Category Archives: PPACA

DC Debrief

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IRS issues HDHP / HSA guidance; House votes to repeal Cadillac tax

The IRS rolled out new rules that could have major implications for people who have chronic diseases, but are also on the hook for thousands of dollars in medical bills. Notice 2019-45 expands the list of preventive care benefits that can be provided by a high deductible health plan (HDHP), on a no-deductible or low-deductible basis, without any adverse effect on HSA eligibility.

In general, “preventive” care does not include treatment for existing illnesses or conditions. Under the current HDHP/HSA rules, treatments of a non-preventive nature that are covered or reimbursed by a health plan without first satisfying HDHP conditions would generally disqualify a covered individual from HSA contribution eligibility.

However, the Administration now acknowledges that the cost barriers for care have resulted in some individuals who are diagnosed with certain chronic conditions failing to seek or utilize effective and necessary care that would prevent exacerbation of the chronic condition. Thus, these regulations are aimed at encouraging individuals to take more responsibility for their health care spending and become better health care consumers.

According to the notice, for services to be covered by an HDHP pre-deductible, they should be “low-cost” and demonstrate a high-impact. In addition, there must be strong evidence that the absence of the service will result in the condition worsening or the development of another serious medical issue. Those services and items, along with the conditions for which they must be prescribed to qualify as preventive care, are listed in an appendix to the guidance. The list includes 14 medical services or items for individuals with 11 specified chronic conditions (such as diabetes and high blood pressure).

While this new guidance is effective immediately, Treasury and HHS will periodically review the list to determine whether additional services or items should be added or removed. This exercise is expected to occur every five to ten years in an effort to promote stability and avoid confusion by participants in, or sponsors or providers of, HDHP arrangements.

Full text:  https://www.irs.gov/pub/irs-drop/n-19-45.pdf

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House Democrats and Republicans joined together in a rare show of unity last week, voting overwhelmingly (419-6) to repeal the ACA’s “Cadillac” tax on high cost health plans.

Delayed repeatedly by Congress, the tax would slap a 40% levy on the value of employer-provided health benefits that exceed $11,200 for individual coverage and $30,100 for family policies beginning in 2022. The idea was to reduce soaring health-care costs by discouraging employers from offering such generous plans.

Insurers and employers (like TASC) oppose the tax because they’d be the ones most exposed to its bite…shifting more costs to policyholders/employees as a result. About 160 million Americans are covered by workplace plans, still the largest source of coverage.

The House vote was aided by a new expedited procedure designed to force votes on measures that have wide bipartisan support (i.e. two-thirds majority). The 350+ cosponsors of HR 748 – titled the Middle Class Health Benefits Tax Repeal Act – not only include conservative Republicans, but members of the progressive wing of the Democratic Party as well…many of whom have championed replacing the current employer-based system with a “Medicare for All’ structure.

It’s unclear whether the Senate will tackle repeal, although a companion bill sponsored by Sen. Mike Rounds (R-SD) has collected 42 cosponsors.

Congress kicks the can down the road

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Cadillac Tax delayed (again); repeal effort maintains strong bipartisan support

On Monday, President Trump signed legislation that will fund the government for another three weeks, thereby ending the three-day government shutdown. The bill includes a provision which delays the effective date of the excise tax on high-cost employer-sponsored health plans for two additional years, until 2022.

Originally included as part of the Affordable Care Act, the tax was an attempt to discourage workers from over-consuming healthcare. The belief/rationale was that many were buying unnecessarily expensive plans; however, opponents argued that the 40% rate on employers offering those plans was too punitive. Initially set to take effect in 2018, it was then postponed until 2020.

The move to delay implementation of the Cadillac Tax yet again is viewed as crucial for maintaining strong employee benefits, because companies typically make health plan decisions well in advance (i.e. 18 to 24 months). This reprieve allows employers to  maintain the health coverage working families want and need.

TASC continues to believe that full repeal is the only real solution to this onerous tax, and looks forward to working with the Trump Administration and Congressional leaders…so employers aren’t forced to choose between paying the tax or reducing benefits.

Christmas Comes Early for GOP

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Lawmakers give final approval to Tax Cuts & Jobs Act conference committee report

The Republican led Congress celebrated passage of the biggest rewrite of the U.S. tax code in decades on Wednesday. President Trump will soon affix his signature to the $1.5 trillion overhaul that is expected to have broad and far reaching implications for both individual and corporate finances….making good on his promise to deliver tax cuts before the holidays.

Key provisions affecting employee benefits are summarized below (changes are effective January 1, 2018 unless otherwise noted).

Fringe Benefit Provisions

Dependent Care – No change to current law.                                                             Note: Under the House proposal, employer-provided dependent care assistance would no longer have been tax exempt; meaning dependent care FSAs would have been eliminated.

Transportation – Repeals employer deduction for any qualified transportation fringe benefit. Employers may not deduct any expense incurred in providing, paying or reimbursing employee commuting expenses. These benefits will continue to be tax exempt for employees.

Bicycle Commuting – Qualified bicycle commuting expenses will no longer be tax exempt to employees effective for tax years between 2017 and 2026 (provision sunsets after 2025).

Health-related Provisions

Individual Mandate – Repealed; reduces the penalty for not purchasing insurance coverage to zero. Effective beginning in 2019.

Medical Expense Deduction – For 2017 and 2018, the deduction threshold will be reduced from 10% to 7.5% (of AGI). For 2019 and beyond, the threshold returns to 10%.

Archer MSAs – No change to current law.                                                                  Note: Under the House proposal, these tax deductible contributions would have been prohibited.

Earlier versions of tax reform would have eliminated or placed a cap on the tax exclusion for employer-provided health care, but – due in part to the efforts of entities like TASC – those proposals were never included in the legislation ultimately considered by the House and Senate. On the flip side, some of our other (pro-active) priorities, like the establishment of Flexible Giving Accounts and repeal of the Cadillac Tax were also left on the cutting room floor. While unfortunate, we will continue to press Congress to address these important issue in 2018.

HAPPY HOLIDAYS!

Gonna Fly Now?

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GOP still likely a long way away from achieving seven year campaign pledge

On May 4, 2017, Republicans completed the first step in the long journey to repeal and replace portions of the ACA with the passage of the American Health Care Act (AHCA) – temporarily salvaging their mission to overhaul the nation’s health system. Previously stalled due to objections, the bill mustered just enough votes in the House (217-213)* after the addition of amendments that would allow states to waive the ACA’s essential health benefits package and insurance requirements for individuals with pre-existing conditions.

There are a number of provisions contained within the final version of the bill that may be of importance to TASC Providers/Clients. Here’s a brief description…

Age 26: Retains the requirement that family policies cover grown children.

Cadillac Tax: Currently set to become effective in 2020, the effective date of the excise tax on high cost health plans will be pushed back until 2026.

Employer/Individual Mandates: Ends tax penalties on individuals who don’t purchase health insurance and on large employers who don’t offer coverage to their workers; allows insurers to apply a 30% surcharge to customers who’ve been uninsured for more than 60 days.

FSA Cap: The cap on employee contributions to a health FSA imposed under the ACA is eliminated for tax years after December 31, 2016.

HSA Catch-Up Contributions: The AHCA will permit both spouses to make additional catch-up contributions to a single HSA; effective for tax years after December 31, 2017.

HSA Contribution Limit: Under the AHCA, the maximum contribution to an HSA will be equal to the sum of the annual deductible and the out-of-pocket expense maximum for single or family coverage; effective for tax years after December 31, 2017.

HSA Distribution Tax:  The ACA increased the excise tax on distributions not used for qualified medical expenses from 10% to 20%. Under the AHCA, that additional tax will revert back to 10% for distributions made after December 31, 2016.

HSA Establishment:  Under current law/regulations, only medical expenses incurred after the establishment of an HSA are considered eligible for reimbursement. In an effort to addresses the administrative problems connected with this requirement, the AHCA provides that as long as the HSA is established within 60 days of the date of health coverage, any medical expenses will be considered eligible regardless of whether they were incurred prior to the establishment of the HSA. This provision will be effective with respect to coverage after December 31, 2017.

Over-the Counter Medicines:  The ACA provided that the only prescribed drugs/medicines or insulin would be considered qualified medical expenses eligible for reimbursement from a FSA, HRA or HSA.  This provision would be eliminated for amounts paid or expenses incurred after December 31, 2016.

The nonpartisan Congressional Budget Office (CBO) was unable to complete an updated analysis detailing the effects of the latest changes in time for last week’s vote…meaning GOP lawmakers acted on the bill without updated figures on how many people would lose coverage or how much it would cost.

The measure is expected to undergo a major overhaul in the Senate, as that body’s politics are expected to prove far dicier than those in the House (i.e. much smaller and quite diverse Republican majority). Plus, the upper chamber operates on procedural rules that may block numerous parts of the AHCA. Senate Majority Leader Mitch McConnell has established a working group of 13 Senators to develop the Senate’s bill.  The content and timing of the Senate’s version is not clear yet.

It’s important to remember that this legislation is still pending, and has not been signed into law. At this time, the ACA (including all associated regulations and penalties) is still the law of the land; compliance is still required. TASC will continue to update you as this legislation moves through the political process to ensure our Providers/Clients compliance with the law.

* The bill was passed under budget reconciliation authority, so many provisions of the ACA could not be addressed or completely repealed by this bill. 

Repeal & Replace: ACA remains law of the land

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Floor loss may go a long way in dictating the GOP’s ambitious Capitol Hill agenda

As you probably know, Congress decided not to proceed with a planned vote on the American Health Care Act (AHCA) last week, which would have repealed and replaced important elements of the Affordable Care Act (ACA).

The proposed legislation would have expanded HSA eligibility, increased HSA contribution amounts, and reversed some of the ACA provisions that were detrimental to consumer-directed health plans…such as the cap on employee contributions to FSAs and the prohibition on reimbursements for over-the-counter medications. The bill also delayed the effective date of the excise tax on high-cost health plans (commonly referred to as the “Cadillac Tax”).

Now what?

Plenty could still change regarding the ACA; legislative action was only part of the GOP’s plan. Another component – making changes to regulations and how the ACA is administered – doesn’t require Congress’ help.

For example, the Trump administration can’t do away with the mandate requiring individuals to have health insurance on its own, but it can greatly weaken it through the IRS. Both the individual and employer mandates are about tax incentives (i.e. get insurance or pay a fine), so the executive branch could simply decide not to enforce that penalty.* In fact, the President has already signed an executive order directing government agencies to begin unraveling portions of the healthcare law. The order encouraged department heads to “waive, defer, grant exemptions from or delay the implementation” of provisions aimed at imposing fiscal burdens on states, companies or individuals.

A looming push to overhaul the U.S. tax code could also include the repeal of ACA levies left intact by the collapse of the Republican measure. Tax Reform will be an important priority for those in the employee benefits space, as discussions are once again likely to include many of the same elements contained in the AHCA (see above)…along with potential changes to dependent care, transit and parking, or even the exclusion of employer provided health insurance.

Regardless of your political views, portions of the AHCA highlighted/recognized the importance of consumer-directed health accounts and TASC will continue to advocate for policies which support and expand these plans.

To be continued…

* The IRS has said it will not reject “silent returns” — tax returns on which a person declines to say whether they have insurance.

Cures Act brings relief to employers without Group insurance

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Small Business HRA provision signed into law

ISSUE

IRS Notice 2013-54 issued in September 2013 limited the ability of small business owners to utilize standalone HRAs. Prior to this guidance, many had used HRAs to reimburse their employees for certain medical expenses using pre-tax dollars. As a result of IRS Notice 2013-54, a company with more than one eligible employee could no longer receive a tax advantage through an HRA unless it sponsored Group insurance – an expense that’s beyond many small companies’ reach – or offered a Limited Purpose HRA. This new legislation overturns a portion of the guidance issued in IRS Notice 2013-54 and once again allows small employers to utilize HRAs as a pre-tax health & welfare benefit.

IMPACT / MOVING FORWARD

Beginning January 1, 2017, qualified businesses can now establish a Small Business HRA (SBHRA) to use tax-advantaged funds to reimburse employees for individual health insurance premiums and family out-of-pocket medical expenses. This change does not affect one-employee, integrated, or Limited Purpose HRA Plans that are already compliant with federal law.

Highlights include:

  • Employers must have fewer than 50 FTEs[i] and cannot offer a group health plan.
  • SBHRAs may reimburse an employee for qualified out-of-pocket medical expenses under §213(d) of the Code and individual health insurance premiums – including for plans purchased on the public ACA Marketplaces.
  • Employer annual contributions will be capped at $4,950 for a single employee and $10,000 for an employee with a family. These numbers will be indexed annually for inflation and are to be prorated for mid-year enrollment.
  • Participation in a SBHRA does not necessarily disqualify participants from receiving Marketplace subsidies (i.e. premium tax credits), but monthly SBHRA reimbursements will be included in income calculations for determining eligibility for any subsidy.
  • Generally, employers must make the same contributions to all eligible employees; however, the benefit may vary based on the cost of health insurance tied to the employee’s age and/or number of family members covered.[ii]
  • Employees must have minimum essential coverage in order to participate; if not, the reimbursement amount will be reflected as part of the employee’s gross income for tax purposes.[iii]
  • SBHRAs are solely funded by an eligible employer; they are employer-sponsored and reimbursed benefits. The employee is not allowed to contribute pre-tax dollars via salary reduction.
  • Unused elected amounts can be carried over to reimburse medical expenses in future years OR can be offered as a use it or lose it feature to limit the employer’s liability to the current Plan Year.
  • Employers must provide notice of the benefit to their employees at least 90 days before the start of each plan year.[iv]
  • The employer is required to report the SBHRA benefit on each employee’s Form W-2[v]
  • Group health premiums (i.e. for coverage offered by a spouse’s employer) cannot be reimbursed.
  • Not considered a group health plan for purposes of COBRA, ERISA, HIPAA, etc.

SBHRAs provide a tremendous opportunity to those small employers who do not, or are no longer able to, offer Group health but want to assist their employees with ever rising healthcare costs. As with any new legislation impacting our business, additional guidance is expected to be issued that may affect the scope of our service offering. Furthermore, any efforts by President-elect Trump and the new GOP Congress to repeal and replace the ACA may very well impact these new rules…stay tuned to TASC’s Capital Connection for more information.

[i] This count is based on the current ACA definition, meaning that the Employer was not considered an “Applicable Large Employer” during the previous year.

[ii] Thus, an employer could provide a greater benefit to an employee who is older or covers multiple family members.

[iii] These payments/reimbursements nevertheless continue to be excluded from wages for employment purposes.

[iv] “Transitional relief” is provided for the first year (2017)…the notice must delivered within 90 days after the date of the enactment of this Act (i.e. on or before March 13, 2017).

[v] Tentatively set to take effect in 2018 (for the 2017 tax year). Currently, this ACA provision only applies to employers with 250+ employees; small employers (i.e. those eligible to offer a SBHRA) are temporarily exempt.

SBHRA language headed to White House as Congress approves Cures Act

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“Stand-alone” HRAs one step closer to compliance

UPDATE: President Obama is expected to sign the measure into law soon after it reaches his desk, meaning a solution for beleaguered small businesses is on the way. Once enacted, a Small Business HRA will allow qualified entities to use tax-advantaged funds to reimburse employees for individual health insurance premiums and other out-of-pocket medical expenses. (Note: This change does not affect integrated or one-employee HRA plans that are already compliant with federal law.)

This legislation provides a tremendous opportunity for those small employers who do not offer group health but want to assist their employees with ever rising health care costs. Be on the look-out for additional communications from TASC (including here at Capital Connection) in the coming weeks to ensure peace of mind for our Providers, Clients and Participants. We’ve got you covered!

For additional details on this topic, please see our previous posts:

Lawmakers reach tentative deal to expand small biz health options (Nov. 28, 2016) https://tasccapitalconnection.com/2016/11/28/lawmakers-reach-tentative-deal-to-expand-small-biz-health-options/

Stand-alone HRAs making a comeback? (June 30, 2016) https://tasccapitalconnection.com/2016/06/30/stand-alone-hras-making-a-comeback/

Lawmakers reach tentative deal to expand small biz health options

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Over the weekend, Congress introduced an end of the year health package containing mental health initiatives, Medicare provisions, medical research funding…AND one of TASC’s top priorities – the Small Business Healthcare Relief Act (SBHRA). If enacted, the SBHRA would allow small businesses to once again use an HRA to assist employees with health insurance premiums and out-of-pocket medical expenses.

Brief summary:

  • Has an effective date of January 1, 2017.
  • Available to small employers (with fewer than 50 full-time employees) who do not offer a group health plan.
  • Participants must have minimum essential coverage in order to receive the benefit.
  • Employer annual contributions would be capped at $4,950 (employee) / $10,000 (family).
  • Generally, employers must make the same contributions to all eligible employees; amounts may vary based on family status (i.e. single vs family).
  • Would not disqualify participants from premium tax credits (i.e. marketplace subsidies); however, monthly HRA reimbursements will be included in income calculations for determining eligibility.

This 900 page, $6.3 billion negotiated deal is expected to be voted on by the House as early as Wednesday. The Senate is then expected to follow suit, taking up the measure sometime before final adjournment in December.

 

ALERT: IRS delays some ACA reporting

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Following consultation with stakeholders, the agency has determined that a substantial number of employers, insurers, and other coverage providers may need additional time to prepare 2016 Forms 1095-B and 1095-C. As a result, the deadline for furnishing this information (to individuals) has been extended from January 31, 2017, to March 2, 2017.

Because some individuals may not receive a Form 1095-B or Form 1095-C by the time they are ready to file their 2016 tax return, taxpayers may rely on other information received from their employer or coverage provider for the purposes of determining eligibility for premium tax credits and confirming that they had minimum essential coverage. Taxpayers do not need to wait to receive Forms 1095-B and 1095-C before filing their returns.

Note: This guidance does not extend the timeframe for submitting 2016 Forms 1094-B, 1095-B, 1094-C, or 1095-C to the IRS…those dates remain the same (February 28, 2017 or March 31, 2017, if filing electronically.)

Notice 2016-70: https://www.irs.gov/pub/irs-drop/n-16-70.pdf