons).  Importantly, the tax treatment of benefits will vary depending on whether they are paid for family or medical reasons.10
\n
\nEmployer’s Right of Recoupment. An employer is not required to continue the coverage of an employee on FMLA leave who fails to make the required premium payments when due. But if the employer does continue coverage, the employer is entitled to recoup the missed payments under the “catch-up” option, without the employee’s prior agreement.11
\n
\nHealth FSAs. Health FSAs are generally subject to the same payment rules as traditional cafeteria plans.12 The regulations do not make clear whether the employer’s right of recoupment, discussed above, applies to health FSAs. If so, it would appear to represent a significant departure from the general risk-shifting rule applicable to health FSAs.
\n
\n
\n
\n


\n
\n1.       Treas. Reg. § 1.125-3, A-3(b).
\n
\n2.       Treas. Reg. § 1.125-3, A-2.
\n
\n3.       Treas. Reg. § 1.125-3, A-3(a).
\n
\n4.       Treas. Reg. § 1.125-3, A-4.
\n
\n5.       Treas. Reg. § 1.125-3, A-5.
\n
\n6.       Treas. Reg. § 1.125-3(a)(1)(i).
\n
\n7.       Treas. Reg. § 1.125-3, A-3(b)(1).
\n
\n8.       Treas. Reg. § 1.125-3, A-3.
\n
\n9.       Treas. Reg. § 1.125-3, A-3.
\n
\n10.      Rev. Rul. 2025-4.
\n
\n11.     Treas. Reg. § 1.125-3, A-3(a).
\n
\n12.     Treas. Reg. § 1.125-3, A-6(a)(1).
\n
\n

\n”,”breadcrumb”:[]},{“publication”:”Tax Facts”,”baseDomain”:”www.thinkadvisor.com/tax-facts”,”presentedBy”:””,”uri”:”/tax-facts/2025/01/08/3797-a-401k-plan-sponsor-distribute-a-former-participants-account-balance-without-consent-after-the-participant-separates-from-service/”,”title”:”3797.01 / Can a 401(k) plan sponsor distribute a former participant’s account balance without consent after the participant separates from service?”,”byline”:”John Manganaro”,”kicker”:””,”timeToRead”:”11 minute”,”authors”:[{“name”:”John Manganaro”,”webUrl”:”/author/profile/john-manganaro/”}],”kickerNode”:[],”categories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”allCategories”:[{“channelName”:”Recently Updated Q&As”,”sectionName”:””,”slug”:”recently-updated-q-and-as-tf”,”channelUri”:””}],”prettyDate”:”January 08, 2025″,”pubDate”:”2025-01-08 08:29:42″,”prettyModifiedDate”:”February 03, 2025 at 01:29 PM”,”readtime”:”11″,”primaryCategory”:{“channelName”:””,”sectionName”:””,”uri”:””},”image”:{“uri”:” SECURE 2.0, employer-sponsored plans can elect to include an automatic cash-out provision to distribute small retirement plan balances when the employee separates from service.
\n
\nQualified plans are not required to contain cash-out provisions that provide for immediate distribution of a participant’s benefits without the participant’s consent upon termination of participation if the value of the benefit is less than the statutory limit (under SECURE 2.0, $7,000 starting in 2024). Plans do have the option of adding a cash-out threshold if the threshold is not more than $7,000. If the threshold established is less than $1,000, the plan can merely cut a check for the participant’s balance.
\n
\nIf the account balance threshold established by the employer is $1,000 or higher, the plan must automatically roll the amounts over into an IRA in the former employee’s name (unless the former employee makes an affirmative election to receive the amount directly or have the amounts rolled over into another eligible retirement plan).
\n
\nThese transfers, known as \”auto-portability,\” involve three elements: (1) the original 401(k) plan that mandates these distributions (the \”transfer out\” plan), (2) a default IRA (in the participant’s name) that receives the distributed amount as a rollover and (3) a \”transfer-in\” plan sponsored by a new employer, which receives the rollover from the default IRA (only if it is determined that the participant has a new account with a new employer).
\n
\nUnder the DOL’s proposed regulations, plan sponsors will be required to search recordkeepers’ systems to determine whether the participant has established a new retirement account with a new employer.
\n
\nThe proposal would also impose regulations on any service providers associated with the auto-portability rules. While these service providers can rely on a new prohibited transaction exemption, they must also acknowledge their fiduciary status with respect to the IRA receiving the rollover distribution (in writing). Further, their fees must be reasonable and approved in writing by the employer-sponsored plan fiduciary.
\n
\nRelatedly, the Department of Labor has begun efforts to collect information to create the “missing participant database” mandated by the 2022 SECURE Act.  As of November 2024, the DOL is requesting that plans provide the name and social security number of participants who separated from service, are owed a benefit from a plan, and are age 65 or older. They are also requesting current contact information for the plan administrator so that individuals meeting these characteristics may contact the plan administrator.  The information collection completely voluntary.
\n
\nThe DOL has announced that a retirement plan sponsor will not violate their fiduciary responsibilities with respect to transfers of small retirement balances of missing plan participants if certain conditions are met.  The plan can transfer retirement benefit payments owed to a missing participant to a state unclaimed property fund if the present value of the participant’s or beneficiary’s vested benefit (including rollover contributions but excluding outstanding loan balances) does not exceed $1,000.  The plan sponsor must also determine that the state unclaimed property fund is a prudent destination for the funds and that the plan itself has implemented a prudent program to locate missing participants (consistent with DOL best practices guidance) yet has still been unable to locate the participant.  The transfer must be made to the unclaimed property fund in the state of the individual’s last known address and the unclaimed property fund must qualify as an eligible state fund (based on DOL criteria).  The plan must also include in its summary plan description disclosures of the fact that the funds will be transferred to an eligible state fund and the unclaimed property fund’s name, address, and phone number for further contact.1
\n

\n
\n


\n
\n1. DOL FAB 2025-1.
\n
\n

“,”breadcrumb”:[]}]},”youmightlike”:[{“uri”:”/2025/07/24/one-big-beautiful-estate-planning-dilemma/”,”title”:”One Big Beautiful Estate Planning Dilemma”,”byline”:”Robin S. Weinberger and Peter N. Katz”,”prettyDate”:”July 24, 2025″,”readtime”:”4″,”image”:{“uri”:” exemption could stay high forever. That changes the planning math.”},{“uri”:”/2025/07/21/the-secs-fiduciary-interpretation-and-life-settlements/”,”title”:”The SEC’s Fiduciary Interpretation and Life Settlements”,”byline”:”Robin S. Weinberger and Peter N. Katz”,”prettyDate”:”July 21, 2025″,”readtime”:”3″,”image”:{“uri”:” authors suggest that the best interest standard applies to clients’ in-force life insurance policies.”},{“uri”:”/2025/07/09/abacus-sues-coventry-over-life-insurance-policy-valuation-conflict/”,”title”:”Abacus Sues Coventry Over Life Insurance Policy Valuation Conflict”,”byline”:”Allison Bell”,”prettyDate”:”July 09, 2025″,”readtime”:”3″,”image”:{“uri”:” publicly traded life settlement firm says its competitor has worked to ruin its reputation. “},{“uri”:”/2025/06/17/can-a-life-settlement-be-the-missing-link/”,”title”:”Can a Life Settlement be the Missing Link?”,”byline”:”Robin S. Weinberger and Peter N. Katz”,”prettyDate”:”June 17, 2025″,”readtime”:”3″,”image”:{“uri”:” life policies and whole life policies have some similarities, but the differences matter.”},{“uri”:”/2025/03/31/borderline-life-settlement-cases-it-cant-hurt-to-try/”,”title”:”Borderline Life Settlement Cases: It Can’t Hurt to Try”,”byline”:”Robin S. Weinberger and Peter N. 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