Health Care Reform, Insurance and Employee Benefits

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Why Can't Employers Pay Directly For Employees' Individual Health Insurance Plans?

Note: None of this should be taken as tax or legal advice

Some companies might want to pay directly for an employee's individual health insurance plans without utilizing an ERISA and HIPAA-compliant defined contribution health plan, but doing so will put the employer out of compliance with federal regulations and increase the employer's (and employee's) tax liability.

There are two major reasons an employer should never pay for its employee's individual health insurance plan:
  1. Federal Compliance Issues - Paying for Individual Health Insurance without a Defined Contribution Plan Causes the Employer to "Endorse" the Individual Health Insurance Plans
  2. Increased Tax Liability -  Paying for Individual Health Insurance without a Defined Contribution Plan Causes the Payments to Become Taxable Income to the Employees
1. Federal Compliance Issues - Paying for Individual Health Insurance without a Defined Contribution Plan Causes the Employer to "Endorse" the Individual Health Insurance Plans

When an employer pays directly for an individual health insurance plan, they effectively endorse each employee's individual insurance plan as part of an employer-sponsored group health benefit offering.  In other words, according to federal law, the employer is treating the individual plan as part of an employee welfare benefit plan regulated by ERISA. Because most individual health insurance plans, do not meet minimum ERISA group plan requirements, the employer is out of compliance.

Separately, an employer is not allowed to know the details of employees HIPAA-protected medical expenses.  Because most individual health insurance costs are based on an employee's health, the health insurance details must be HIPAA protected.  When an employer pays for the individual policy, they can violate HIPAA-privacy requirements because they know the details of a HIPAA-protected employee expense.

The federal government has guidelines for employers who want to contribute to employee's individual health insurance premiums without violating the HIPAA and ERISA regulations. 

An ERISA and HIPAA-compliant defined contribution health plan will ensure compliance with federal law.


2. Increased Tax Liability -  Paying for Individual Health Insurance without a Defined Contribution Plan Causes the Payments to Become Taxable Income to the Employees

If an employer pays for employee's individual health insurance premiums without utilizing a defined contribution health plan, such payments must be reported as taxable income to the employees.

The IRS requires that legal plan documents be established in order for employees to deduct the individual health insurance premiums from taxable income on the annual W-2.
An IRS-compliant defined contribution health plan will ensure the tax deductibility of employee's individual health insurance premiums.
Click here to read more about defined contribution health plans.

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Who we are...
Clarifying Health is a blog about health insurance, health benefits, and everything else related to how Americans pay for medical expenses.

If you have any tips or suggestions for this blog, send an email to blog@ZaneBenefits.com and let us know. We always appreciate feedback

We also run a company called Zane Benefits where we're doing everything we can to help America out of the current healthcare mess.

If you want to learn more about how Zane Benefits helps companies with their benefits, or you're interested in working with us, visit the Zane Benefits website.
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