February, 2011 | Employee Health Benefits and Insurance Blog

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Can I Self Administer an HRA (Health Reimbursement Arrangement)?

 
compliance

Last week, Renee Kuhs, a compliance attorney at HNI Risk Services, wrote an interesting
article entlited, "Are You Really Saving Money by Self Administering Your HRA?" (see excerpt below). 

Small Business Tax Credit - HRA Distributions for Individual Health Insurance Premiums

 
small business tax creditsThis should not be taken as legal or tax advice.

The recently passed Affordable Care Act created a new tax credit for eligible small companies who provide health care to their employees.

In a previous post regarding how the small employer health care tax credit works, several readers asked if employer-sponsored HRAs (like ZaneHRA) would qualify for the tax credit.

Background

Many companies establish health reimbursement arrangements (HRAs) that allow employees to reimburse their individual health insurance premiums with tax-free dollars. If a company meets the size and annual wage requirements, and contributes at least 50% of employees' health insurance, then it may be eligible for the health care tax credit.

This post discusses how a company that sponsors an HRA described above might claim the tax credit.

HRA Contributions Do Not Qualify for the Tax Credit, but HRA Distributions May

The IRS recently issued IRS Notice 2010-82 to help companies determine if they qualify for the tax credit. Notice 2010-82 clearly states that HRA contributions do not qualify for the tax credit:

“...employer contributions to HRAs... are not taken into account for purposes of the credit.” 

However, it appears that HRA distributions qualify for the tax credit if the employer follows the guidelines outlined in Notice 2010-82 for “Employers Offering More Than One Plan”.

Important Note: In order to take the tax credit for employer contributions to multiple individual health plans, the employer must endorse specific individual policies as part of an employer-sponsored plan. As explained here, payment/endorsement of individual health insurance policies by an employer may cause federal compliance issues if the individual health plan premium is based on individual medical underwriting.

According to Notice 2010-82, in order to receive the tax credit, an eligible small employer must pay a uniform percentage (not less than 50 percent) of the premium for each employee enrolled in health insurance coverage offered by the employer. This is referred to as the uniform requirement.

If an employer offers more than one health insurance plan, the employer can satisfy the contribution requirement in one of two ways:

Option 1. The company can claim the credit if the the company's payments toward the premium for each plan satisfy the uniform requirement on a plan-by-plan basis.  The amounts or percentages of premium paid by the employer for each plan do not need to be the same as long as the payments satisfy the uniform requirement independently for each plan.

Option 2. The employer may designate a “reference plan” and make contributions in accordance with the following requirements:
    1. The employer determines a level of employer contributions for each employee such that, if all eligible employees enrolled in the reference plan, the contributions would satisfy the uniform requirement.
       
    2. The employer allows each employee to apply the amount determined in (1) either toward the reference plan or toward the cost of coverage under any of the other available plans.
       
    3. There is also an anti-abuse rule for employers offering more than one plan and using a reference plan. The self-only “composite rate” for the reference plan must be at least 66 percent of the self-only composite rate for each non-reference plan with respect to which the employer claims the credit. The “composite rate” is the average rate determined by adding the premiums for all employees eligible to participate in the a specific health insurance plan and dividing by the total number of such eligible employees.
Click here to read Notice 2010-82.

Study: 6 out of 10 Employers in Favor of Health Repeal

 
health repeal
This should not be taken as legal or tax advice.
 
According to a national study by Market Strategies International, 6 out of 10 employers hope Congress will repeal health care reform. Additionally, 7 out of 10 employers do not believe the legislation will alleviate health care costs:

"62% of employers included in our study hope health care reform is repealed, with 29 percent strongly in favor of repeal... and 72 percent disagree that it will reduce their company's health care cost burden. This is independent of firm size and whether or not employee health benefits are currently offered." - Susan McIntyre, Senior VP

The study was conducted as a national web-based survey of 1,065 "Employee Benefits Decision Makers" with at least 2 full-time employees. The sample was stratified by firm size (number of full-time employees) and health benefits status (offer/not) and weighted to the overall US employer benefits market based on population estimates provided in the 2010 Kaiser Family Foundation HRET Employer Health Benefits Survey.


7 States Receive Grants to Develop Exchanges

 
u.s. grants for health exchanges
This should not be taken as legal or tax advice.

The federal government has awarded $241 million in grants to seven states to develop new state-based Health Insurance Exchanges.

The states receiving grants include: 
    • Kansas ($31.5 million)
    • Maryland ($6.2 million)
    • Massachusetts ($35.6 million)
    • New York ($27.4 million)
    • Oklahoma ($54.6 million)
    • Oregon ($48.1 million)
    • Wisconsin ($37.8 million)
Individuals and small employers will be eligible to use the exchanges beginning in 2014.

4 States Receive Federal Waivers From Health Reform

 
health reform waivers
This should not be taken as legal or tax advice.

The federal government has granted waivers to four states allowing health insurance companies to continue offering limited benefit policies that are no longer allowed under the new federal health care law.

The states include:
    • Florida
    • New Jersey
    • Ohio
    • Tennessee
According Steven Larsen, a federal insurance regulator, each of the states (above) had a law, policy or program that required or encouraged health plans to offer limited-benefit coverage.

To qualify for a waiver, a state must prove that compliance with the federal requirement would cause “a significant increase in premiums or a decrease in access to benefits.”

Click here to read more from the New York Times. 

Self-Employed Can Take Tax Deduction for Individual Health Insurance

 
self employed deduction individual healthThis should not be taken as legal or tax advice.

Eligible self-employed individuals can use the self-employed health insurance deduction to reduce their Social Security tax in addition to their income tax liability for the 2010 tax year.

The IRS recently released Tax Tip 2011-3  Important Tax Law Changes for 2010, which includes the following:

Health Insurance Deduction Reduces Self Employment Tax  In 2010, eligible self-employed individuals can use the self-employed health insurance deduction to reduce their social security self-employment tax liability in addition to their income tax liability. As in the past, eligible taxpayers claim this deduction on Form 1040 Line 29. But in 2010, eligible taxpayers can also enter this amount on Schedule SE Line 3, thus reducing net earnings from self-employment subject to the 15.3 percent social security self-employment tax.

Premiums paid for health insurance covering the taxpayer, spouse and dependents generally qualify for this deduction. Premiums paid for coverage of an adult child under age 27 at the end of the year, for the time period beginning on or after March 30, 2010, also qualify for this deduction, even if the child is not the taxpayer’s dependent.

As before, the insurance plan must be set up under the taxpayer’s business, and the taxpayer cannot be eligible to participate in an employer-sponsored health plan. Details, including a worksheet, are in the instructions to Form 1040.

Colorado Department of Insurance Changes Stance on HRAs

 
colorado stance hras

On November 16, 2010, the Colorado Department of Insurance issued Final Agency Order No O-11-064 which adjusts and finalizes the department's stance on health reimbursement arrangements (HRAs).

Utah Requires Insurers To Offer Child-Only Plans

 
UtahThis should not be taken as legal or tax advice.

Effective January 25, 2011, the state of Utah is requiring insurance companies to issue child-only plans to individuals under the age of 19 who have obtained a "certificate of insurability". 

To receive a certificate of insurability, an individual must apply to HIPUtah - the state's High Risk Pool. If the individual qualifies for a HIPUtah plan, he or she will be offered HIPUtah coverage. If not, the individual will be issued a certificate of insurability, which must be honored by ever insurer in the Utah individual market. 

Health Insurance Agents Increase Direct-to-Employee Sales

 
direct to employee health insuranceHealth Care Reform Requires Agents to Develop a Direct Relationship with Each Employee

Until recently, employer health benefits meant a single group policy covering each employee and their dependents with the same benefits. Today, more and more employers are allowing employees to choose their own individual or family policy and pay for it with pre-tax defined contributions and/or pre-tax salary reductions.

“The fire of employers switching from group policies to employer-funded individual policies started before 2010,” says economist Paul Zane Pilzer, author of The New Health Insurance Solution, “But then along came health care reform which has had the effect of pouring gasoline on this fire.”

This is especially true in the small employer group market, says Pilzer, where several insurance companies have strategically chosen to exit the small group market and increase sales in the individual market.

“Insurance companies in the small employer group market were trapped between a rock and a hard place, stuck between rising medical costs and state limits such as rating bands on small group premiums. Now,” says Pilzer, “insurance carriers can retain customers by switching them to more profitable individual policies funded by employer-sponsored defined contribution health plans.”

The premium rates on individual plans are regulated differently in most states, and, unlike group plans, private carriers are allowed to reject high-risk employees with medical problems. However, new regulations require states to provide guaranteed coverage (at higher rates) for employees with medical problems that were formerly covered by a terminated group plan. Additionally, a new temporary federal risk pool, PCIP, has been created for the individuals who do not qualify for guaranteed-issue individual plans in their state. 

Click here to read the full press release. 

Federal Judge Rules Health Law is Unconstitutional

 
federal judge
Note: This should not be taken as tax or legal advice

Yesterday, a Florida federal judge ruled that the individual mandate of the health care bill passed last March is unconstitutional.  This ruling is considered the most high-profile of a series of lawsuits against the health overhaul (26 states are involved in similar suits).

In the ruling, Judge Roger Vinson found that the health care law’s requirement that individuals carry insurance is outside of Congress’s commerce clause.

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Disclaimer: The information provided on this website is general in nature and does not apply to any specific U.S. state except where noted. Health insurance regulations differ in each state. See a licensed agent for detailed information on your state. Zane Benefits, Inc. does not sell health insurance.