How does a plan sponsor determine whether different health benefit arrangements within a single employment-based plan are different benefits options?
The regulations at 45 C.F.R. ยง 149.2 define benefit option as “a particular benefit design, category of benefits, or cost-sharing arrangement offered within an employment-based plan.” In its application, a sponsor must define each benefit option for which it might request program reimbursement. We believe it generally to be true that when a single employment-based plan uses different health insurance issuers or different third-party administrators (TPAs) for different health benefit arrangements, each such issuer or TPA is offering a different benefit design, category of benefits, and/or cost-sharing arrangement from each other. Therefore, in the portion of the application where the sponsor is required to identify each benefit option, the sponsor should identify each different health insurance issuer or TPA through which health benefits are provided or administered. We realize that a given health insurance issuer or TPA might offer multiple discrete benefit designs, categories of benef
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